负压创面治疗技术联合削痂植皮治疗深度烧伤的疗效分析

发布时间：2018-01-19 18:50

  本文关键词： 烧伤 皮肤移植 削痂 负压创面治疗技术　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的在烧伤创面削痂清创术联合邮票皮片或大张皮植皮术后,包扎换药成为常规的后续创面治疗。这种治疗常引起创面的感染、局部水肿以及皮片成活率低及创面愈合不理想等不良反应。现负压创面治疗技术(vacuum sealing drainage,VSD)被应用于临床削痂植皮术后的治疗。本研究旨在量化对比广泛深度烧伤(extensive deep burns,EDB)后的患者行削痂植皮术(tangential excision and skin grafting,TESG)联合VSD技术治疗与削痂植皮术联合传统治疗对创面愈合过程中皮片愈合及预后质量的影响,分析探讨其影响因素。以期为临床应用VSD技术的可行性提供一定的临床参考。方法回顾性调查2014年3月至2016年12月山东大学附属济南市中心医院烧伤科连续收治的35例深Ⅱ度～Ⅲ度烧伤行削痂植皮术联合VSD技术治疗(A组),以及43例深Ⅱ度～Ⅲ度烧伤行削痂植皮术联合传统治疗(B组)患者的资料。通过单因素方差分析与卡方检验比较A、B组两种不同的后续治疗方法在首次植皮成功率、术后14d植皮成活率、创面愈合时间、愈合质量、换药次数以及住院费用上的差异。结果(1)A组共35例38次手术纳入研究,男17例,女18例,年龄(31.74土30.67)岁,烧伤总面积(6.83±5.95)%TBSA,深Ⅱ度面积(4.37±5.24)%TBSA,Ⅲ度面积(2.46±1.77)%TBSA;B组共43例49次手术纳入研究,男25 例,女 18 例,年龄(35.44±23.69)岁,烧伤总面积(8.09±7.45)%TBSA,深Ⅱ度面积(5.12±6.40)%TBSA,Ⅲ度面积(2.98±1.99)%TBSA。两组患者以上资料经单因素方差分析及卡方检验比较,差异无统计学意义(P0.05),对结果无影响。(2)A组35例病人有3例须再次行植皮手术;B组43例病人有6例须再次行植皮手术。A组术后14d植皮成活率(87.43± 19.79)%TBSA、B组术后14d植皮成活率(75.00±25.10)%TBSA;A组愈合时间为(22.06±10.79)d,B组愈合时间为(28.74±13.37)d;A组换药次数为(5.77±3.17)次,B组换药次数为(9.53±4.05)次;A组愈合质量有21例优,10例良,3例良,1例差。B组愈合质量有13例优,17例良,7例中,6例差;A组住院费用为(40282.49± 17464.59)元,B 组住院费用为(35301.60±30587.53)元。两组患者以上资料经单因素方差分析及卡方检验比较,其中首次植皮成功率、住院费用无统计学意义(P0.05)。术后14d植皮成活率、愈合时间、愈合质量有统计学意义(P0.05)。换药次数有紧密的统计学意义(P0.01)。结论对广泛深度烧伤创面采用削痂植皮术联合负压创面治疗技术与传统治疗相比,有效缩短了残余创面的愈合时间,提高了术后14d植皮成活率,提高了愈合质量,明显地减少了平均换药次数。尽管治疗组的住院费用平均数高于传统组,但在统计学上并无明显差异。在手术次数上,两种治疗方法的首次植皮成功率都很高,在统计学上无明显差异。可能由于缩短了住院时间,所以其在住院费用上并没有明显高于传统治疗方法,总体上来说值得在临床推广应用。
[Abstract]:Objective after burn wound debridement combined with stamp skin grafts or large skin grafting bandaging and dressing change become routine follow-up wound treatment. This treatment often causes wound infection. Local edema, low survival rate of skin grafts and poor wound healing were all adverse reactions. Vacuum sealing drainage was used to treat the wound under negative pressure. VSD) has been used in clinical escharectomy and skin grafting. The purpose of this study was to quantitatively compare extensive deep burn with extensive deep burns. The patients were treated with tangential excision and skin grafting after escharectomy and skin grafting. Effects of VSD combined with scab removal and skin grafting combined with traditional treatment on skin graft healing and prognosis during wound healing. To provide some clinical reference for the feasibility of clinical application of VSD technique. Methods A retrospective investigation was conducted from March 2014 to December 2016 in the center of Jinan affiliated to Shandong University. 35 cases of deep 鈪，

本文编号：1445123