负压封闭引流技术联合自体游离皮片移植对下肢静脉性溃疡病人创面愈合及生活质量评分的影响

Effect of VSD combined with autologous free skin graft on wound healing and VLU-QoL score in patients with venous leg ulcers

目的探讨负压封闭引流技术(VSD)联合自体游离皮片移植治疗下肢静脉溃疡(VLU)病人生活质量问卷(VLU-QoL)评分及创面愈合的影响。方法 2018年5月~2019年11月期间收治的VLU病人62例,采用随机数字表法分为对照组和观察组,每组各31例,对照组采用单纯自体游离皮片移植,观察组采用VSD联合自体游离皮片移植。术后5~7天拆除VSD引流装置。比较两组病人创面愈合情况、术后感染情况、换药次数、创面愈合时间、总住院时间以及VLU-QoL评分。结果观察组病人创面愈合的良好率为93.55%,对照组为70.97%,两组比较差异有统计学意义(P<0.05)。观察组病人皮片感染率、换药次数、创面愈合时间以及总住院时间分别为3.23%、(8.70±1.69)次、(17.32±3.30)天、(13.61±2.20)天,对照组分别为22.58%、(15.79±2.58)次、(25.39±4.88)天和(22.13±2.68)天,两组比较差异均有统计学意义(P<0.05)。观察组病人术后12周VLU-QoL总分及日常生活、主观感受、局部症状3个维度评分分别为(36.87±7.92)分,(13.56±4.18)分,(13.01±3.24)分,(10.30±2.36)分;对照组分别为(53.05±14.82)分,(19.72±4.96)分,(18.55±3.26)分,(14.78±2.90)分,两组与术前比较,差异均有统计学意义(P<0.05)。组间比较,术后12周观察组VLU-QoL总分及日常生活、主观感受、局部症状3个维度评分低于对照组,差异有统计学意义(P<0.05)。结论对VLU病人给予VSD联合自体游离皮片移植治疗可促进创面愈合,降低皮片感染率,减少换药次数,降低创面愈合时间、总住院时间,提高生活质量VLU-QoL评分。

Objective The effect of VSD combined with autologous free skin graft on wound healing and VLU-QoL score in patients with venous leg ulcers.Methods 62 cases of VLU patients admitted to our hospital from May 2018 to November 2019 were selected as subjects.They were divided into two groups by random number table, 31 cases in each group.The control group was treated with simple autologous skin graft.The observation group was treated with VSD combined with autologous free skin graft, and the VSD drainage device was removed 5~7 days after surgery.Wound healing, postoperative infection, dressing times, wound healing time, total hospital stay, and VLU-QoL score were analyzed.Results The good rate of wound healing was 93.55% in the observation group and 70.97% in the control group(P<0.05).The skin infection rate, dressing change times, wound healing time and total hospitalization time of the observation group were 3.23%,(8.70±1.69),(17.32±3.30)d,(13.61±2.20)d, respectively, which were significantly lower than those of the control group[22.58%,(15.79±2.58),(25.39±4.88)d,(22.13±2.68)d] with significant difference(P<0.05).The total score of vlu QOL,daily life, subjective feelings and local symptoms of the two groups were[(36.87±7.92),(13.56±4.18),(13.01±3.24) and(10.30±2.36) VS(53.05±14.82),(19.72±4.96),(18.55±3.26) and(14.78±2.90),respectively],which were significantly lower than those before operation.Comparison between groups, 12 weeks after surgery to observe group VLU-QoL scores and the subjective feeling of daily life, the three dimensions, local symptoms score lower than the control group, the difference was statistically significant(P<0.05).Conclusion VSD combined with autologous free skin graft treatment for patients with venous leg ulcers can promote wound healing, reduce the rate of skin infection, reduce the number of dressing changes, reduce wound healing time, total hospital stay, and improve quality life of VLU-QoL score.