负压封闭引流联合输氧冲洗治疗骨科术后感染性伤口的研究

忽宁宁; 陈淑芳; 朱宁宁; 张梦; 朱勋兵

doi:10.16766/j.cnki.issn.1674-4152.002982

负压封闭引流联合输氧冲洗治疗骨科术后感染性伤口的研究

doi: 10.16766/j.cnki.issn.1674-4152.002982

1.
蚌埠医学院研究生院，安徽蚌埠 233000
2.
蚌埠医学院第二附属医院骨科，安徽蚌埠 233000
3.
蚌埠医学院护理学院

基金项目:

安徽省高校自然科学研究重点项目 KJ2018A0243

蚌埠医学院研究生创新课题 Byycx21019

详细信息

通讯作者:
陈淑芳，E-mail: 75398724@qq.com

中图分类号: R619.3
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出版历程
- 收稿日期: 2022-11-12

Negative pressure closed drainage combined with oxygen transfusion irrigation for infectious wounds after orthopedic surgery

1.
The Graduate School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨负压封闭引流联合输氧冲洗治疗骨科术后感染性伤口的临床效果，为研究骨科及相关外科术后感染性伤口方面提供参考。方法选择2020年10月—2022年6月蚌埠医学院第二附属医院收治的骨科术后感染性伤口患者28例，按照随机数字表法分为实验组和对照组，每组各14例。对照组给予负压封闭引流联合生理盐水冲洗治疗；实验组在对照组基础上给予联合输氧冲洗治疗，2组分别于术前、术后5~10 d使用无菌伤口测量尺测量并计算创面肉芽组织覆盖率、伤口体积缩小率、创面愈合率及愈合时间、细菌清除率，之后视创面情况决定二期手术或重新填入(更换)敷料继续封闭引流，直至愈合。结果干预5~10 d后，实验组肉芽组织覆盖率、体积缩小率、细菌清除率[(93.03±4.05)%、(42.92±9.20)%、(95.93±4.19)%]均高于对照组[(74.73±5.08)%、(35.18±9.46)%、(87.20±2.35)%]，差异均有统计学意义(t=-10.535、-2.193、-6.796；均P < 0.05)；实验组治疗愈合率为85.71%(12/14)，高于对照组的78.57%(11/14)，差异无统计学意义(P=0.999)；实验组创面愈合时间[(29.43±8.54)d]低于对照组[(32.43±9.04)d], 差异无统计学意义(t=0.903，P=0.375)。结论负压封闭引流联合输氧冲洗治疗相比于单独负压封闭引流联合冲洗能够促进肉芽组织生长，缩小伤口体积，提高创面细菌清除率，值得临床推广应用。
- 术后感染性伤口 /
- 负压封闭引流 /
- 输氧 /
- 伤口愈合
Abstract: Objective To explore the clinical effect of negative pressure closed drainage and oxygen infusion irrigation on infectious wounds after orthopedic surgery, and to provide reference for the study of infectious wounds after orthopedics and related surgery. Methods A total of 28 patients with infectious wounds after orthopedic surgery were selected from the Second Affiliated Hospital of Bengbu Medical College from October 2020 to June 2022. They were divided into experimental and control groups according to the random number table method, with 14 patients in each group. The control group received negative pressure closure drainage combined with saline irrigation treatment, while the experimental group received combined oxygen delivery irrigation treatment based on the control group. The two groups were measured and calculated using a sterile wound measuring scale before and 5 to 10 days after surgery, including the wound granulation tissue coverage rate, wound volume reduction rate, wound healing rate, healing time, and bacterial clearance rate. After that, depending on the condition of the wound, a second stage operation or refilling (replacing) the dressing was decided to continue sealing and drainage until it healed. Results Intervention after 5-10 d, the granulation tissue coverage rate, volume reduction rate and bacterial clearance rate of the experimental group [(93.03±4.05)%, (42.92±9.20)%, (95.93±4.19)%] were higher than those of the control group [(74.73±5.08)%, (35.18±9.46)%, (87.20±2.35)%]. The differences were statistically significant (t=-10.535, -2.193, -6.796; all P < 0.05); The healing rate of the experimental group was 85.71% (12/14), which was higher than 78.57%(11/14) of the control group, and the difference was not statistically significant (P=0.999). The wound healing time of the experimental group [(29.43±8.54) d] was lower than that of the control group [(32.43±9.04) d], and the difference was not statistically significant (t=0.903, P=0.375). Conclusion Compared with negative pressure closed drainage alone, negative pressure closed drainage combined with oxygen transfusion irrigation can promote granulation tissue growth and reduce wound volume, which is worthy of clinical application.
- Postoperative infectious wound /
- Negative pressure closure and drainage /
- Oxygen delivery /
- Wound healing
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图 1 骨科术后感染性伤口不同阶段创面情况

