Ⅲ级~Ⅳ级骶尾部压疮不同治疗方法效果评价对比研究

Comparative study on effect evaluation of different treatment methods for gradeⅢ~Ⅳsacrococcygeal Pressure ulcer

目的:对比分析应用湿润烧伤膏换药、负压封闭引流术、湿润烧伤膏换药联合负压封闭引流术三种方法治疗Ⅲ级~Ⅳ级骶尾部压疮的临床效果。方法:选取2019年4月~2020年4月吉林省人民医院烧伤整形外科收治的60例Ⅲ级~Ⅳ级骶尾部压疮患者,随机分为湿润烧伤膏换药组(换药组)、负压封闭引流组(负压组)及联合治疗组,三组一般资料差异无统计学意义(P>0.05),回顾性分析三组患者创面体积缩小率、愈合单位创面体积所需时间、单位时间内愈合单位创面体积所需费用、换药次数、负压引流次数、住院前后疼痛评分以及治疗满意度调查问卷评分等资料。结果:联合治疗组创面体积缩小率最高为(87.52±17.45)%,分别高于负压组的(69.04±23.03)%及换药组的(51.70±26.84)%,差异具有统计学意义(P<0.001);愈合单位创面体积联合治疗组所需时间最短,为(1.59±1.56)d/cm 3,分别优于负压组的(2.53±2.36)d/cm 3及换药组的(3.29±3.75)d/cm 3,联合治疗组与换药组治疗时间差异有统计学意义(P=0.015<0.05);单位时间内愈合单位创面体积所需费用联合组治疗组为(9.69±13.21)元/(cm^(3)·d),明显低于换药组的(18.20±12.83)元/(cm^(3)·d)及负压组的(25.84±34.31)元/(cm^(3)·d);联合组明显低于换药组(P=0.009)及负压组(P=0.001),但是换药组与负压组之间未见统计差异。换药组、联合治疗组及负压组通过治疗后,疼痛缓解率分别为94.74%(18/19)、100%(17/17)及95.00%(19/20),但差异均无统计学意义(P>0.05)。三种治疗满意度调查之间差异有统计学意义(P<0.001),且联合治疗组的患者表示满意者最多,达85%。结论:针对Ⅲ级~Ⅳ级骶尾部压疮,湿润烧伤膏换药联合负压封闭引流术是一种疗效显著且经济实用的治疗方法,值得在临床上推广应用。

Objective To analyze and evaluate the effects of three treatments for gradeⅢ~Ⅳsacrococcygeal Pressure ulcers:wet burn plaster dressing change,negative pressure closed drainage,wet burn plaster dressing change and negative Pressure closed drainage.Method Sixty patients with gradeⅢ~Ⅳsacrococcygeal Pressure ulcer were treated in the department of burn and plastic surgery in Jilin Provincial People's Hospital from April 2019 to April 2020,and they were randomly divided into three groups(wet burn plaster dressing change group,negative pressure closed drainage group,wet burn plaster dressing change and negative Pressure closed drainage group),There was no significant difference in general data among the three groups.The reduction rate of the wound volume,healing time of Per unit would volume,the cost of healing Per unit would volume in Per unit time,dressing change times,negative pressure drainage times,Pain scores before and after hospitalization,and treatment satisfaction of patients and their families were retrospectively analyzed.Results The reduction rate of wound volume in the combined treatment group was the highest(87.52±17.45)%,which was higher than that in the negative Pressure group(69.04±23.03)%,and in the dressing change group(51.70±26.84)%,with statistical difference(P<0.001).The time needed for the combined treatment group was the shortest(1.59±1.56)days/cm 3,Compared with the negative Pressure group(2.53±2.36)days/cm 3 and the drug change group(3.29±3.75)days/cm 3,the treatment time of the combined treatment group and the drug change group was statistically different(P=0.015<0.05);The cost of Wound Healing Per unit volume Per unit time in the combined group was(9.69±13.21)yuan/(cm^(3)·day),significantly lower than that in the dressing group(18.20±12.83)yuan/(cm^(3)·day)and the negative pressure grouP(25.84±34.31)yuan/(cm 3×day);the combined group was significantly lower than that in the dressing group(P=0.009)and the negative Pressure group(P=0.001),but there was no statistical difference between the dressing group and the negative Pressure group.The pain relief rates of the dressing change group,the combined treatment group and the negative Pressure group were 94.74%(18/19),100%(17/17)and 95.00%(19/20)respectively after treatment,but the difference was not statistically significant(P>0.05).The differences among these three kinds of treatment satisfaction surveys were statistically significant(P<0.001),and the patients in the combined treatment group were the most satisfied(85%).Conclusion For gradeⅢ~Ⅳsacrococcygeal pressure ulcers,the combination of wet ointment dressing changes and negative Pressure drainage treatment is a more effective,economical and Practical treatment method,which is worth popularizing and applying in clinical practice.