负压封闭引流术治疗胫骨骨折患者术后感染的效果

Effect of vaccum sealing drainage on treatment of tibial fracture patients with postoperative infection

目的探讨胫骨骨折患者术后感染病原菌特点,探究不同治疗方式对微循环与相关血清细胞因子的影响,为临床诊疗工作提供参考依据。方法回顾性分析2016年1月-2017年10月萍乡市人民医院收治的胫骨骨折术后早期感染患者124例的临床资料,根据术后治疗方式将入选患者区分为常规治疗组67例与负压封闭引流技术(vaccum sealing drainage,VSD)组57例,探讨术后感染的病原菌情况,分析两组患者术后微循环及相关血清细胞因子的指标水平评估临床疗效,其中微循环通过对比治疗前及治疗后1 d、3 d和7 d的流态积分、管襻积分、襻周状态积分及综合积分评估,血清细胞因子通过对比治疗前后的slCAM-1、sVCAM-1及核因子κB评估。结果124例感染患者共分离培养病原菌149株,其中革兰阴性菌56株占37.58%,革兰阳性菌89株占59.73%,真菌4株占2.68%,以金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌为主,治疗后1 d、3 d、7 d VSD组患者流态积分、管襻积分、襻周状态积分及综合积分均低于常规治疗组,治疗后VSD组细胞间黏附因子-1(slCAM-1)、可溶性血管细胞黏附因子-1(sVCAM-1)分别为(2.50±0.58)pg/ml、(5.04±1.03)pg/ml,均低于常规治疗组,而核因子κB为(0.98±0.15)ng/ml,高于常规治疗组(P<0.05)。结论VSD技术可有效改善患者局部甲襞微循环,从而为局部血供的改善奠定基础,也可通过调节血清细胞因子,加速骨折创面的愈合,具有一定的临床价值。

OBJECTIVE To investigate the etiological characteristics of postoperative infection of tibial fracture patients and explore the effects of different treatment methods on microcirculation and related serum cytokines,so as to provide reference for clinical diagnosis and treatment.METHODS A retrospective analysis was conducted for the clinical data of 124 cases of tibial fracture patients with early postoperative infection treated in the hospital from Jan.2016 to Oct.2017.According to the postoperative treatment method,the patients were divided into conventional treatment group and vaccum sealing drainage(VSD)group,with 67 and 57 cases,respectively.The pathogens of postoperative infection were discussed,the postoperative microcirculation and levels of related serum cytokines indicators in the two groups of patients were analyzed to evaluate the clinical curative effect.The microcirculation was evaluated by comparing the flow integral,loop integral,loop state integral and comprehensive integral before treatment and 1 d,3 d and 7 d after treatment.Serum cytokines were evaluated by comparing slcam-1,svcam-1 and nuclear factorκB before and after treatment.RESULTS A total of 149 strains of pathogens were isolated and cultured from 124 infected patients,of which 56 strains were Gram-negative bacteria(37.58%),89 strains were Gram-positive bacteria(59.73%)and 4 strains were fungi(2.68%).Staphylococcus aureus,Escherichia coli and Staphylococcus epidermidis were the main pathogenic bacteria.After 1,3 and 7 days of treatment,the flow integral,loop integral,loop state integral and comprehensive integral in the VSD group were all lower than those in the conventional treatment group.The levels of slCAM-1 and sVCAM-1 in the VSD group after treatment were(2.50±0.58)pg/ml and(5.04±1.03)pg/ml,respectively,significantly lower than those in the conventional treatment group,while the nuclear factor KB was(0.98±0.15)ng/ml,significantly higher than that in the conventional treatment group(P<0.05).CONCLUSION VSD technology can effectively improve the local nail fold microcirculation in patients,thus laying a foundation for the improvement of local blood supply.It can also accelerate the healing of fracture wounds by regulating serum cytokines,which has certain clinical value.