封闭式负压引流术联合游离植皮、皮瓣移植术治疗四肢难治性感染创面的效果及对疼痛的影响

Effect of VSD combined with free skin grafting, skin flap grafting treating limbs refractory wound infection and influence of pain

目的探讨封闭式负压引流术（VSD）联合游离植皮、皮瓣移植术对四肢难治性感染创面患者的疗效及对疼痛的影响。方法选取茂名市中医院2012年1月-2014年1月收治的四肢皮肤软组织感染创面患者48例，按照随机数字表法分成观察组（24例）与对照组（24例）。观察组患者采用封闭式负压引流术联合游离植皮及皮瓣移植进行治疗，对照组患者采用传统治疗方法进行治疗。比较两组患者治疗后的疗效，并对两组患者治疗前及治疗后24h、3d的疼痛程度进行动态观察，并比较两组患者的换药时间、疼痛缓解时间、创面愈合时间、住院天数、以及治疗期间的并发症情况。结果观察组患者的显效率与总有效率分别为75．0％、91．7％，显著高于对照组（45．8％、66．7％），差异有统计学意义（P〈0．05）。治疗后3d，两组患者的NRS疼痛评分分别较治疗前及治疗后24h明显降低，且观察组患者治疗后3d的NRS疼痛评分显著低于对照组，差异有统计学意义（P〈0．05）。观察组的换药次数明显少于对照组，观察组患者的疼痛缓解时间、创面愈合时间及住院天数均少于对照组，差异有统计学意义（P〈0．05）。观察组无再次感染病例，2例发生出血，5例出现薄膜下积液、3例出现创缘皮损张力性水疱，对照组4例出现再次感染，8例发生出血，12例出现薄膜下积液、9例出现创缘皮损张力性水疱，观察组患者的并发症发生率明显低于对照组（29．2％比45．8％），差异有统计学意义（P〈0．05）。结论VSD联合游离植皮、皮瓣移植术治疗四肢难治性感染创面能够提高疗效，促进患者创面愈合，缓解患者的疼痛，减少并发症的发生率，值得在临床上推广使用。

Objective To investigate the effect of VSD combined with free skin grafting, skin flap grafting treating limbs refractory wound infection and the influence of pain. Methods From January 2012 to January 2014, in Maoming Hospital of Traditional Chinese Medicine, 48 patients with limbs refractory wound infection were selected, according to random number table, they were divided into observation group （24 cases） and control group （24 cases）. Patients in the observation group were given VSD combined with free skin grafting, skin flap grafting, the control group were given traditional treatment methods. The efficacy of two groups was compared, pain degree of two groups before treatment and 24 h, 3 d after treatment were given dynamic observation, the dressing time, pain relief time, wound healing time and length of stay, complications during the treatment were compared. Results The effective rate and total effective rate of the observation group were 75% and 91.7% respectively, which were significantly higher than those of the control group （45.8%, 66.7%）, the differences were statistically significant （P 〈 0.05）. 3 d after treatment, NRS pain score of patients in two groups were significantly lower than before treatment and after 24 h treatment, the differences were statistically significant （P 〈 0.05）. The frequency of dressing change in observation group less than that of the control group, pain relief time, wound healing time and hospital stay in observation group were significantly less than those in the control group, the differences were statistically significant （P 〈 0.05）. In the observation group, no infection occurred, 2 cases occurred bleeding, 5 cases occurred effusion, 3 cases occurred skin lesions, in the control group, 4 cases occurred bleeding, 8 cases were occurred bleeding, 12 cases occurred effusion, 9 cases occurred skin lesions, the incidence of complications inthe observation group were significantly lower than that in the control group （45.8% vs29.2%）, the difference was statistically significant （P 〈 0.05）. Conclusion VSD combined with with free skin grafting, skin flap grafting treating limbs refractory wound infection can improve the curative effect, promote the healing of wounds in patients, alleviate the patient＇s pain, reduce complication incidence, it is worth promotion and application in clinical.