急性软组织损伤合并糖尿病患者应用VSD的临床疗效分析
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摘要
目的:探讨糖尿病患者合并急性软组织损伤应用VSD治疗的临床疗效。方法:将河南科技大学第二附属医院和郑大一附院急诊科2016-03—2018-11期间急诊收治的64例急性软组织损伤合并糖尿病患者作为研究对象,随机将其分为负压组(32例)与对照组(32例)。对照组患者采用常规清创换药治疗,观察组患者采取VSD治疗,回顾性分析两组患者在治疗过程中创面感染率,创面愈合时间,抗生素使用时间,换药次数,留院时间以及在创伤指数、清创时间、血常规指标、血糖指标、血糖控制时间等方面的情况。结果:经综合治疗后,负压组患者的感染概率,抗生素控制时间等均明显少于对照组,创面愈合率明显高于对照组,组间比较,差异具有统计学意义(P<0.05);负压组治疗后伤口愈合时间、换药次数、留院时间显著低于对照组,组间比较,差异具有统计学意义(P<0.01)。结论:相比正常清创换药,采用VSD治疗急性软组织损伤合并糖尿病患者临床疗效明显,能显著缩短治疗时间。
Objective:To investigate the clinical efficacy of VSD in the treatment of acute soft tissue injury in diabetic patients.Method:Sixty-four patients with acute soft tissue injury and diabetes mellitus admitted to the emergency department of Henan University of Science and Technology and the First Affiliated Hospital of Zhengzhou First Affiliated Hospital from March 2016 to November 2018 were enrolled in the study according to the random number table method.Divided into negative pressure group(32 cases)and control group(32 cases).Patients in the control group were treated with conventional debridement and dressing.Patients in the observation group were treated with VSD.The wound infection rate,wound healing time,antibiotic control time,dressing times,and hospitalization time were analyzed retrospectively.As well as the trauma index,debridement time,blood routine indicators,blood glucose indicators,blood sugar control time and so on.Result:After comprehensive treatment,the infection rate and antibiotic control time of the patients in the negative pressure group were significantly lower than those in the control group.The wound healing rate was significantly higher than that in the control group.The difference was statistically significant(P<0.05).The time of wound healing,the number of dressing changes,and the time of hospitalization were significantly lower in the negative pressure group than in the control group.The difference was statistically significant(P <0.01).Conclusion:Compared with normal debridement dressing,the clinical effect of VSD in the treatment of diabetic patients with acute soft tissue injury is more significant,which can effectively stimulate the growth of wound granulation and significantly shorten the treatment time.
Objective:To investigate the clinical efficacy of VSD in the treatment of acute soft tissue injury in diabetic patients.Method:Sixty-four patients with acute soft tissue injury and diabetes mellitus admitted to the emergency department of Henan University of Science and Technology and the First Affiliated Hospital of Zhengzhou First Affiliated Hospital from March 2016 to November 2018 were enrolled in the study according to the random number table method.Divided into negative pressure group(32 cases)and control group(32 cases).Patients in the control group were treated with conventional debridement and dressing.Patients in the observation group were treated with VSD.The wound infection rate,wound healing time,antibiotic control time,dressing times,and hospitalization time were analyzed retrospectively.As well as the trauma index,debridement time,blood routine indicators,blood glucose indicators,blood sugar control time and so on.Result:After comprehensive treatment,the infection rate and antibiotic control time of the patients in the negative pressure group were significantly lower than those in the control group.The wound healing rate was significantly higher than that in the control group.The difference was statistically significant(P<0.05).The time of wound healing,the number of dressing changes,and the time of hospitalization were significantly lower in the negative pressure group than in the control group.The difference was statistically significant(P <0.01).Conclusion:Compared with normal debridement dressing,the clinical effect of VSD in the treatment of diabetic patients with acute soft tissue injury is more significant,which can effectively stimulate the growth of wound granulation and significantly shorten the treatment time.
引文
[1]傅先军,赵呈龙,王新全,等.负压封闭引流技术在不同创面的应用研究进展[J].西南国防医药,2018,28(12):1292-1294.