注：A 为感染性创面；B 为感染性伤口清创后创面；C 为VSD覆盖创面后连接负压装置和引流管。

Figure 1. The wound surface of infected wound in different stages after orthopedic surgery

下载: 全尺寸图片幻灯片

图 2 干预后5~10 d创面

注：A 为Ⅰ期创面；B 为Ⅱ期缝合创面。

Figure 2. Wound surfaces in 5-10 days after intervention

下载: 全尺寸图片幻灯片

表 1 2组骨科术后切口感染患者基线资料比较(x±s)

Table 1. Two Group Comparison of baseline data of patients with postoperative orthopedic incision infection(x±s)

组别	例数	年龄 (岁)	切口体积 [M(P₂₅, P₇₅), cm³]	切口持续时间 (d)	肉芽组织覆盖率(%)
对照组	14	56.29±13.05	421.43(218.16, 518.03)	23.07±8.83	14.25±4.85
实验组	14	55.79±13.59	465.00(100.00, 530.80)	27.21±6.44	18.02±5.90
统计量		0.099^a	-0.322^b	1.419^a	-1.847^a
P值		0.922	0.748	0.168	0.077
注：^a为t值，^b为Z值。

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表 2 2组骨科术后切口感染患者切口体积、肉芽组织覆盖率比较(x±s)

Table 2. Comparison of incision volume and granulation tissue coverage of infected patients after surgery in two groups(x±s)

组别	例数	切口体积[M(P₂₅, P₇₅), cm³]		统计量	P值	肉芽组织覆盖率(%)		t值	P值
组别	例数	治疗前	治疗后	统计量	P值	治疗前	治疗后	t值	P值
对照组	14	421.43(218.16, 518.03)	240.25(48.75, 326.13)	-3.297^b	< 0.001	14.25±4.85	74.73±5.08	-56.888	< 0.001
实验组	14	465.00(100.00, 530.80)	241.90(65.16, 287.65)	-3.296^b	0.001	18.02±5.90	93.03±4.05	-78.920	< 0.001
统计量		-0.322^b	-0.919^b			-1.847^a	-10.535^a
P值		0.748	0.358			0.077	< 0.001
注：^a为t值，^b为Z值。

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表 3 2组骨科术后切口感染患者肉芽组织覆盖率、体积缩小率、细菌清除率比较(x±s，%)

Table 3. Comparison of granulation tissue coverage, volume reduction rate and bacterial clearance rate in patients with incision infection after surgery in two groups (x±s, %)

组别	例数	肉芽组织覆盖率	体积缩小率	细菌清除率
对照组	14	74.73±5.08	35.18±9.46	87.20±2.35
实验组	14	93.03±4.05	42.92±9.20	95.93±4.19
t值		-10.535	-2.193	-6.796
P值		< 0.001	0.037	< 0.001

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表 4 2组骨科术后切口感染患者愈合时间与愈合率比较

Table 4. Comparison of healing time and healing rate of patients with infected incision after surgery in 2 groups

组别	例数	愈合情况[例(%)]		愈合时间 (x±s, d)
组别	例数	愈合	未愈合	愈合时间 (x±s, d)
对照组	14	11(78.57)	3(21.43)	32.43±9.04
实验组	14	12(85.71)	2(14.29)	29.43±8.54
统计量				0.903^b
P值		0.999^a		0.375
注：^a为采用Fisher精确检验，^b为t值。

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