负压封闭引流与外科常规换药对腹部术后伤口愈合不良的疗效观察

Observation on the Effects of Vacuum Sealing Drainage and Routine Dressing Change on the Refractory Wound Healing After Abdominal Surgery

目的 探究负压封闭引流(vacuum sealing drainage, VSD)与伤口常规换药对腹部术后伤口愈合不良的临床疗效。方法 选取2020-08-01/2023-09-30日作者医院普通外科225例腹部术后伤口愈合不良患者进行回顾性研究。根据伤口换药方式,将患者分为VSD组(n=110)和常规伤口换药组(n=115)。比较两组腹部术后伤口愈合不良患者的临床疗效、住院天数、换药次数、换药天数、Ⅱ期清创缝合时间、血清学炎症指标。结果 225例腹部术后伤口愈合不良患者中,伤口出现脂肪液化或组织坏死110例(VSD组53例、常规伤口换药组57例),大量脓液或深部脓腔80例(VSD组42例、常规伤口换药组38例),切口裂开35例(VSD组15例、常规伤口换药组20例)。两组腹部术后伤口愈合不良患者的基线资料比较差异无统计学意义(P>0.05)。VSD组腹部术后伤口愈合不良患者中,伤口出现脂肪液化或组织坏死、大量脓液或深部脓腔、切口裂开的患者的临床疗效总有效率明显高于常规伤口换药组,住院天数、换药天数、换药次数、Ⅱ期清创缝合时间均少于常规伤口换药组,差异均有统计学意义(P均<0.05)。换药后,两组腹部术后伤口愈合不良患者伤口出现脂肪液化或组织坏死、大量脓液或深部脓腔、切口裂开的患者的白细胞(white blood cell, WBC)、中性粒细胞(neutrophil, NEU)、白细胞介素6(interleukin 6,IL-6)、降钙素原(procalcitonin, PCT)、C-反应蛋白(C-reactive protein, CRP)水平较换药前均明显下降,且VSD组低于常规换药组(P均<0.05)。结论 与常规伤口换药相比,应用VSD伤口换药有利于加快腹部术后伤口愈合不良患者伤口恢复,降低感染发生率,有效缩短创面Ⅱ期清创缝合时间,改善患者血清炎症指标,促进术后恢复,值得临床推广应用。

Objective To explore the clinical effects of vacuum sealing drainage(VSD)and routine dressing change on refractory wound after abdominal surgery.Methods A total of 225 patients with refractory wound after abdominal surgery in the general surgery department of author's hospital from 1,August 2020 to 30,September 2023 were select-ed for retrospective study.Patients were divided into VSD group(n=110)and conventional wound dressing change group(n=115)according to dressing change mode.The clinical efficacy,hospitalization days,times of dressing change,days of dressing change,the time of debridement and suture in stageⅡand indexes of serological inflammation of patients with refractory wound after abdominal surgery were compared between the two groups.Results Among the 225 patients with refractory wound after abdominal surgery,fat liquefaction or tissue necrosis of wounds occurred in 110 cases(53 ca-ses in the VSD group and 57 cases in the conventional wound dressing change group),there were 80 cases with large a-mount of pus or deep pus cavity(42 cases in VSD group and 38 cases in conventional wound dressing change group),there were 35 cases of incision rupture(15 cases in VSD group and 20 cases in conventional wound dressing change group).There was no significant difference in baseline data of patients with refractory wound after abdominal surgery be-tween the two groups(P>0.05).Among patients with refractory wound after abdominal surgery in the VSD group,the total effective rate of clinical efficacy in patients with fat liquefaction or tissue necrosis,large amount of pus or deep ab-scess cavity and incision dehiscence on the wound was significantly higher than that in the conventional wound dressing change group,the hospitalization days,days of dressing change,times of dressing change,the time of debridement and suture in stageⅡand indexes of serolog-ical inflammation in the observation group were shorter than those in the conventional wound dressing change group,and the differences were statistically significant(all P<0.05).After dressing change,the white blood cell(WBC),neutrophil(NEU),interleukin 6(IL-6),procalcitonin(PCT)and C-reactive protein(CRP)levels in patients with refractory wound after abdominal surgery with fat liquefaction or tissue necrosis,a large amount of pus or deep abscess cavity and incision dehiscence on the wound in the two groups were significantly lower than those before,and those in VSD group were lower than those in conventional wound dressing change group(all P<0.05).Conclusion Compared with conventional wound dressing change,the application of VSD wound dressing change is conducive to accelerate the recovery of patients with refractory wounds after abdominal surgery,reduce the incidence of infection,effectively shorten the time of debridement and suture in stageⅡ,improve the serum in-flammatory indicators of the patients and promote postoperative recovery,which is worthy of clinical promotion and appli-cation.