皮下持续负压引流对预防肝癌手术肥胖患者切口脂肪液化和感染的效果评价

Effect of subcutaneous continuous negative pressure drainage on prevention of incision fat liquefaction and infection in obese patients undergoing hepatic carcinectomy

目的观察皮下持续负压引流对肝癌手术肥胖患者切口脂肪液化和感染的预防控制效果,为临床工作提供依据。方法选取2014年1月-2016年1月医院进行肝癌切除术的100例患者为研究对象,将所有患者随机分为两组,对照组术后接受常规护理,引流组接受皮下持续负压引流,比较两组患者术后脂肪液化及伤口感染的发生率,分析其危险因素。结果引流组的脂肪液化率为2.00%(1/50),伤口感染率为4.00%(2/50);对照组分别为22.00%(11/50)及34.00%(17/50),差异有统计学意义(P<0.05);年龄、术前BMI、糖尿病、高频电刀的使用是患者脂肪液化发生的危险因素,而切口引流是保护因素,相关性具有统计学意义(P<0.05);年龄、术前BMI、糖尿病及低蛋白血症是患者伤口感染发生的危险因素,而切口引流是保护因素,相关性具有统计学意义(P<0.05)。结论皮下持续负压引流可降低肝癌手术肥胖患者切口脂肪液化和感染的发生率。

OBJECTIVE To observe the effect of subcutaneous continuous negative pressure drainage on prevention and control of incision fat liquefaction and infection in obese patients undergoing hepatic carcinectomy so as to provide guidance for clinical practice. METHODS A total of 100 patients who underwent the hepatic carcinectomy in the hospital from Jan 2014 to Jan 2016 were recruited as the study objects and randomly divided into the two groups. The control group was treated with conventional nursing, while the drainage group was given the subcutaneous continuous negative pressure drainage. The incidence rates of postoperative fat liquefaction and wound infection were compared between the two groups of patients, and the risk factors were analyzed. RESULTS The rate of fat liquefaction was 2.00% （1/50） in the drainage group, 22.00% （11/50） in the control group; the incidence rate of wound infection was 4.00% （2/50） in the drainage group, 34.00% （17/50） in the control group, and there was significant difference （P〈0.05）. The risk factors for the fat liquefaction included the age, preoperative BMI, diabetic mellitus, and use of high-frequency electric knife, however, the incision drainage was the protective factor, and there was significant difference （P〈0.05）. The risk factors for the wound infection included the age, preoperative BMI, diabetic mellitus, and hypoproteinemia, while the incision drainage was the protective factor, and there was significant difference （P〈0.05）. CONCLUSION The subcutaneous continuous negative pressure drainage may reduce the rate of incision fact liquefaction and incidence rate of infection.