开腹手术切口持续封闭负压引流的临床效果观察
|
摘要
目的探讨腹部开腹手术切口持续封闭负压引流的临床疗效。方法选择行开腹手术患者150例,随机分成两组,试验组74例,对照组76例。均行开腹手术治疗。手术结束时,试验组腹部切口缝合后行持续封闭负压引流,对照组则给予常规纱布敷料包扎。术后每天观察患者症状、体征,记录切口皮肤红肿、热痛及渗液情况,肠功能恢复和术后下床活动时间。结果术后观察7～21 d,出现切口感染20例,均为浅表感染,试验组和对照组的感染发生率比较有统计学差异(2.7%vs23.7%,P <0.05)。结论持续封闭负压引流安全、无创和有效,可以明显减少腹部开腹手术切口感染发生率。
引文
[1]Mangram AJ,Horan TC,Pearson ML,et al.Guideline for prevention of surgical site infection,1999[J].American journal of Infection Control,1999,27(2):97-132.
[2]樊跃平,任建安,吴秀文,等.腹部污染切口术后手术部位感染和致病菌分布的前瞻性研究[J].中华消化外科杂志,2015,14(10):835-838.
[3]Gomoll AH,Lin A,Harris MB.Incisional vacuum-assisted closure therapy[J].Journal of Orthopaedic Trauma,2006,20(10):705-709.
[4]Blackham AU,Farrah JP,Mccoy TP,et al.Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy[J].American Journal of Surgery,2013,205(6):647-654.
[5]Mueller TC,Loos M,Haller B,et al.Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery:a systematic review and meta-analysis[J].Langenbeck's Archives of Surgery,2015,400(2):167-181.
[6]Fan Y,Wei Z,Wang W,et al.The incidence and distribution of surgical site infection in mainland China:a meta-analysis of 84prospective observational studies[J].Scientific Reports,2014,4:6783.
[7]Diener MK,Knebel P,Kieser M,et al.Effectiveness of triclosan-coated PDS Plus versus uncoated PDSⅡsutures for prevention of surgical site infection after abdominal wall closure:the randomised controlled PROUD trial[J].Lancet(London,England),2014,384(9938):142-152.
[8]Pinkney TD,Calvert M,Bartlett DC,et al.Impact of wound edge protection devices on surgical site infection after laparotomy:multicentre randomised controlled trial(ROSSINI Trial)[J].BMJ,2013,347:f4305.
[9]Bennett-Guerrero E,Pappas TN,Koltun WA,et al.Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery[J].The New England Journal of Medicine,2010,363(11):1038-1049.
[10]De Oliveira AC,Ciosak SI,Ferraz EM,et al.Surgical site infection in patients submitted to digestive surgery:risk prediction and the NNIS risk index[J].American Journal of Infection Control,2006,34(4):201-207.
[11]Lee JS,Terjimanian MN,Tishberg LM,et al.Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy[J].Journal of the American College of Surgeons,2011,213(2):236-244.
[12]Kugler NW,Carver TW,Paul JS.Negative pressure therapy is effective in abdominal incision closure[J].The Journal of Surgical Research,2016,203(2):491-494.
[13]Krug E,Berg L,Lee C,et al.Evidence-based recommendations for the use of negative pressure wound therapy in traumatic wounds and reconstructive surgery:steps towards an international consensus[J].Injury,2011,42 Suppl 1:S1-12.
[14]Mihaljevic AL,Schirren R,Muller TC,et al.Postoperative negative-pressure incision therapy following open colorectal surgery(Poniy):study protocol for a randomized controlled trial[J].Trials,2015,16:471.
[15]Timmers MS,Le Cessie S,Banwell P,et al.The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion[J].Annals of Plastic Surgery,2005,55(6):665-671.
[16]Kilpadi DV,Cunningham MR.Evaluation of closed incision management with negative pressure wound therapy(CIM):hematoma/seroma and involvement of the lymphatic system[J].Wound Repair and Regeneration,2011,19(5):588-596.
[2]樊跃平,任建安,吴秀文,等.腹部污染切口术后手术部位感染和致病菌分布的前瞻性研究[J].中华消化外科杂志,2015,14(10):835-838.
[3]Gomoll AH,Lin A,Harris MB.Incisional vacuum-assisted closure therapy[J].Journal of Orthopaedic Trauma,2006,20(10):705-709.
[4]Blackham AU,Farrah JP,Mccoy TP,et al.Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy[J].American Journal of Surgery,2013,205(6):647-654.
[5]Mueller TC,Loos M,Haller B,et al.Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery:a systematic review and meta-analysis[J].Langenbeck's Archives of Surgery,2015,400(2):167-181.
[6]Fan Y,Wei Z,Wang W,et al.The incidence and distribution of surgical site infection in mainland China:a meta-analysis of 84prospective observational studies[J].Scientific Reports,2014,4:6783.
[7]Diener MK,Knebel P,Kieser M,et al.Effectiveness of triclosan-coated PDS Plus versus uncoated PDSⅡsutures for prevention of surgical site infection after abdominal wall closure:the randomised controlled PROUD trial[J].Lancet(London,England),2014,384(9938):142-152.
[8]Pinkney TD,Calvert M,Bartlett DC,et al.Impact of wound edge protection devices on surgical site infection after laparotomy:multicentre randomised controlled trial(ROSSINI Trial)[J].BMJ,2013,347:f4305.
[9]Bennett-Guerrero E,Pappas TN,Koltun WA,et al.Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery[J].The New England Journal of Medicine,2010,363(11):1038-1049.
[10]De Oliveira AC,Ciosak SI,Ferraz EM,et al.Surgical site infection in patients submitted to digestive surgery:risk prediction and the NNIS risk index[J].American Journal of Infection Control,2006,34(4):201-207.
[11]Lee JS,Terjimanian MN,Tishberg LM,et al.Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy[J].Journal of the American College of Surgeons,2011,213(2):236-244.
[12]Kugler NW,Carver TW,Paul JS.Negative pressure therapy is effective in abdominal incision closure[J].The Journal of Surgical Research,2016,203(2):491-494.
[13]Krug E,Berg L,Lee C,et al.Evidence-based recommendations for the use of negative pressure wound therapy in traumatic wounds and reconstructive surgery:steps towards an international consensus[J].Injury,2011,42 Suppl 1:S1-12.
[14]Mihaljevic AL,Schirren R,Muller TC,et al.Postoperative negative-pressure incision therapy following open colorectal surgery(Poniy):study protocol for a randomized controlled trial[J].Trials,2015,16:471.
[15]Timmers MS,Le Cessie S,Banwell P,et al.The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion[J].Annals of Plastic Surgery,2005,55(6):665-671.
[16]Kilpadi DV,Cunningham MR.Evaluation of closed incision management with negative pressure wound therapy(CIM):hematoma/seroma and involvement of the lymphatic system[J].Wound Repair and Regeneration,2011,19(5):588-596.