四肢骨折术后伤口引流管早期夹闭与自然引流的比较

Comparison of Efficacy Between Early Clipping Wound Drainage and Natural Wound Drainage of Limb Fracture After Surgery

目的：探讨四肢骨折术后早期夹闭伤口引流管对伤口引流量的影响。方法：选取四肢闭合性骨折术中使用止血带的患者74例,随机分为观察组（伤口引流管术后夹闭6h再开放组）和对照组（术后引流管立即开放）两组;各组37例。观察术后24h,48h及拔管时伤口总引流量及引流管放置时间;比较术前术后血红蛋白含量改变情况;至少随访至术后3月观察其伤口愈合情况。结果：术后第1天伤口引流量,观察组32.26ml显著少于对照组96.28ml（P〈0.05）;术后第2天观察组伤口引流量增加15.96ml,较对照组21ml无显著增加（P〈0.05）。观察组所有患者均在术后第2天拔除伤口引流管,对照组中有5例患者术后第3天拔除引流管。拔除引流管时观察组的总引流量为49.23ml,小于对照组的118.46ml。术后第3天红细胞数,对照组3.28×1012/L显著少于观察组3.94×10^（12）/L（P〈0.05）。术后第3天时血红蛋白含量,对照组107.72g/L显著少于观察组121.88g/L（P〈0.05）。两组均未出现伤口并发症,术后伤口外渗的血量及换药次数无差异。结论：四肢骨折术后早期夹闭伤口引流管可减少伤口引流量并减轻血红蛋白的丢失且不增加伤口并发症。

Objective：To investigate the effect of early clipping the drainage tube on wound drainage of limb fracture after surgery.Methods：This randomized controlled study included 74 patients（37 patients in observation group and 37 in the control group）with tourniquet in closed limb fracture surgery.The drainage tube were open after 6 hours in the observation group and immediately open in the control group.The total wound drainage and drainage tube placement time were observed at 24 hand 48 hafter operation.The changes of hemoglobin content were compared before operation and after operation.The wound healing was observed for at least 3 months after operation.Results：On the first day postoperation,the amount of wound drainage was significantly less in observation group as 32.26 ml than 96.28 ml in control group（P〈0.05）.On the second day postoperation,the wound drainage in observation group increased to 15.96 ml,which was not significantly more than 20.76 ml in control group（P〉0.05）.All patients in the observation group had their wounds drained for 2 days after surgery.Five patients in the control group hadbeen removed drainage tubes for 3 days after surgery.When the drainage tube was removed,the total drainage volume of the observation group was 49.23 ml,which was less than 118.46 ml of the control group.The number of erythrocytes at the third day after operation was significantly less in the control group（3.28×1012/L vs 3.94×1012/L,P〈0.05）.The hemoglobin content at the third day after operation was significantly lower in the control group（107.72 g/L）than in the observation group（121.88 g/L,P〈0.05）.There was no wound complications in both groups.No difference in wound extravasation and wound dressing change after operation was noted.Conclusion：Closure of the wound drainage tube of limb fracture early after surgery can reduce the wound drainage and also reduce the hemoglobin loss without increasing the wound complications.