摘要
目的研究负压封闭引流(VSD)治疗深度烧伤创面(DBW)及对血清炎性因子、致痛因子的影响。方法 2015年1月—2017年12月内江市第一人民医院治疗DBW患者106例,其中男性69例,女性37例;年龄25～59岁,平均44. 5岁;受伤至入院时间0. 5～13d,平均5. 65d。致伤原因:火烧伤75例,热液烧伤31例。按照治疗方法分为VSD组(n=53)和对照组(n=53),VSD组行VSD+游离植皮治疗,对照组行常规清创换药+游离植皮治疗。治疗7d后观察两组创面愈合率及视觉模拟疼痛评分(VAS)、创面完全愈合时间、住院时间、住院费用,治疗前及治疗后7d血清超敏C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、补体C3a等炎性因子及血清5-羟色胺(5-HT)、脑内神经肽(NPY)、前列腺素E2(PGE2)等致痛因子水平。结果治疗后7d VSD组创面愈合率大于对照组[(80. 86±9. 12)%vs.(69. 58±7. 30)%],疼痛评分、创面完全愈合时间、住院时间及住院费用均少于对照组[(2. 78±0. 29)分vs.(5. 79±0. 62)分,(19. 26±2. 04) d vs.(25. 74±2. 65) d,(23. 63±2. 44) d vs.(30. 51±3. 19) d,(3. 29±0. 35)万元vs.(3. 92±0. 41)万元](P <0. 05)]。治疗后7d,VSD组血清CRP、TNF-α、IL-8、补体C3a及5-HT、NPY、PGE2水平均低于对照组[(8. 92±9. 93) mg/L vs.(18. 87±1. 96) mg/L,(35. 74±3. 61)μg/L vs.(67. 94±6. 88)μg/L,(32. 92±4. 37)μg/L vs.(60. 76±6. 19)μg/L,(13. 52±1. 50)μg/L vs.(16. 77±1. 72)μg/L,(109. 92±10. 16) ng/L vs.(143. 97±15. 22) ng/L,(112. 86±11. 41)μg/L vs.(154. 37±16. 03)μg/L,(121. 33±12. 42) pg/m L vs.(186. 93±18. 72) pg/m L,P <0. 05)]。结论 VSD可促进DBW愈合,降低炎性因子及致痛因子水平,患者康复快。
Objective To study the treatment of deep burn wound(DBW)with vacuum sealing drainage(VSD)and its influence on inflammatory factors and pain-causing factors.Methods A total of 106 DBW patients treated in our hospital from Jan.2015 to Dec.2017 were selected and divided into VSD group(n=53)and control group(n=53)according to the therapeutic method.There were 69 males and 37 females aged from 25-59(average,44.50)years.The time from injury to admission was 0.5-13(5.65 on average)days.Seventy five were injured from burning and 31 were from hot liquid burning.Patients in the VSD group were treated with VSD+free skin grafting,while the control group were treated with conventional debridement and replacement plus free skin grafting.After 7 days of treatment,the wound healing rate,pain score,wound healing time,hospitalization time and hospitalization expenses of the two groups were observed.Levels of inflammatory factors such as CRP,TNF-α,IL-8,complement c3a and pain-causing factors such as 5-HT,NPY,PGE2 in serum before treatment and 7 days after treatment were also observed.Results Seven days after treatment,the wound healing rate in the VSD group was greater than that in the control group((80.86±9.12)%vs.(69.58±7.30)%),and the pain score,wound healing time,hospitalization time and hospitalization cost were less than those in the control group((2.78±0.29)points vs.(5.79±0.62)points,(19.26±2.04)days vs.(25.74±2.65)days),(23.63±2.44)days vs.(30.51±3.19)days,(32.9±3.5)thousand yuan vs.(39.2±4.1)thousand yuan,P<0.05).Seven days after treatment,the levels of CRP,TNF-α,IL-8,complement C3a,5-HT,NPY and PGE2 in VSD group were all lower than those in control group((8.92±9.93)mg/L vs.(18.87±1.96)mg/L,(35.74±3.61)μg/L vs.(67.94±6.88)μg/L,(32.92±4.37)μg/L vs.(60.76±6.19)μg/L,(13.52±1.50)μg/L vs.(16.77±1.72)μg/L,(109.92±10.16)ng/L vs.(143.97±15.22)ng/L],(112.86±11.41)μg/L vs.(154.37±16.03)μg/L,(121.33±12.42)pg/mL vs.(186.93±18.72)pg/mL,P<0.05).Conclusion VSD can promote wound healing and survival of skin graft of DBW,reduce the levels of inflammatory factors and pain factors,and achieve fast recovery.
作者
黎鸿章
肖昌明
银西洋
邹杰
杨坤
刘攀
LI Hong-zhang;XIAO Chang-ming;YIN Xi-yang;ZOU Jie;YANG Kun;LIU Pan(Department of Burn and Plastic Surgery,First People s Hospital of Neijiang,Neijiang,Sichuan 641000,China)
出处
《创伤外科杂志》
2019年第1期60-64,共5页
Journal of Traumatic Surgery
关键词
烧伤
负压封闭引流
创面
植皮
burns
vacuum sealing drainage
wound
skin grafting
