负压网片腹膜牵引对开放性腹部手术腹膜愈合的治疗效果及影响因素研究

Combination of mesh, vacuum and traction closure technique for closure of the open abdomen and influential factor

目的观察负压网片腹膜牵引治疗腹部外伤腹膜关闭过程中的作用及体液量对治疗效果的影响。方法研究对象为2010-01～2014-Ol因腹部外伤腹膜暂时无法关闭而接受负压网片腹膜牵引治疗的患者。研究比较了经治疗后腹腔闭合和未闭合（即腹疝或腹膜部分闭合）患者的临床数据，比较输液量对腹腔闭合的影响。结果患者平均年龄（45．0±10．1）岁，治疗平均时间（31．0±6．8）d，腹膜闭合率60％。根据体质量计算得到体液负荷量平均值为7．2kg（-8．0～21．6kg），即治疗后平均体质量增加11．5％（-9．5％～27％）。液体导致体质量增加≥10％的患者腹膜闭合率比体质量增加〈10％的患者低（39％VS77％）。液体导致体质量增加≥20％的患者腹膜闭合率更低，提示随着液体在体内的积累，腹膜闭合率呈剂量依赖性降低。结论负压网片腹膜牵引方法可使腹部外伤患者获得较高的腹膜闭合率，但体液过量不利于腹膜的闭合。因此，病情严重患者进行静脉液体复苏时注意体液不应过量。

Objective To observe the therapeutic effects of the vacuum fascia1 traction and the role of body fluid volume for treatment on peritoneal closure process for traumatic abdominal trauma patients. Methods Research objects were temporarily unclosed abdominal trauma patients received vacuum fascial traction from 2010 January to 2014 January. The clinical data of abdominal closure and unclosed patients （ i. e. , ventral hernia or peritoneal partially closed） were observed. The influence of transfuse volume to abdominal close was detected. Results The average age of patients was （45.0 ± 10.1 ） years old, the average duration of treatment was （31.0 ±6.8） days. Peritoneal closure rate was 60%. Average fluid volume was 7.2 kg （range ： - 8.0 - 21.6 kg）, namely average weight gained by 11.5% （range ： - 9.5%- 27% ） after treatment. Patients with weight gain ≥ 10% had a lower facial closure rate than weight gain 〈 10% （39% vs 77% ）. Facial closure rate seems to further decrease with weight gain 20%, suggesting a dose - response effect of progressive fluid accumulation. Conclusion The mesh, vacuum and traction closure technique can get higher peritoneal closure rate. But fluid overload is not conducive to the peritoneal closure. Therefore, for serious illness patients, overdose intravenous fluid resuscitation should be avoided.