胰蛋白酶在VSD治疗骨科急慢性创面中的疗效分析

Analysis of the efficacy of trypsin in VSD for the treatment of acute and chronic orthopaedic wounds

目的分析胰蛋白酶在封闭式负压引流技术(VSD)治疗骨科急慢性创面中的应用效果。方法38例行VSD治疗的骨科急慢性创面患者,根据是否使用胰蛋白酶分为对照组和观察组,每组19例。两组均进行常规清创治疗,术后均用3000 ml生理盐水通过VSD副管匀速冲洗管道,观察组在此基础上术后每8小时通过副管用胰蛋白酶灌洗创面。比较两组VSD使用次数、住院时间、堵管率,治疗前后创面面积及治疗后肉芽组织评分。结果观察组患者VSD使用次数(1.53±0.64)次少于对照组的(2.50±1.37)次,住院时间(28.44±1.28)d短于对照组的(35.19±1.44)d,堵管率8.7%低于对照组的40.0%,差异均具有统计学意义(P<0.05)。治疗1、2周及结束后,观察组创面面积均小于本组治疗前,差异具有统计学意义(P<0.05);治疗2周、结束,对照组创面面积小于本组治疗前,差异具有统计学意义(P<0.05);治疗1、2周,观察组创面面积分别为(50.07±7.42)、(47.29±8.02)cm^(2),小于对照组的(57.25±8.89)、(54.23±9.04)cm^(2),差异具有统计学意义(P<0.05);治疗结束后,两组创面面积比较差异无统计学意义(P>0.05)。治疗1、2周后,观察组肉芽组织评分分别为(7.00±1.81)、(8.33±1.21)分,均高于对照组的(5.69±1.89)、(6.83±1.85)分,差异具有统计学意义(P<0.05);治疗结束后,两组肉芽组织评分比较差异无统计学意义(P>0.05)。结论骨科急慢性创面患者在传统生理盐水冲洗的基础上加用胰蛋白酶灌洗创面,可有效降低VSD堵管率及使用次数,加快了创面愈合及肉芽组织增生,缩短了患者的住院时间,减轻了患者的经济负担,值得临床应用推广。

Objective To analyze the application effect of trypsin in vacuum sealing drainage(VSD)for the treatment of acute and chronic orthopaedic wounds.Methods A total of 38 patients with acute and chronic orthopaedic wounds treated by VSD were divided into control group and observation group according to whether trypsin was used or not,with 19 cases in each group.Both groups underwent conventional debridement treatment and postoperative flushing of the canal with 3000 ml of saline through the VSD secondary tube at a uniform rate,and the observation group irrigated the wound with trypsin through the secondary tube every 8 hours after surgery on this basis.The frequency of VSD use,hospital stay,rate of tube occlusion,wound area before and after treatment,and granulation tissue score after treatment were compared between the two groups.Results The frequency of VSD use(1.53±0.64)times in the observation group was less than(2.50±1.37)times in the control group;the hospital stay(28.44±1.28)d in the observation group was shorter than(35.19±1.44)d in the control group;the rate of tube occlusion 8.7%in the observation group was lower than 40.0%in the control group;the differences were all statistically significant(P<0.05).After 1 week,2 weeks and the end of treatment,the wound area of the observation group was smaller than that of this group before treatment,and the difference was statistically significant(P<0.05).After 2 weeks and the end of treatment,the wound area of the control group was smaller than that of this group before treatment,and the difference was statistically significant(P<0.05).After 1 and 2 weeks of treatment,the wound areas of the observation group were(50.07±7.42)and(47.29±8.02)cm^(2),which were smaller than(57.25±8.89)and(54.23±9.04)cm^(2) of the control group,and the differences were all statistically significant(P<0.05).After treatment,there was no statistically significant difference in wound area between the two groups(P>0.05).After 1 and 2 weeks of treatment,the granulation tissue scores of the observation group were(7.00±1.81)and(8.33±1.21)points,which were higher than(5.69±1.89)and(6.83±1.85)points of the control group,and the differences were all statistically significant(P<0.05);After treatment,there was no statistically significant difference in granulation tissue scores between the two groups(P>0.05).Conclusion The addition of trypsin irrigation to conventional saline irrigation in orthopedic patients with acute and chronic wounds can effectively reduce the rate of VSD occulusion and times of using the tube,accelerate wound healing and granulation tissue proliferation,shorten patients'hospital stay and reduce their economic burden,which is worthy of clinical application and promotion.