游离植皮联合负压创面治疗技术治疗Ⅲ/Ⅳ度烧伤创面效果分析(1)
[摘要]目的：探讨清创植皮联合负压创面治疗技术(Negative pressure wound therapy，NPWT)治疗Ⅲ/Ⅳ度烧伤创面的临床效果。方法：选取2015年2月-2017年3月笔者医院烧伤科收治的Ⅲ/Ⅳ度烧伤患者78例为研究对象，根据患者治疗方案分为干预组(清创后NPWT联合游离植皮修复，42例)和对照组(清创后传统换药联合游离植皮修复，36例)，比较两组患者创面愈合时间、住院时间、治疗费用及创面封闭成功率、术后并发症发生率。结果：干预组创面愈合时间、住院时间、1%烧伤面积治疗费用均低于对照组，差异有统计学意义(P<0.05)。干预组一次性手术创面封闭成功率为80.95%高于对照组的58.33%，干预组创面感染率、肺部感染率(2.38%、0.00%)均低于对照组(16.67%、11.11%)，差异有统计学意义(P<0.05)。干预组瘢痕增生程度明显低于对照组，差异有统计学意义(P<0.05)。结论：NPWT联合清创植皮治疗Ⅲ/Ⅳ度烧伤创面可缩短治疗时间、提高治疗效果，减轻术后瘢痕增生程度，具有显著治疗价值。
, 百拇医药 [关键词]烧伤；清创；植皮；负压创面治疗技术
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0020-04
Abstract： Objective To investigate the therapeutic effect of free skin grafting combined with negative pressure wound therapy in the treatment of Ⅲ/Ⅳ degree burns wounds. Methods Selected 78 case of Ⅲ/Ⅳ degree burn patients in our hospital from February 2015 to March 2017 as research subjects. All patients were divided into the intervention group (repair of NPWT combined with free skin grafting after debridement， 42 cases) and the control group (repair of traditional dressing combined with free skin grafting after debridement， 36 cases). The wound healing time， hospitalization time， treatment cost， wound closure success rate and postoperative complication rate were compared between the two groups. Results The wound healing time， hospitalization time， and 1% burn area treatment cost in intervention group were lower than those in control group， the differences were statistically significant(P<0.05). The successful rate of wound closure in the intervention group was 80.95% higher than that of the control group (58.33%)， the infection rate of the wound and the rate of pulmonary infection (2.38%， 0.00%) in the intervention group were lower than those of the control group (16.67%， 11.11%)， the differences were statistically significant(P<0.05). The degree of hypertrophic scar in the intervention group was significantly lower than that of the control group(P<0.05). Conclusion NPWT combined with debridement and skin grafting to treat Ⅲ/Ⅳ degree burn wounds can shorten the treatment time， improve the therapeutic effect， and reduce postoperative scar hyperplasia， which has significant therapeutic value.
, http://www.100md.com
Key words： burns； debridement； skin grafting； negative pressure wound therapy
Ⅲ/Ⅳ度烧伤属于深度烧伤，烧伤创面可累及骨骼、肌肉组织等，传统治疗方法为早期清创并换药，待患者一般情况、创面基本条件稳定后，再实施手术清除创面坏死组织并移植皮瓣或直接植皮封闭创面[1]。但临床实践过程中发现，深度烧伤患者组织渗出物较严重，如何在首次清创后充分引流、早期准确判定间生态组织活力指导坏死组织切除范围，仍无完善解决措施和判定标准[2-3]。负压创面治疗技术(Negative pressure wound therapy，NPWT)为上世纪末开始应用于临床治疗技术，采用负压装置对创面进行持续性负压引流，在急性感染创面、烧伤、挤压伤、软组织损伤及糖尿病足等难治性创面中应用广泛[4]。研究指出，深度烧伤清创后，创面引流质量直接影响患者创面感染控制、創面愈合及植皮成功率[5]。NPWT通过半透膜封闭创面，置管进入封闭创面最低位置持续进行引流，能够快速将创面分泌物引出，有效预防感染，并可保持创面处于湿润状态，加快创面生长和愈合[6]。为探究NPWT在Ⅲ/Ⅳ度烧伤患者中的治疗优势，笔者回顾性分析2015年2月-2017年3月笔者医院烧伤科收治的Ⅲ/Ⅳ度烧伤患者78例，根据患者是否采用NPWT辅助治疗进行分组研究，现报道如下。, http://www.100md.com(雷磊 高优 许建允)
, 百拇医药 [关键词]烧伤；清创；植皮；负压创面治疗技术
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0020-04
Abstract： Objective To investigate the therapeutic effect of free skin grafting combined with negative pressure wound therapy in the treatment of Ⅲ/Ⅳ degree burns wounds. Methods Selected 78 case of Ⅲ/Ⅳ degree burn patients in our hospital from February 2015 to March 2017 as research subjects. All patients were divided into the intervention group (repair of NPWT combined with free skin grafting after debridement， 42 cases) and the control group (repair of traditional dressing combined with free skin grafting after debridement， 36 cases). The wound healing time， hospitalization time， treatment cost， wound closure success rate and postoperative complication rate were compared between the two groups. Results The wound healing time， hospitalization time， and 1% burn area treatment cost in intervention group were lower than those in control group， the differences were statistically significant(P<0.05). The successful rate of wound closure in the intervention group was 80.95% higher than that of the control group (58.33%)， the infection rate of the wound and the rate of pulmonary infection (2.38%， 0.00%) in the intervention group were lower than those of the control group (16.67%， 11.11%)， the differences were statistically significant(P<0.05). The degree of hypertrophic scar in the intervention group was significantly lower than that of the control group(P<0.05). Conclusion NPWT combined with debridement and skin grafting to treat Ⅲ/Ⅳ degree burn wounds can shorten the treatment time， improve the therapeutic effect， and reduce postoperative scar hyperplasia， which has significant therapeutic value.
, http://www.100md.com
Key words： burns； debridement； skin grafting； negative pressure wound therapy
Ⅲ/Ⅳ度烧伤属于深度烧伤，烧伤创面可累及骨骼、肌肉组织等，传统治疗方法为早期清创并换药，待患者一般情况、创面基本条件稳定后，再实施手术清除创面坏死组织并移植皮瓣或直接植皮封闭创面[1]。但临床实践过程中发现，深度烧伤患者组织渗出物较严重，如何在首次清创后充分引流、早期准确判定间生态组织活力指导坏死组织切除范围，仍无完善解决措施和判定标准[2-3]。负压创面治疗技术(Negative pressure wound therapy，NPWT)为上世纪末开始应用于临床治疗技术，采用负压装置对创面进行持续性负压引流，在急性感染创面、烧伤、挤压伤、软组织损伤及糖尿病足等难治性创面中应用广泛[4]。研究指出，深度烧伤清创后，创面引流质量直接影响患者创面感染控制、創面愈合及植皮成功率[5]。NPWT通过半透膜封闭创面，置管进入封闭创面最低位置持续进行引流，能够快速将创面分泌物引出，有效预防感染，并可保持创面处于湿润状态，加快创面生长和愈合[6]。为探究NPWT在Ⅲ/Ⅳ度烧伤患者中的治疗优势，笔者回顾性分析2015年2月-2017年3月笔者医院烧伤科收治的Ⅲ/Ⅳ度烧伤患者78例，根据患者是否采用NPWT辅助治疗进行分组研究，现报道如下。, http://www.100md.com(雷磊 高优 许建允)
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