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[4]陈友慈,廖坚文,李灿彬.全厚皮片联合封闭负压引流装置修复皮肤撕脱伤的应用效果分析[J].广东医学,2018,39(9):1376-1379.
[5]赵德杰,祝然然,李晨,等.糖尿病皮肤软组织感染的防治[J].中国中西医结合外科杂志,2018,24(2):248-252.
[6]张桢.负压封闭引流与传统创面换药治疗糖尿病慢性溃疡临床效果比较[J].深圳中西医结合杂志,2018,28(4):151-152.
[7]吴晓霞,左阿芳,吴建义,等.老年糖尿病患者医院感染的临床特点及影响因素分析[J].中华医院感染学杂志,2017,27(22):5122-5125.
[8]王爽,李小兵,樊军,等.负压封闭对口引流治疗糖尿病足合并蜂窝织炎的临床效果[J].中华烧伤杂志,2018,34(1):47-50.
[9]黎鸿章,肖昌明,银西洋,等.负压封闭引流治疗深度烧伤创面及对炎性因子、致痛因子的影响[J].创伤外科杂志,2019,21(1):60-64.
[10]吴晓艳,刘军,沈清,等.降钙素原与乳酸水平的监测在糖尿病酮症酸中毒合并感染中的相关分析[J].临床急诊杂志,2017,18(3):225-228.
[11]Buch A,Kaur S,Nair R,Platelet volume indices as predictive biomarkers for diabetic complications in Type 2diabetic patients[J].J Lab Physicians,2017,9(2):84-88.
[12]中国医师协会神经内科医师分会疼痛和感觉障碍专委会.糖尿病性周围神经病理性疼痛诊疗专家共识[J].全科医学临床与教育,2019,17(2):100-103,107.
[13]赵文,王喜园,温晓东.骨科创伤感染VSD治疗的临床疗效分析[J].临床医药文献电子杂志,2018,5(45):42-43.
[14]张莉莉,彭晓容,张文凤,等.负压封闭引流技术治疗骨科创伤及感染创面的护理研究[J].实用临床医药杂志,2017,21(4):98-100.
[15]邓艳斌,王齐兵,谭金波.急诊切痂植皮术后应用VSD技术处理烧伤患者的临床价值[J].临床急诊杂志,2016,17(11):855-857,869.
[16]解杰,杨帆,陈驾君,等.VSD在开放性骨折及MODS防治中的应用[J].创伤外科杂志,2018,20(7):485-489.
[17]潘雄,应行,林道超.负压封闭引流技术(VSD)在肢体大面积皮肤撕脱伤原位植皮治疗中的比较研究[J].浙江创伤外科,2015,20(2):271-272.
[18]陈友慈,廖坚文,李灿彬.全厚皮片联合封闭负压引流装置修复皮肤撕脱伤的应用效果分析[J].广东医学,2018,39(9):1376-1379.
[19]Tan L,Hou ZY,Gao YZ.Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6,TNF-αand IL-2[J].Exp Ther Med,2018,15(1):288-294.
[20]Niu XF,Yi JH,Zha GQ,et al.Vacuum sealing drainage as a pre-surgical adjunct in the treatment of complex(open)hand injuries:Report of 17cases[J].Orthop Traumatol Surg Res,2017,103(3):461-464.
[21]何开湖.改良VSD技术治疗四肢骨折术后深部组织感染效果探讨[J].临床医药文献电子杂志,2018,5(61):41,44.
[22]Scalise A,Tartaglione C,Bolletta E,et al.The enhanced healing of a high-risk,clean,sutured surgical incision by prophylactic negative pressure wound therapy as delivered by PrevenaTM CustomizableTM:cosmetic and therapeutic results[J].Int Wound J,2015,12(2):218-223.
[2]李志锐.新型负压引流冲洗敷料的研发及其治疗感染性软组织损伤疗效的评价[D].北京:中国人民解放军医学院,2016.
