微动力负压技术用于儿童四肢及躯干创面植皮术中的疗效观察

Clinical effect of micro-dynamic negative pressure wound therapy on skin grafting of limbs and trunk wounds of childron

目的对比儿童四肢及躯干创面植皮术中应用打包加压、负压封闭引流(VSD)技术和微动力负压技术(MDNPWT)固定皮片的效果,分析MDNPWT应用于儿童创面四肢及躯干植皮术的临床疗效。方法采用前瞻性随机对照研究,选择2019年8月至2021年5月昆明市儿童医院收治的符合入组标准并完成研究的患儿共90例,将患儿按随机数字表法分为MDNPWT组、VSD组及打包组。3组患儿入院后均行术前常规创面处理,手术清创后取自体大张中厚皮移植修复创面,MDNPWT组使用微动力负压护创敷料固定移植皮片,其余2组分别使用VSD及传统打包方法固定移植皮片。3组患儿均于术后7 d拆除敷料,常规换药至创面完全愈合。观察并记录3组患儿手术时间、创面愈合率、术后换药次数、手术及术后治疗总费用、疼痛情况(FLACC评分)及术后不良反应发生情况。数据比较分别采用单因素方差分析、SNK-q检验、重复测量方差分析及χ^(2)检验。结果MDNPWT组与打包组及VSD组的手术时长分别为(46.1±10.5)、(77.0±11.6)、(53.9±19.6)min,组间总体比较差异有统计学意义(F=85.54,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=17.51,P<0.01),与VSD组比较,差异有统计学意义(q=3.79,P<0.01)。MDNPWT与打包组、VSD组的创面愈合率分别为(96.3±3.2)、(77.2±10.9)、(91.8±7.3)%,组间总体比较差异有统计学意义(F=47.85,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=13.11,P<0.01),MDNPWT组与VSD组比较,差异无统计学意义(q=3.79,P>0.05)。MDNPWT组与打包组及VSD组的术后换药次数分别为(2.4±1.2)、(8.4±2.8)、(2.5±1.7)次,组间总体比较差异有统计学意义(F=82.36,P<0.01);MDNPWT组与打包组比较比较,差异有统计学意义(q=15.66,P<0.01),与VSD组比较,差异无统计学意义(q=0.25,P>0.05)。MDNPWT组与打包组及VSD组的手术及术后治疗费用分别为(5253.7±652.3)、(7545.6±736.8)、(6543.3±481.4)元,组间总体比较差异有统计学意义(F=96.53,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=19.64,P<0.01),与VSD组比较,差异有统计学意义(q=10.47,P<0.05)。MDNPWT组与打包组及VSD组术后1 h FLACC评分分别为(3.7±1.2)、(5.6±1.7)、(5.5±1.5)分,组间总体比较差异有统计学意义(F=15.35,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=7.03,P<0.01),与VSD组比较,差异有统计学意义(q=6.36,P<0.05)。MDNPWT组与打包组及VSD组术后48 h FLACC评分分别为(2.1±0.7)、(2.7±0.9)、(3.2±0.6)分,组间总体比较差异有统计学意义(F=13.46,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=3.71,P<0.05),与VSD组比较,差异有统计学意义(q=7.34,P<0.01)。术后首次换药,MDNPWT组与打包组及VSD组分别为(3.1±1.3)、(4.8±1.4)、(4.3±1.5)分,组间比较差异有统计学意义(F=10.61,P<0.01);MDNPWT组与打包组比较,差异有统计学意义(q=6.37,P<0.01),与VSD组比较,差异有统计学意义(q=4.43,P<0.01)。术后不良反应:MDNPWT组与打包组及VSD组感染发生率分别为3.4%、5.9%、3.7%,组间比较差异无统计学意义(χ^(2)=0.63,P>0.05)。MDNPWT组与打包组及VSD组湿疹发生率分别为3.4%、5.9%、25.9%,组间比较差异有统计学意义(χ^(2)=6.06,P<0.05);MDNPWT组与打包组比较,差异无统计学意义(χ^(2)=0.20,P>0.05),与VSD组比较,差异有统计学意义(χ^(2)=5.77,P<0.05)。MDNPWT组与打包组及VSD组张力性水疱发生率分别为0、5.9%、18.5%,组间比较差异有统计学意义(χ^(2)=8.67,P<0.05);MDNPWT组与打包组比较,差异有统计学意义(χ^(2)=1.76,P<0.05),与VSD组比较,差异有统计学意义(χ^(2)=5.90,P<0.05)。结论在儿童四肢及躯干创面植皮治疗中,应用MDNPWT固定移植皮片能有效缩短手术时间,提高创面愈合率及减少术后换药次数及疼痛、降低治疗费用,减少术后不良反应,安全有效。

