皮肤牵张器联合负压伤口治疗技术治疗大面积皮肤缺损创面的临床研究

Clinical study on skin distractor combined with negative pressure wound therapy in treating large area cutaneous defect wound

目的探讨皮肤牵张器联合负压伤口治疗(NPWT)技术治疗大面积皮肤缺损创面(LACDW)的临床效果。方法选择2015年1月~2017年6月在秦皇岛市第二医院治疗的LACDW患者61例,按照随机数字表法者分为观察组(31例)和对照组(30例),对照组给予NPWT技术治疗,观察组在对照组的基础上另加用皮肤牵张器治疗。比较两组创面面积,透明质酸(HA)及血管内皮生长因子(VEGF)水平,创面分泌物的细菌计数,分析患者HA及VEGF水平与创面面积及创面分泌物的细菌计数的相关性。结果两组治疗后创面面积及创面分泌物的细菌计数均逐渐降低,且观察组治疗后1、7、10 d的创面面积及创面分泌物的细菌计数均明显小于对照组,差异均有统计学意义(P<0.05)。治疗后10 d两组的HA及VEGF水平均分别明显高于治疗前,且观察组明显高于对照组,差异均有统计学意义(P<0.05)。Spearman相关性分析结果显示:患者HA水平与创面面积及创面分泌物的细菌计数呈负相关(r=-0.688、-0.579,P<0.05);患者VEGF水平与创面面积及创面分泌物的细菌计数呈负相关(r=-0.623、-0.594,P<0.05)。结论联合应用皮肤牵张器以及NPWT技术治疗LACDW患者疗效显著,能够有效降低缺损创面的面积及创面分泌物的细菌计数,增加VEGF及HA水平,值得给予推广。

Objective To discuss the clinical effect of skin distractor combined with negative pressure wound therapy（NPWT） in the treatment of large area cutaneous defect wound（LACDW）. Methods From January 2015 to June 2017,in Second Hospital of Qinhuangdao City, 61 patients with LACDW were selected, they were divided into observation group（31 cases） and control group（30 cases） according to the random number table. The control group was treated with NPWT technique, the observation group was treated with skin distractor on the basis of control group. The wound area,hyaluronic acid（HA） and vascular endothelial growth factor（VEGF）, bacterial count of wound secretions in two groups were compared, the correlations of HA and VEGF levels with wound area and bacterial count of wound secretions were analyzed. Results The wound area and the bacterial count of the wound secretions in the two groups were gradually decreased after treatment, the wound area and the bacterial count of wound secretions on the 1 st, 7 th and 10 th day after treatment in observation group was significantly smaller than the control group, the differences were statistically significant（P〈0.05）. On the 10 th day after treatment, the levels of HA and VEGF in the two groups were significantly higher than before treatment, the levels of HA and VEGF in observation group were significantly higher than the control group, the differences were statistically significant（P〈0.05）. The result of Spearman correlation analysis method showed that the level of HA was negatively correlated with the wound area and the bacterial count of wound secretions（r =-0.688,-0.579, P〈0.05）.The level of VEGF was negatively correlated with the wound area and the bacterial count of wound secretions（r =-0.623,-0.594, P〈0.05）. Conclusion The clinical effect of skin distractor combined with NPWT in the treatment of LACDW is effective, it can effectively reduce the area of defect wound and bacteria count of wound secretions, and increase the levels of VEGF and HA, it is worth to be promoted.