扩创植皮联合封闭负压引流技术治疗大面积烧伤感染难愈创面的疗效

Effect of expanded skin grafting combined with vacuum sealing drainage on treatment of large area burns patients with refractory wound infection

目的探讨扩创植皮联合封闭负压引流术(Vacuum sealing drainage,VSD)治疗大面积烧伤感染难愈创面的疗效及对患者血清炎症因子水平的影响。方法选取2017年1月-2018年10月四川省人民医院收治的68例大面积烧伤后期感染难愈创面患者为研究对象,分为研究组和对照组,每组34例。对照组用扩创植皮进行治疗,研究组在对照组基础上联合VSD治疗。观察两组患者治疗效果,术后第3天植皮成活率、术后第6天创面愈合率、术后前3次换药时疼痛情况。分析治疗前、治疗后7 d、治疗后14 d患者血清炎症因子的水平变化。结果研究组术后第3天植皮成活率和术后第6天的创面愈合率分别为76.47%和79.41%均高于对照组的41.18%和35.29%,差异有统计学意义(P<0.05);研究组术后前3次换药时疼痛模拟分均低于对照组(P<0.05);研究组治疗的疗效高于对照组(Z=-2.221,P=0.026);研究组治疗后7 d时血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)和超敏C-反应蛋白(hs-CRP)表达水平分别为(35.26±3.24)ng/ml、(56.36±18.36)ng/ml、(20.36±3.33)ng/ml和(8.69±3.58)mg/ml,治疗后14d时分别为(20.36±6.54)ng/ml、(32.01±12.65)ng/ml、(18.26±2.14)ng/ml和(5.24±2.46)mg/ml,均低于对照组(P<0.05)。结论扩创植皮联合VSD治疗大面积烧伤后期感染难愈创面患者的效果较好,并明显改善患者血清炎症因子水平,值得临床推广。

OBJECTIVE To explore the effect of expanded skin grafting combined with vacuum sealing drainage(VSD)on treatment of large area burns patients with refractory wound infection and observe the influence on serum inflammatory factors.METHODS A total of 68 large area burns patients with refractory wound infection who were treated in Sichuan People′s Hospital from Jan 2017 to Oct 2018 were recruited as the study objects and divided into the study group and the control group,with 34 cases in each group.The control group was treated with expanded skin grafting,while the study group was given VSD on basis of the treatment of the control group.The curative effect,survival rate of grafted skin on Day 3 after surgery,wound healing rate on Day 6 after the surgery and visual analogue scale(VAS)score during the first 3 times of dressing change after surgery were observed,and the levels of serum inflammatory factors were analyzed before the treatment and after the treatment for 7 and 14 days.RESULTS The survival rate of grafted skin on Day 3 after surgery and wound healing rate on Day 6 after the surgery of the study group were respectively 76.47%and 79.41%,significantly higher than 41.18%and 35.29%(P<0.05).The VAS score during the first3 times of dressing change after surgery was lower in the study group than in the control group(P<0.05).The effective rate of treatment of the study group was significantly higher than that of the control group(Z=-2.221,P=0.026).The levels of serum interleukin-6(IL-6),IL-8,tumor necrosis factor(TNF-α)and high-sensitivity C-reactive protein(hs-CRP)of the study group were respectively(35.26±3.24)ng/ml,(56.36±18.36)ng/ml,(20.36±3.33)ng/ml and(8.69±3.58)mg/ml after the treatment for 7 days,significantly lower than those of the control group;the levels of above indexes of the study group were respectively(20.36±6.54)ng/ml,(32.01±12.65)ng/ml,(18.26±2.14)ng/ml and(5.24±2.46)mg/ml after the treatment for 14 days,lower than those of the control group.CONCLUSION The expanded skin grafting combined with VSD can achieve significant effect on treatment of the large area burns patients with refractory wound infection and significantly improve the levels of serum inflammatory factors,and it is worthy to be promoted in the hospital.