负压封闭引流联合冲洗技术治疗难愈性创面的临床效果

Clinical effects of negative pressure wound therapy with instillation in the treatment of refractory wounds

目的观察负压封闭引流联合冲洗技术治疗难愈性创面的临床效果。方法2019年01月-2019年11月,笔者单位收治的5例难愈性创面患者,其中男3例,女2例,年龄在46~65岁,平均年龄为57.6岁;创面3例位于足部,1例位于小腿,1例位于左髋部。其中4例患者有糖尿病病史。本组患者创面面积为4.0cm×2.5cm~14.0cm×12.0cm。采用负压封闭引流联合冲洗技术进行治疗,冲洗液选择生理盐水及重组人碱性成纤维细胞生长因子(rh-bFGF,盖扶),负压吸引模式采用间断负压冲洗(即停止负压后,滴注冲洗液,冲洗液可自由渗透至无效腔、间隙),以每15min生理盐水+rh-bFGF冲洗浸泡+3h负压封闭引流为治疗模式(rh-bFGF于每日第一次生理盐水冲洗创面后注入、浸泡),负压值选择150mmHg左右,每次冲洗液的使用量使负压装置泡沫敷料浸没在液体中即可。对有黑色结痂、大量牢固附着坏死组织的创面应首先进行溶痂、削痂磨痂、清创术后,再行封闭创面负压引流联合冲洗技术治疗创面,每7天左右更换负压引流装置,观察统计平均每天创面愈合率,并发症,有无复发及患者满意度。结果在创面完全被新鲜肉芽组织覆盖后,有2例患者选择植皮术,3例患者选择继续保守换药治疗,创面均得到良好的治疗效果,其中1例患者应用负压装置过程中出现创周湿疹,1例患者出现踝关节活动稍受限。未见创面复发,患者均满意。结论负压封闭引流联合冲洗技术可有效治疗难愈性创面。

Objective To observe the clinical effects of negative pressure wound therapy with instillation in the treatment of refractory wounds.Methods From January 2019 to November 2019,5 patients with refractory wounds were admitted to our department,including 3 males and 2 females,aged 46-65 years,with an average age of 57.6 years;3 wounds were in the foot,1 in the lower leg and 1 in the left hip.Four of them had a history of diabetes.The wound area of this group was 4.0cm×2.5cm~14.0cm×12.0cm.The wound surface was closed by negative pressure wound therapy with instillation.The normal saline and recombinant human basic fibroblast growth factor for external use(rh-bFGF)were selected as the washing solution.The negative pressure suction mode was intermittent negative pressure washing(i.e.after the negative pressure was stopped,the washing solution was dripped,and the washing solution could infiltrate freely into the dead cavity and space).The normal saline+rh-bFGF washing and soaking+3h negative pressure sealing were used for the washing solution is the treatment mode(the rh-bFGF is injected and soaked in the first normal saline after washing the wound).The negative pressure value is about 150mmHg,and the volume of each rinse solution is used to immerse the negative pressure device foam dressing in the liquid.For the wound with black scab and a large number of firmly attached necrotic tissue,the first step is to dissolve the scab,cut the scab and grind the scab,after debridement,and then to seal the wound with egative pressure wound therapy with instillation.The negative pressure drainage device should be replaced every 7 days or so.Observe and count the average daily wound healing rate,complications,recurrence and patient satisfaction.Results After the wound was completely covered by fresh granulation tissue,2 patients chosed skin grafting,3 patients chosed to continue the conservative treatment,and the wound got good treatment effect.One patient had eczema around the wound during the application of negative pressure device,and one patient had slightly limited ankle joint activity.No wound recurrence was found and the patients were satisfied.Conclusions The negative pressure wound therapy with instillation can effectively treat refractory wounds.