软组织分层放置自制引流管行负压伤口疗法的临床应用33例

Clinical application of self-made drainage tubes in different layers of soft tissue for negative-pressure wound therapy in 33 patients

2014年1月-2018年6月,东南大学医学院附属江阴医院收治28例、郑州市第一人民医院收治5例不同类型深部软组织损伤或感染患者,其中男24例、女9例,年龄18~89(40±20)岁。笔者将一次性吸痰管侧壁开孔自制引流管,分别放置于清创后深部不同软组织层面和创面表层,创面表层引流管有效引流段使用银离子抗菌功能性敷料包裹,应用生物透性薄膜封闭术区,将创面深层和浅层所有引流管用三通管并联后接壁式医用负压吸引器,以-20.0^-10.6 kPa行负压伤口疗法。深层引流管一般于术后4 d或5 d拔除或更换,拔除或更换深层引流管时同步更换创面表层引流管。本组患者于术后4~15 d拔除深层引流管,术后8~25 d拔除创面表层引流管,改为常规换药,直至创面完全愈合或创基能接受皮片或组织瓣移植。本组患者创面深层引流管留置时间为(6.2±2.8)d,创面表层引流管留置时间为(12.0±3.0)d,创面愈合时间为(22±5)d,住院时间为(29±7)d,创面培养细菌由治疗前的6种11株减少为治疗后的3种4株,治疗过程中未发生创面出血、刺激性疼痛、慢性窦道形成等不良事件。23例患者随访13~28个月,未观察到与治疗相关的并发症。

From January 2014 to June 2018,28 patients with different types of deep soft tissue injury or infection were admitted to the Affiliated Jiangyin Hospital of Medical College of Southeast University;5 patients were admitted to the Zhengzhou First People′s Hospital.There were 24 males and 9 females,aged 18-89(40±20)years.Disposable suction tubes with holes cut on side walls were used as self-made drainage tubes.The authors placed the self-made drainage tubes on different deep soft tissue layers and wound surfaces after debridement.The effective drainage sections of the wound surface drainage tubes were wrapped with silver ion antimicrobial functional active dressings.Bio-permeable membrane was used to close the operative area.The drainage tubes in the deep layer of wound and wound surface were connected in parallel by a tee and connected to wall-hanging medical negative-pressure suction device to conduct negative-pressure wound treatment at-20.0 to-10.6 kPa.The deep drainage tubes were usually removed or changed 4 or 5 days after surgery.The drainage tubes in the wound surface were synchronously replaced when removing or replacing he drainage tubes in the deep layer of wound.On 4 to 15 days after surgery,the deep drainage tubes were removed.On 8 to 25 days after surgery,the wound surface drainage tubes were removed.Then the treatment was changed to a conventional dressing change until the wounds were completely healed or the wound bed was ready for skin grafts or tissue flaps.The indwelling time of deep drainage tubes in this group of patients was(6.2±2.8)days,and the indwelling time of wound surface drainage tubes was(12.0±3.0)days.The wound healing time was(22±5)days,the hospital stay time was(29±7)days,and wound bacteria were reduced from 6 species and 11 strains before treatment to 3 species and 4 strains after treatment.No adverse events such as wound bleeding,irritative pain,and chronic sinus occurred during treatment.Twenty-three patients were followed up for 13 to 28 months,no treatment-related complications were observed.