封闭负压引流技术干预四肢植皮创面量效关系研究

Quantity-effect relationship of vacuum-assisted closure techniques on free skin graft of limbs

目的:探讨封闭负压引流(vacuum-assisted closure,VAC)技术干预四肢植皮创面的量效关系。方法:根据拟植皮创面面积大小,将本院2014年1月至2015年3月四肢慢性创面床准备完成拟行植皮术的120例创面划分为小、中、大3个等级,每个等级各40例创面。在每个植皮创面面积组内再随机分为4个处理组,每组10例创面,分别施加10、20、30、40 k Pa的负压,观察敷料下正压值及皮片存活率的变化。结果:负压强度、植皮创面面积对敷料下正压值与皮片存活率影响均有统计学意义(P<0.001),且二者交互作用也显著(P<0.001);敷料下正压值与皮片存活率以及植皮创面面积、负压强度与敷料下正压值之间存在显著的量效关系。结论:模型能较好地解释了VAC干预四肢植皮创面的量效关系,拟合度高,具有较强的稳健性和实用性,能够为临床应用提供科学依据。

Objective：To study on quantity-effect relationship of vacuum-assisted closure（VAC）techniques on free skin graft of limbs.Methods：According to skin wound size,chronic wound bed preparation on 120 patients with skin graft of limbs in surgical ward of emergency department of The Second Affiliated Hospital of Chongqing Medical University from 2014 January to 2015 March was completed. All patients were divided into small-,medium-,large- level（each level having 40 cases of wound）.Each area within the group was randomly divided into four treatment groups（each group having 10 cases）. All groups were treated with continuous VAC under 10,20,30,40 k Pa negative pressure. The dressings under positive pressure and b-viability of free skin graft changes were measured. Results：Negative pressure strength and skin grafting wound area values for the dressings under positive pressure and viability of free skin graft were significantly different（P〈0.001）and the interaction between the two was also significantly different（P〈0.001）. Statistically significant quantity-effect relationship existed between the dressings under positive pressure and viability of free skin graft,between wound areas,between negative pressure strength and the dressings under positive pressure. Conclusion：The model could explain reasonably well quantityeffect relationship of VAC intervention on free skin graft of limbs,with high goodness-of-fit,robustness,and practicability,able to provide a scientific basis for clinical application.