院外环境中便携式负压伤口治疗用于创伤伤口的效果评价

Evaluation of the effect of portable negative pressure wound therapy in out-of-hospital environment for traumatic wounds

目的负压伤口治疗在国外住院环境、家庭环境和战创伤救治中普遍使用。国内基本在医院内使用,而医院外环境使用的研究较少,证据不足,限制了其推广应用。文章评价院外环境中便携式负压伤口治疗处理创伤伤口的安全性、可行性和有效性效果,为野外应用该技术处理创伤伤口提供借鉴依据。方法纳入各类创伤伤口患者82例,非随机分为对照组(医院治疗模式)34例和干预组(院外治疗模式)48例,2组均使用相同的治疗仪和参数,干预时间至少14 d,对照组患者在伤口门诊和病房接受负压治疗,干预组将调节好治疗参数的便携式负压治疗仪带回家接受治疗,每隔48~72 h到伤口门诊更换填充敷料和管道。负压治疗结束后为随访治疗,根据个体状况实施标准化湿性治疗至愈合或3个月止。观察两组患者脱落率和与负压治疗相关的不良事件发生率,负压治疗前和后14 d面积、深度和体积、随访期末的治愈率及愈合时间。结果对照组脱落率8.82%(3/34)、干预组脱落率2.08%(1/48),差异无统计学意义(P>0.05)。对照组31例、干预组47例完成了预期的负压治疗和随访治疗,2组负压治疗时间接近[(15.41±5.92)d vs(16.48±4.97)d,P>0.05]。2组与负压治疗相关的伤口加深、湿性皮炎发生率差异亦无统计学意义(P>0.05),无一例发生相关性伤口出血和伤口并发症。干预组随访期末的愈合时间[(47.88±15.34)d]较对照组[(57.00±14.44)d]缩短(P<0.05)。结论院外环境中便携式负压伤口治疗能够安全、有效用于各类创伤性伤口,可借鉴用于野外战创伤伤口的处理。

Objective Negative pressure wound therapy(NPWT) is a globally recognized effective method device of acute and chronic wounds, which is widely used in the hospital, home and war abroad. In China, it is basically used in the hospital.Little research on the use of the device outside the hospital andthe lack of evidences limit the popularization and application of this device. This article aims to evaluatethe safety, feasibility and efficacy of the portable NPWT for traumatic wounds in the out-of-hospital environment in order to provide related evidences for the management of traumatic wounds in the outdoor. Methods A total of 82 patients with traumatic wounds were enrolled, and were divided into the control group(hospital, n=34) and the intervention group(out-of-hospital, n=48). Both groups used the same NPWT device and parameters, and the intervention time was at least 14 days. Patients in the control group were treated by the NPWT at the wound care center and wards, whilepatients in the intervention group were treated by the portable NPWT device with the settled parameters at home. The filling dressing and the tube were replaced every 48-72 hours. After the NPWT, standardized moist therapy was performed according to the individual condition until healing or for 3 months. The shedding rate, the incidence of adverse events associated with NPWT,the wound area, depth and volume of the 14 days before and after NPWT, as well as the wound healing rate and the healing time at the end of follow-upwere observed. Results The shedding rate in the control and intervention group was 8.82%(3/34)and 2.08%(1/48) respectively. There was no significant difference in both groups(P>0.05). 31 patients in the control group and 47 patients in the intervention group completed the expected NPWT and follow-up treatment. The time of NPWT in two groups was similar(15.41±5.92 d vs 16.48±4.97 d, P>0.05). After 14 days of treatment, the wound area and depth reduction rate of the two groups were close(P>0.05). There was no significant difference in the incidence of wound deepening and dermatitis associated with NPWT in both groups(P>0.05). No related wound bleeding and wound complications occurred. At the end of follow-up, the healing time of the intervention group [(47.88±15.34) days] was shorted than the control group [(57.00±14.44) days]. Conclusion Portable NPWT in the out-of-hospital can be safely and effectively used in various traumatic wounds, and can be used for the treatment of wounds in the war.