扩创植皮术联合负压封闭引流技术治疗烧伤患者耐甲氧西林金黄色葡萄球菌感染难愈创面的效果观察

Observation of debridement and skin grafting combined with vacuum sealing dainage in treating refractory burn wound with methicillin-resistant stphylococcus aureus infection

目的探讨扩创植皮术联合负压封闭引流技术（VSD）治疗烧伤患者耐甲氧西林金黄色葡萄球菌（MRSA）感染难愈创面的效果。方法选取2012年2月至2015年2月于第四军医大学第一附属医院就诊的82例烧伤MRSA感染难愈创面患者为研究对象，采用随机数字表法分为对照组和观察组，各41例。对照组VSD治疗，创面肉芽组织新鲜后进行植皮手术，观察组采用扩创植皮术联合VSD治疗。比较2组治疗后临床疗效，治疗前后白细胞计数（WBC）、C反应蛋白（ClIP）、红细胞沉降率（ESR）、白细胞介素1（IL-1）变化情况及2组住院时间、感染控制时间、创面恢复正常时间、疼痛评分情况。结果观察组治愈率、总有效率明显高于对照组，差异有统计学意义[39．0％（16／41）比17．0％（7／41）、95．1％（39／41）比78．0％（32／41）]（P〈0．05）。治疗后2组WBC、ESR、CRP、IL-1均较治疗前明显下降，且观察组治疗后低于对照组，差异均有统计学意义[对照组：（10．7±1．3）×10^9／L比（14．5±2．4）×10^9／L、（21．2±2．3）mm／1h比（56．3±8．9）mm／1h、（6．4±1．2）mg／L比（81．3±4．4）mg／L、（94±8）ng／L比（167±45）ng／L，观察组：（7．8±1．0）×10^9／L比（14．6±2．4）×10^9／L、（13．5±1．5）min／1h比（56．4±9．0）mm／1h、（4．6±1．0）mg／L比（81．4±4．5）mg／L、（79±6）ng／L比（168±45）ng／L]（均P〈0．05）。观察组住院时间、感染控制时间、创面恢复正常时间、疼痛评分均明显小于对照组，差异均有统计学意义[（52±8）d比（61±11）d、（41±6）d比（49±8）d、（50±7）d比（58±9）d、（3．4±0．9）分比（5．8±1．2）分]（均P〈0．05）；观察组甲级愈合率明显高于对照组，丙级愈合率和并发症发生率明显低于对照组，差异均有统计学意义[56．1％（23／41）比46．3％（19／41）、4．9％（2／41）比22．0％（9／41）、14．6％（6／41）比58．5％（24／41）]（均P〈0．05）。结论扩创植皮术联合VSD治疗烧伤患者MRSA感染难愈创面疗效明显。

Objective To observe the curative effect of debridement and skin grafting combined with vacuum sealing drainage （VSD） on healing of refractory burned patients wound with methieillin-resistant stphylococcus anreus（MRSA） infection. Methods Totally 82 patients with MRSA infected refractory bum wound from February 2012 to February 2015 in the First Affiliated Hospital of the Fourth Military Medical University were randomly divided into control group and observation group, with 41 cases in each group. The control group was treated with VSD therapy and skin grafting operation was performed after wound fresh granulation tissues. The observation group was treated with debridement and skin grafting operation combined with VSD. Clinical curative effects were observed in both groups. White blood cell （WBC）, C-reactive protein （CRP）, erythroeyte sedimentation rate （ESR）, interleukin-1 （IL-1）, length of hospital stay, length of infection control, length of wound healing and pain score were analyzed. Results In observation group, cure rate and total effective rate were significantly higher than those in control group[ 39.0% （16/41） vs 17.0% （7/41）, 95.1% （39/41） vs 78.0% （32/41）] （P 〈 0. 05）. After treatment, WBC, ESR, CRP, IL-1 were lower than those before treatment in both groups, and these indexes in observation group were lower than those in control group; differences were statistically significant [ control group：（10.7±1.3） ×10^9/L vs （14.5 ±2.4） × 10^9/L, （21.2 ±2.3）mm/1 h vs （56.3 ± 8.9）mm/1 h, （6.4 ± 1.2）mg/L vs （81.3 ±4. 4） mg/L, （94 ±8） ng/L vs （167 ±45） ng/L; observation group： （7.8 ± 1.0） × 10^9/L vs （14.6±2.4） ×10^9/L, （13.5 ±1.5）mm/1 h vs （56.4 ±9.0）mm/1 h, （4.6 ±1.0）mg/L vs （81.4 ± 4. 5 ） mg/L, （79 ± 6） ng/L vs （ 168 ±45 ） ng/L ] （ P 〈 0. 05 ）. In observation group, length of stay, length of infection control, length of wound healing and pain score were significantly lower than those in control group [（52 ±8）d vs （61 ±11）d,（41 ±6）d vs （49 ±8）d,（50 ±7）d vs （58 ±9）d,（3.4 ±0. 9） scores vs （5.8 ± 1.2） scores ] （ P 〈 0.05 ）. In observation group, Class-A healing rate was higher than that in control group, Class-C healing rate and complication rate were lower than those in control group; differences were statistically significant[56. 1% （23/41） vs 46. 3% （ 19/41 ）, 4. 9% （2/41） vs 22. 0% （9/41）, 14. 6% （6/41） vs 58.5% （24/41） ] （P 〈 0.05 ）. Conclusion Debridement and skin grafting combined with VSD treating MRSA infected refractory burned patients wound is effective.