超声清创结合光子治疗在慢性创面治疗中的应用

Application of ultrasonic debridement combined with photon therapy in the treatment of chronic wounds

目的探讨超声清创结合光子治疗在慢性创面治疗中的临床应用效果。方法选取2021年10月至2022年12月上海市徐汇区大华医院伤口护理门诊收治的慢性创面患者40例,进行前瞻性随机对照研究。采用随机数字表法将其分为对照组和研究组,每组20例。对照组患者中男8例,女12例;平均年龄(62±17)岁;24个创面。研究组患者中男9例,女11例;平均年龄(65±12)岁;26个创面。对照组采用机械清创方法,即用手术刀、血管钳、刮匙将坏死组织、不健康的肉芽组织清除等。研究组在机械清创方法基础上采用超声清创机对伤口进行清创后给予光子治疗。2组患者根据伤口情况首次清创后前3天每天用上述方法清创,后根据伤口情况改为2~3 d换药1次。比较2组患者首次清创后7、14、21、28、60 d伤口愈合率,首次清创后创面细菌培养阳性率,清创时及清创后疼痛评分,首次清创后换药次数及费用等。结果研究组患者首次清创后7、14、21、28、60 d伤口愈合率均明显高于对照组,首次清创后创面细菌培养阳性率明显低于对照组,差异均有统计学意义(P<0.05)。2组患者清创前疼痛评分比较,差异无统计学意义(P>0.05);研究组患者清创中及清创后疼痛评分均明显低于对照组,换药次数明显少于对照组,差异均有统计学意义(P<0.05)。2组患者换药总费用比较,差异无统计学意义(P>0.05)。结论采用超声清创结合光子术治疗慢性创面较传统外科清创方法的疗效更佳,创面愈合时间短,疼痛轻,感染控制效果好,且能减少换药频次,从而降低换药费用。

Objective To investigate the clinical effect of ultrasonic debridement combined with photon therapy in the treatment of chronic wounds.Methods A prospective randomized controlled study was conducted on 40 patients with chronic wounds who were treated in the wound care clinic of Dahua Hospital of Xuhui District,Shanghai from October 2021 to December 2022.They were divided into control group and study group by random number table method,with 20 cases in each group.In the control group,there were eight males and 12 females,with an average age of(62±17)years and 24 wounds.There were nine males and 11 females in the study group,with an average age of(65±12)years and 26 wounds.The control group was treated with mechanical debridement,that is,using a scalpel,vascular clamp,and a spoon to remove necrotic tissue and remove unhealthy granulation tissue.On the basis of mechanical debridement,the study group used ultrasonic debridement machine to debrid the wound and then gave photon therapy.According to the wound condition,the patients in the two groups were debrided with the above method every day for the first three days after the first debridement,and then changed to dressing change once every two to three days according to the wound condition.The wound healing rate at seven,14,21,28 and 60 days after the first debridement,the positive rate of wound bacterial culture after the first debridement,the pain score at the time of debridement and after debridement,the frequency and cost of dressing change after the first debridement were compared between the two groups.Results The wound healing rate of the study group was significantly higher than that of the control group at seven,14,21,28 and 60 days after the first debridement,and the positive rate of wound bacterial culture after the first debridement was significantly lower than that of the control group,the differences were statistical significance(P<0.05).There was no significant difference in pain scores between the two groups before debridement(P>0.05).The pain scores during and after debridement in the study group were significantly lower than those in the control group,and the number of dressing changes was significantly lower than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total cost of dressing change between the two groups(P>0.05).Conclusion Ultrasonic debridement combined with photon therapy is more effective than traditional surgical debridement in the treatment of chronic wounds.The wound healing time is short,the pain is light,the infection control effect is good,and the frequency of dressing change can be reduced,thereby reducing the cost of dressing change.