清创后VSD负压创面引流联合游离植皮修复对Ⅲ、Ⅳ度烧伤患者的疗效及HAMA、HAMD评分的影响

Effect of VSD Negative Pressure Wound Drainage Combined with Free Skin Grafting Repair after Debridement onⅢ,ⅣDegree Burn Patients and Its Influence on HAMA and HAMD Scores

目的:研究清创后负压封闭引流技术(VSD)负压创面引流联合游离植皮修复对Ⅲ、Ⅳ度烧伤患者的疗效及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分的影响。方法:选取2019年1月-2021年3月沈阳积水潭医院收治的95例Ⅲ、Ⅳ度烧伤患者,按照随机数字表法将其分为联合组(n=48)和对照组(n=47)。对照组清创后实施游离植皮修复,联合组则于对照组的基础上增用VSD负压创面引流。比较两组临床疗效、血清疼痛介质[5-羟色胺(5-HT)、脑内神经肽(NPY)、前列腺素E_(2)(PGE_(2))]、炎症因子水平[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)]及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分。结果:联合组总有效率高于对照组,差异有统计学意义(P<0.05)。术后7 d,联合组5-HT、NPY、PGE;水平均低于对照组,差异均有统计学意义(P<0.05)。术后7 d,联合组IL-6、IL-8及CRP水平均低于对照组,差异均有统计学意义(P<0.05)。术后,联合组HAMA、HAMD评分分别为(10.49±2.16)、(11.48±2.73)分,均低于对照组的(16.97±2.74)、(20.05±2.89)分,差异均有统计学意义(P<0.05)。结论:清创后VSD负压创面引流联合游离植皮修复对Ⅲ、Ⅳ度烧伤患者的疗效较佳,可显著改善患者心理负性情绪,降低血清疼痛因子及炎症因子水平。

Objective:To study the efficacy of vacuum sealing drainage(VSD)negative pressure wound drainage combined with free skin grafting repair after debridement on Ⅲ,Ⅳ degree burn patients and its influence on Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)scores.Method:A total of 95 patients with Ⅲ,Ⅳ degree burns admitted to Shenyang Jishuitan Hospital from January 2019 to March 2021 were selected,they were divided into combined group(n=48)and control group(n=47)according to random number table method.The control group was treated with free skin grafting repair after debridement,while the combined group was treated with VSD negative pressure wound drainage on the basis of the control group.Clinical efficacy,serum pain mediators[5-hydroxytryptamine(5-HT),brain neuropeptide(NPY),prostaglandin E_(2)(PGE_(2))],inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),C reactive protein(CRP)],Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)scores were compared between two groups.Result:The total effective rate in combined group was higher than that in control group(P<0.05).7 d after surgery,the levels of 5-HT,NPY and PGE;in the combined group were lower than those in the control group,the differences were statistically significant(P<0.05).7 d after surgery,the levels of IL-6,IL-8 and CRP in the combined group were lower than those in the control group,the differences were statistically significant(P<0.05).HAMA and HAMD scores in the combined group were(10.49±2.16)and(11.48±2.73)points,respectively,which were lower than(16.97±2.74)and(20.05±2.89)points in the control group,the differences were statistically significant(P<0.05).Conclusion:VSD negative pressure wound drainage combined with free skin grafting repair after debridement has a good effect on patients with Ⅲ,Ⅳ degree burn,which can significantly improve patients’psychological negative emotions and reduce the levels of serum pain factors and inflammatory factors.