自制皮下引流管持续冲洗负压吸引预防腹部切口感染的双中心随机对照研究

Application of self-made subcutaneous continuous irrigating drainage tube sucked by negative pressure in abdominal incision infection: A double center randomized controlled study

目的探讨自制皮下引流管持续冲洗负压吸引预防腹部Ⅳ类切口感染的价值。方法将2012年1月至2017年1月在佛山市第一人民医院普外科和伽师县人民医院普外科行Ⅳ类切口开腹手术的220例患者随机分为试验组和对照组。试验组患者关腹时放置自制皮下引流管,术后持续负压冲洗3 d后拔除;对照组采用传统不放置皮下引流管的关腹方法。观察并比较两组患者术后伤口恢复情况及围手术期临床资料。结果试验组平均术后住院时间、术后治疗费用、总治疗费用显著低于对照组,差异均有统计学意义(P<0.01)。两组腹腔液细菌培养结果差异无统计学意义(χ^2=0.017,P=0.992),试验组的切口愈合程度显著优于对照组(χ^2=8.208,P=0.017),切口感染发生率显著低于对照组(χ^2=8.206,P=0.004)。多因素分析结果显示,是否放置皮下引流管(P=0.008)、原发疾病部位(P=0.004)、术前降钙素原水平(P=0.008)、合并糖尿病(P=0.006)是术后伤口感染的危险因素。结论Ⅳ类切口手术放置自制皮下引流管持续冲洗和负压吸引,能有效预防术后切口感染,减少住院时间,降低住院费用。

Objective To explore the value of continuous flushing and negative pressure suction with self-made subcutaneous drainage tube in the prevention of type abdominal incision infection. Methods From January 2012 to January 2017 in the Department of General Surgery of the First People’s Hospital of Foshan and People’s Hospital of Jiashi County, two hundred and twenty patients with type Ⅳ incision undergoing laparotomy were randomly divided into the trial group and the control group. A subcutaneous drainage tube was placed and continuous flushing and negative pressure suction were used for three days after the operation in the trial group. The traditional method without placing the subcutaneous drainage tube was adopted in the control group. The perioperative clinical data and the condition of wound recovery were observed and compared. Results The average hospitalization time, treatment costs and total treatment costs of the trial group were significantly lower than those of the control group(P<0.01). There was no significant difference in bacterial culture results between the two groups(χ^2=0.017, P=0.992). The wound healing degree of the trial group was significantly better than that of the control group(χ^2=8.208, P=0.017), and the incidence of wound infection was significantly lower(χ^2=8.206, P=0.004). Multivariate analysis showed that subcutaneous drainage(P=0.008), location of primary disease(P=0.004), preoperative procalcitonin level(P=0.008) and diabetes mellitus(P=0.006) were risk factors for postoperative wound infection. Conclusion Self-made subcutaneous continuous irrigating drainage tube sucked by negative pressure in type incision can effectively prevent postoperative wound infection, reduce hospitalization time and hospitalization costs.