[3]Scalise A,Calamita R,Tartaglione C,et al.Improving wound healing and preventing surgical site complications of closed surgical incisions:A possible role of Incisional Negative Pressure Wound Therapy.A systematic review of the literature[J].Int Wound J,2016,13(6):1260-1281.
[4]陈友慈,廖坚文,李灿彬.全厚皮片联合封闭负压引流装置修复皮肤撕脱伤的应用效果分析[J].广东医学,2018,39(9):1376-1379.
[5]赵德杰,祝然然,李晨,等.糖尿病皮肤软组织感染的防治[J].中国中西医结合外科杂志,2018,24(2):248-252.
[6]张桢.负压封闭引流与传统创面换药治疗糖尿病慢性溃疡临床效果比较[J].深圳中西医结合杂志,2018,28(4):151-152.
[7]吴晓霞,左阿芳,吴建义,等.老年糖尿病患者医院感染的临床特点及影响因素分析[J].中华医院感染学杂志,2017,27(22):5122-5125.
[8]王爽,李小兵,樊军,等.负压封闭对口引流治疗糖尿病足合并蜂窝织炎的临床效果[J].中华烧伤杂志,2018,34(1):47-50.
[9]黎鸿章,肖昌明,银西洋,等.负压封闭引流治疗深度烧伤创面及对炎性因子、致痛因子的影响[J].创伤外科杂志,2019,21(1):60-64.
[10]吴晓艳,刘军,沈清,等.降钙素原与乳酸水平的监测在糖尿病酮症酸中毒合并感染中的相关分析[J].临床急诊杂志,2017,18(3):225-228.
[11]Buch A,Kaur S,Nair R,Platelet volume indices as predictive biomarkers for diabetic complications in Type 2diabetic patients[J].J Lab Physicians,2017,9(2):84-88.
[12]中国医师协会神经内科医师分会疼痛和感觉障碍专委会.糖尿病性周围神经病理性疼痛诊疗专家共识[J].全科医学临床与教育,2019,17(2):100-103,107.
[13]赵文,王喜园,温晓东.骨科创伤感染VSD治疗的临床疗效分析[J].临床医药文献电子杂志,2018,5(45):42-43.
[14]张莉莉,彭晓容,张文凤,等.负压封闭引流技术治疗骨科创伤及感染创面的护理研究[J].实用临床医药杂志,2017,21(4):98-100.
[15]邓艳斌,王齐兵,谭金波.急诊切痂植皮术后应用VSD技术处理烧伤患者的临床价值[J].临床急诊杂志,2016,17(11):855-857,869.
[16]解杰,杨帆,陈驾君,等.VSD在开放性骨折及MODS防治中的应用[J].创伤外科杂志,2018,20(7):485-489.
[17]潘雄,应行,林道超.负压封闭引流技术(VSD)在肢体大面积皮肤撕脱伤原位植皮治疗中的比较研究[J].浙江创伤外科,2015,20(2):271-272.
[18]陈友慈,廖坚文,李灿彬.全厚皮片联合封闭负压引流装置修复皮肤撕脱伤的应用效果分析[J].广东医学,2018,39(9):1376-1379.
[19]Tan L,Hou ZY,Gao YZ.Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6,TNF-αand IL-2[J].Exp Ther Med,2018,15(1):288-294.
[20]Niu XF,Yi JH,Zha GQ,et al.Vacuum sealing drainage as a pre-surgical adjunct in the treatment of complex(open)hand injuries:Report of 17cases[J].Orthop Traumatol Surg Res,2017,103(3):461-464.
[21]何开湖.改良VSD技术治疗四肢骨折术后深部组织感染效果探讨[J].临床医药文献电子杂志,2018,5(61):41,44.
[22]Scalise A,Tartaglione C,Bolletta E,et al.The enhanced healing of a high-risk,clean,sutured surgical incision by prophylactic negative pressure wound therapy as delivered by PrevenaTM CustomizableTM:cosmetic and therapeutic results[J].Int Wound J,2015,12(2):218-223.