Objective To compare the effects of applying packing compression,vacuum sealing drainage(VSD)technology and micro-dynamic negative pressure therapy(MDNPWT)in skin grafting on children′s limbs and trunk wounds,and analyze the clinical efficacy of MDNPWT in children′s wound skin grafting.Methods The prospective randomized controlled study were used,from August 2019 to May 2021,Kunming Children′s Hospital admitted a total of 90 children who met the enrollment criteria and completed the study.The children were divided into MDNPWT group and VSD group according to the random number table method.And packaging group.After admission,the three groups of children underwent routine preoperative wound treatment.During the operation,the wound was debrided and then a large medium thick leather was used to repair the wound.The MDNPWT group used microdynamic negative pressure wound dressing to fix the skin graft,and the other two groups used VSD and traditional packaging methods to fix the skin graft.piece.The dressings were removed 7 days after the operation of the children in the 3 groups,and the dressing was changed routinely until the wounds healed completely.Observed and recorded the operation time,wound healing rate,number of postoperative dressing changes,surgical and postoperative treatment costs,pain(FLACC score)and postoperative adverse reactions in the three groups.The measurement data were compared by one-way analysis of variance test,SNK-q test and repeated measures analysis of variance,the count data were compared byχ^(2) test.Results The operation time of MDNPWT group,packing group and VSD group:(46.1±10.5),(77.0±11.6),(53.9±19.6)min,respectively,the difference between the groups was statistically significant(F=85.54,P<0.01);The MDNPWT group was compared with the packaged group,the difference was statistically significant(q=17.51,P<0.01),and compared with the VSD group,the difference was statistically significant(q=3.79,P<0.01).The wound healing rates of MDNPWT,packaged group and VSD group were(96.3±3.2)%,(77.2±10.9)%,(91.8±7.3)%,respectively,and the difference between the groups was statistically significant(F=47.85,P<0.01);Comparing MDNPWT group with packaged group,the difference was statistically significant(q=13.11,P<0.01),comparing MDNPWT group with VSD group,the difference was not statistically significant(q=3.79,P>0.05).The number of postoperative dressing changes in the MDNPWT group,the packaged group and the VSD group were(2.4±1.2),(8.4±2.8),(2.5±1.7)times,respectively,and the difference between the groups was statistically significant(F=82.36,P<0.01);the MDNPWT group was compared with the packaged group,the difference was statistically significant(q=15.66,P<0.01),compared with the VSD group,the difference was not statistically significant(q=0.25,P>0.05).The surgical and postoperative treatment costs of the MDNPWT group,the packing group and the VSD group were(5253.7±652.3),(7545.6±736.8)and(6543.3±481.4)yuan,respectively.There was a statistically significant difference between the groups(F=96.53,P<0.01);the MDNPWT group was compared with the packaged group,the difference was statistically[CM(137mm]significant(q=19.64,P<0.01),and compared with the VSD group,the differences were statistically[CM)]significant(q=10.47,P<0.05).FLACC score:1 h after operation,MDNPWT group,packaged group and VSD group were respectively(3.7±1.2),(5.6±1.7),(5.5±1.5)points,and the difference between the groups was statistically significant(F=15.35,P<0.01);MDNPWT group compared with packaged group,the difference was statistically significant(q=7.03,P<0.01),compared with VSD group,the difference was statistically significant(q=6.36,P<0.05).48 hours after the operation,the scores of the MDNPWT group,the packing group and the VSD group were(2.1±0.7),(2.7±0.9)and(3.2±0.6)points,respectively.The difference between the groups was statistically significant(F=13.46,P<0.01);the MDNPWT group was compared with the packaged group,the difference was statistically significant(q=3.71,P<0.05),and compared with the VSD group,the differences were statistically significant(q=7.34,P<0.01).After the first dressing change after operation,the scores of MDNPWT group,packaged group and VSD group were(3.1±1.3),(4.8±1.4),and(4.3±1.5)points,respectively.The difference between the groups was statistically significant(F=10.61,P<0.01);the MDNPWT group was compared with the packaged group,the difference was statistically significant(q=6.37,P<0.01),and compared with the VSD group,the differences were statistically significant(q=4.43,P<0.01).Adverse reactions after surgery:The incidence of infection was 3.4%,5.9%,and 3.7%in the MDNPWT group,packaged group and VSD group,respectively.There was no statistically significant difference between the groups(χ^(2)=0.63,P>0.05).The incidence of eczema was 3.4%,5.9%,and 25.9%in the MDNPWT group and the packaged group and the VSD group,respectively.The difference between the groups was statistically significant(χ^(2)=6.06,P<0.05);the MDNPWT group was compared with the packaged group,the difference was not statistically significant(χ^(2)=0.20,P>0.05),compared with the VSD group,the difference was statistically significant(χ^(2)=5.77,P<0.05).The incidence of tension blisters was 0,5.9%,and 18.5%in the MDNPWT group,the packing group and the VSD group,respectively.The difference between the groups was statistically significant(χ^(2)=8.67,P<0.05);the MDNPWT group was compared with the packing group,the difference was statistically significant(χ^(2)=1.76,P<0.05),compared with the VSD group,the difference was statistically significant(χ^(2)=5.90,P<0.05).Conclusion In the treatment of children′s limbs and trunk wounds with skin grafts,the application of microdynamic negative pressure technology to fix the skin grafts can effectively shorten the operation time,improve wound healing rate,reduce the number of postoperative dressing changes and pain,reduce treatment costs,and reduce postoperative adverse reactions,Safe and effective.