胃肠手术患者切口感染合并组织坏死的清创方案研究

Debridement methods for patients with incision infections and tissue necrosis after gastrointestinal surgery

目的比较不同清创方案在胃肠手术患者切口感染合并组织坏死创面治疗中的临床效果,为切口感染的治疗方案的选择提供依据。方法选取医院2012年1月-2014年12月切口感染伴组织坏死的68例患者为研究对象,将其随机分为对照组和治疗组,各34例,对照组患者给予传统敷料高渗盐水纱布清创,观察组患者采用交互式清创治疗,比较两组患者新生肉芽组织开始生长时间、切口愈合时间、临床疗效、抗菌药物使用时间、换药次数、医疗费用、疼痛状况及患者对治疗的满意度。结果与对照组比较,治疗组患者创面新生肉芽组织开始生长时间及切口愈合时间显著缩短,差异有统计学意义(P<0.01);治疗总有效率治疗组为97.06%,对照组为82.35%,两组比较差异有统计学意义(P<0.01);至清创完成为止,治疗组患者抗菌药物使用时间、换药次数、医疗费用分别为(10.81±3.34)d、(11.41±2.39)次、(1 198.76±389.56)元,明显低于对照组的(17.49±5.71)d、(26.95±5.17)次、(1 702.63±319.41)元,差异均有统计学意义(P<0.01);治疗组患者疼痛评分为(3.74±0.73)分,较对照组的(6.49±0.81)分显著降低,差异均有统计学意义(P<0.05)。结论交互式清创方案可以缩短胃肠手术切口感染患者切口愈合时间,提高治疗效果和患者满意度,并降低医疗费用,值得在临床推广。

OBJECTIVE To compare clinical effect of different debridement methods in treatment of incision infec‐tions and tissue necrosis in patients after gastrointestinal surgery ,and to provide the basis for selecting treatment program of wound infections .METHODS Totally 68 patients with postoperative incision infections accompanied with tissue necrosis after gastrointestinal surgery from Jan .2012 to Dec .2014 in our hospital were selected and divided into the control group and the treatment group ,34 cases in each group .The control group was given tradi‐tional dressing hypertonic saline gauze debridement ,and the treatment group accepted interactive debridement treatment .The time of new granulation tissues starting to grow ,time of wound healing ,clinical efficacy ,time of antibiotic usage ,frequency of dressing changes ,medical expenses ,pain condition and patient satisfaction with treatment were compared between the two groups of patients .RESULTS Compared with the control group ,time of new granulation tissues starting to grow and time of wound healing in the treatment group were significantly short‐ened ,the difference was significant （P〈0 .01） .The total effective rate was 97 .06% （33/34） in the treatment group and 82 .35% （28/34） in the control group ,the difference was significant （P〈0 .01） .Up to the finish of de‐bridement ,time of antibiotic usage ,frequency of dressing changes and medical expenses [（10 .81 ± 3 .34） days , （11 .41 ± 2 .39） times ,（1 198 .76 ± 389 .56） yuan] in the treatment group were significantly lower than in the con‐trol group [（17 .49 ± 5 .71） days ,（26 .95 ± 5 .17） times ,（1 702 .63 ± 319 .41） yuan] （P〈0 .01） .The mean pain score was （6 .49 ± 0 .81） points in the treatment group ,significantly reduced compared with （3 .74 ± 0 .73） points in the control group significant （P〈 0 .01） .CONCLUSION The interactive debridement can shorten t time of wound healing in patients with incision infection after gastrointestinal surgery and can improve clinical efficacy and patient satisfaction and reduce medical costs ,which is worthy of wide clinical application .