高压氧联合负压封闭引流治疗四肢创伤后感染性难愈合创面的疗效观察

Therapeutic effect of hyperbaric oxygen therapy combined with vacuum sealing drainage on patients with hard-healing wound of traumatic infections in extremities

目的观察高压氧联合负压封闭引流(VSD)治疗四肢创伤后感染性难愈合创面的临床疗效。方法选择2016-01~2018-01该院收治的四肢创伤3周后感染性难愈合伤口患者40例,按是否愿意接受高压氧治疗分为对照组(在常规外科治疗基础上予VSD治疗)和高压氧组(在对照组基础上进行高压氧治疗),每组20例。观测两组治疗前及治疗第24天后(相当于高压氧治疗20次)的创面面积、视觉模拟评分法(VAS)评分、白细胞计数(WBC)、C反应蛋白(CRP)、血小板(PLT)的变化情况。比较两组患者治疗12d和24d换药后创面细菌培养阳性情况。结果两组患者治疗24d后创面面积、VAS评分、WBC、CRP、PLT较治疗前都有改善,高压氧组优于对照组(P<0.05)。两组患者治疗第12天创面细菌培养阳性率比较差异无统计学意义(P>0.05),第24天创面细菌培养阳性率比较差异有统计学意义(P<0.05)。结论高压氧联合VSD能加速四肢创伤后感染性难愈合创面的修复,有较好的临床应用价值。

Objective To observe the therapeutic effect of hyperbaric oxygen therapy combined with vacuum sealing drainage(VSD) on patients with hard-healing wound of traumatic infections in extremities. Methods Forty patients with hard-healing wound of traumatic infections in extremities 3 weeks afteRlimb trauma who were treated in ouRhospital from January 2016 to January 2018 were seleeted, and they were randomly divided into the hyperbaric oxygen group(receiving hyperbaric oxygen therapy combined with VSD and surgical therapy) and the control group (receiving surgical therapy plus VSD) according to different treatments, with 20 cases in each group. The changes of wound area, Visual Analogue Scale(VAS) scores, and white blood cell(WBC), C-reactive protein(CRP) and platelets(PLT) were compared between the two groups before and 24 days afteRtreatment(the equivalent of hyperbaric oxygen therapy foR20 times). The positive results of wound bacteria culture afteRdressing changes were compared between the two groups on day 12 and day 24 of treatment. Results Compared with those before treatment, the wound area, VAS scores, WBC, CRP and PLT improved significantly afteRtreatment in the two groups, but the improvements of the above indicators in the hyperbaric oxygen group were betteRthan those in the control group( P<0.05). The positive results of wound bacteria culture on the 12th day of treatment were not significantly different between the two groups( P>0.05), but there were significant differences in the positive results of wound bacteria culture on the 24th day of treatment between the two groups( P<0.05). Conclusion Hyperbaric oxygen therapy combined with VSD therapy can accelerate the recovery of hard-healing wound of traumatic infections in extremities afteRlimb trauma and has great practical value.