自黏性软聚硅硐有边型泡沫吸收性敷料联合防漏膏在经皮肝穿刺胆道引流管渗漏患者中的应用

Application of mepilex absorptive dressing combined with leakproof ointment in patients with percutaneous transhepatic cholangiodrainage catheter leakage

目的观察在经皮肝穿刺胆道引流术(PTCD)管渗漏患者中使用自黏性软聚硅硐有边型泡沫吸收性敷料联合防漏膏换药的临床效果。方法将2013年7月至2016年7月襄阳市中心医院普外二科PTCD管渗漏患者147例采取随机数字表法分为对照组、观察1组和观察2组,每组各49例,对照组采用临床常规方法无菌纱布块换药;观察1组使用无菌纱布联合防漏膏换药;观察2组应用自黏性软聚硅硐有边型泡沫吸收性敷料联合防漏膏保护引流口周皮肤黏膜。观察三组患者带管期间舒适度、并发症、渗漏和换药情况。结果观察2组与对照组在舒适度方面比较差异有统计学意义(Z=-4.921,P<0.001),观察1组与对照组在舒适度方面比较差异无统计学意义(Z=-0.748,P=0.454);观察2组患者在周围刺激性皮炎方面并发症(2例)低于观察1组(8例)和对照组(12例)患者(P<0.167),三组患者在意外脱管方面差异无统计学意义(P>0.05)。观察2组患者渗液和换药频次为(2.25±0.17)次,明显低于对照组(F=881.03,P=0.000)。结论使用自黏性软聚硅硐有边型泡沫吸收性敷料联合防漏膏处理PTCD管渗漏,增加了患者带管期间的舒适度,减少了刺激性皮炎的发生,同时换药次数的减少也减轻了临床医疗护理的工作量,值得临床推广。

Objective To observe the clinical effect of mepilex absorptive dressing combined with leakproof ointment in patients with percutaneous transhepatic cholangiodrainage（ PTCD） catheter leakage. Methods One hundred and forty-seven patients with PTCD catheter leakage in Second Department of General Surgery,Xiangyang Central Hospital from July 2013 to July 2016 were enrolled. Patients were randomly assigned into control group,observation group 1 and observation group 2,49 cases in each group. The control group was treated with aseptic gauze block dressing change,observation group 1 was treated with aseptic gauze combined with leakproof ointment dressing change,and observation group 2 was treated with mepilex absorptive dressing combined with leakproof ointment to protect skin and mucosa around drainage mouth. The comfort,complications,leakage and dressing change of the three groups were observed.Results The difference of comfort between observation group 2 and control group was statistically significant（ Z =-4. 921,P〈0. 001）. The difference of comfort between observation group 1 and control group was not statistically significant（ Z =-0. 748,P =0. 454）. The complications of peripheral irritant dermatitis（ 2 cases） in the observation group 2 were lower than those in the observation group 1（ 8 cases） and the control group（ 12 cases）（ P〈0. 167）. There was no significant difference in the complications of accidental detachment among the three groups（ P〈0. 05）. The frequency of exudation and dressing change in the observation group 2 was（ 2. 25± 0. 17）,which was significantly lower than that in the control group（ F = 881. 03,P = 0. 000）. Conclusion The application of mepilex absorptive dressing combined with leakproof ointment can increase the comfort of patients with PTCD catheter leakage,and reduce the occurrence of irritant dermatitis,meanwhile,the number of dressing changes reduces the workload of clinical medical care,which is worthy of clinical promotion.