负压伤口治疗结合纳米银敷料处理创伤性慢性伤口的效果比较

Comparison of the effectabout improved negative pressure wound therapy with filling dressing for treating traumatic wounds.

目的如何使用负压伤口治疗(NPWT)伤口感染目前尚无明确建议。文章旨在将纳米银敷料作为填充敷料实施NPWT,并观察其效果,为优化NPWT技术提供依据。方法纳入东部战区总医院门诊伤口护理中心就诊、符合物理性创伤性伤口患者80例,完全随机化方法分为干预组和对照组,每组40例。对照组采用等渗盐水纱布为填充敷料的标准NPWT,干预组将NPWT的填充敷料改进为纳米银敷料,所有患者负压治疗至少14 d,后采用湿性治疗随访至愈合或3个月。全分析集(FAS)和符合方案集(PPS)分析2组干预后14 d的体积缩小率,另比较干预后14 d细菌阳性率和随访3个月末的伤口治愈率和愈合时间。结果对照组36例、干预组40例完成了预期的负压治疗时间和随访时间。治疗前2组基线接近。FAS显示对照组、干预组NPWT治疗后14 d伤口体积缩小率分别为(59.48±27.24)%、(70.95±20.73)%,差异有统计学意义(P>0.05);PPS显示对照组、干预组伤口体积缩小率分别为(64.42±22.33)%、(70.95±20.73)%,差异有统计学意义(P<0.05)。2组患者伤口治疗后效果比较显示,与对照组细菌阳性率(44.44%)比较,干预组细菌阳性率(20.00%)降低(P<0.05);与对照组愈合时间[(62.58±16.18)d]比较,干预组[(50.85±15.81)d]缩短(P<0.05);与对照组伤口治愈率(66.67%)比较,干预组(97.50%)提高(P<0.05)。结论改进NPWT填充敷料能有效缩小创伤性伤口的体积和降低致病菌阳性率,有助于控制伤口感染和改善伤口愈合结局。

Objective The purpose of this study is to use nano-silver dressing as filling dressing for negative pressure wound therapy,and to observe the effect of treating traumatic infected wounds,so as to provide a basis for optimizing negative pressure Methods Eighty patients with physical traumatic wounds were enrolled in the outpatient wound care center. They were randomly divided into the intervention group and the control group(n=40 in each group). In the intervention group,the filling dressing for negative pressure wound therapy used nano silver dressing. In the control group,the standard negative pressure wound therapy with normal saline gauze as filling dressing was adopted. All patients were treated with negative pressure for at least 14 days,and then were treated with moist wound therapy until followed up for wound healed. The wound volume reduction rate was the main outcome indicator 14 days after intervention in the two groups. The bacterial positive rate and the wound healing rate at the end of 3 months follow-up,and final healing time were the secondary outcome indicators.Results36 cases in the control group and 40 cases in the intervention group completed the expectednegative pressure wound therapy time and follow-up. The baseline data of the two groups had no difference. The wound volume reduction rate(70.95±20.73)% in the intervention group after 14 days of treatment was significantly higher than that in the control group(64.42±22.33)%(P< 0.05),and the bacterial positive rate(20%)was lower than that in the control group(44.44%)(P< 0.05). At the end of the follow-up,the healing rate of the intervention group(97.50%)was higher than that of the control group(66.67%)(P<0.001). The healing time of the intervention group(50.85±15.81 d)was shorter than of the intervention group(62.58±16.18 d)(P<0.05).ConclusionImproving the filling dressing for negative pressure wound therapy can effectively reduce the volume of traumatic wound and the positive rate of pathogenic bacteria,and help to control wound infection and improve wound healing outcomes.