目的:探讨负压封闭引流(VSD)联合间断快速冲洗技术在下肢开放性骨折合并软组织缺损的应用研究。方法:选取我院创伤骨科2020年1月~2020年10月收治的50例下肢开放性骨折合并软组织缺损行VSD负压引流术后的患者,分为实验组25例用生理盐水快速间断冲洗创面及对照组25例用生理盐水持续冲洗创面,分别对两组护理效果进行比较。通过记录每例发生引流管堵塞的次数、患者疼痛指数评分、使用VSD平均治疗时间、创面愈合效果及疗效显现时间、出院患者满意度进行对比。结果:VSD负压引流术后采用间断冲洗与持续冲洗防止引流管管道堵塞的效果无差别(P > 0.05),实验组的疼痛程度低于对照组(P < 0.05),实验组使用VSD平均治疗时间短于对照组,实验组创面愈合效果优于对照组(P < 0.05),实验组疗效显现时间短于对照组(P < 0.05),实验组的满意度高于对照组(P < 0.05)。结论:负压封闭引流(VSD)联合间断快速冲洗技术能显著促进下肢开放性骨折合并软组织缺损创面的愈合,降低患者的疼痛程度,缩短治疗时间,提高患者满意度,值得推广应用。 Objective: To investigate the application of negative pressure closed drainage (VSD) combined with intermittent rapid irrigation in the treatment of open fractures of lower limbs complicated with soft tissue defects. Methods: A total of 50 patients with open fractures of lower extremity combined with soft tissue defects admitted to the Department of Trauma and Orthopedics of our hospital from January 2020 to October 2020 were selected after VSD negative pressure drainage. The patients were divided into the experimental group (n = 25) and the control group (n = 25), who were rapidly and discontinuously irrigated with normal saline. The nursing effects of the two groups were compared respectively. The frequency of blockage of drainage tube, pain index score of patients, average treatment time with VSD, wound healing effect and curative effect appearance time, and satisfaction of discharged patients were recorded. Results: After VSD negative pressure drainage by intermittent flush with continuous irrigation to prevent drainage pipe blockage effect difference (P > 0.05), the experimental group level of pain is lower than the control group (P < 0.05), the experimental group used the VSD treatment time is shorter than the control group on average, the experimental group wound healing effect is better than that of control group (P < 0.05), the experimental group curative effect appears shorter than the control group (P < 0.05), the satisfaction degree of the experimental group is higher than control group (P < 0.05). Conclusion: The technique of negative pressure sealed drainage (VSD) combined with intermittent rapid irrigation can significantly promote the wound healing of lower extremity open fracture combined with soft tissue defect, reduce the pain degree of patients, shorten the treatment time and improve patient satisfaction, which is worthy of promotion and application.
目的:探讨负压封闭引流(VSD)联合间断快速冲洗技术在下肢开放性骨折合并软组织缺损的应用研究。方法:选取我院创伤骨科2020年1月~2020年10月收治的50例下肢开放性骨折合并软组织缺损行VSD负压引流术后的患者,分为实验组25例用生理盐水快速间断冲洗创面及对照组25例用生理盐水持续冲洗创面,分别对两组护理效果进行比较。通过记录每例发生引流管堵塞的次数、患者疼痛指数评分、使用VSD平均治疗时间、创面愈合效果及疗效显现时间、出院患者满意度进行对比。结果:VSD负压引流术后采用间断冲洗与持续冲洗防止引流管管道堵塞的效果无差别(P > 0.05),实验组的疼痛程度低于对照组(P < 0.05),实验组使用VSD平均治疗时间短于对照组,实验组创面愈合效果优于对照组(P < 0.05),实验组疗效显现时间短于对照组(P < 0.05),实验组的满意度高于对照组(P < 0.05)。结论:负压封闭引流(VSD)联合间断快速冲洗技术能显著促进下肢开放性骨折合并软组织缺损创面的愈合,降低患者的疼痛程度,缩短治疗时间,提高患者满意度,值得推广应用。
负压封闭引流,VSD,间断快速冲洗,下肢开放性骨折,软组织缺损
Qijun Long1, Meichun Yang2*, Juan Yang3, Lizhen Huang1, Yuting Zhang1
1Youjiang Medical University for Nationalities, Baise Guangxi
2Affiliated Hospital of Youjiang Medical University for Nationalities, Baise Guangxi
3Heavy Metal and Arsenic Fluoride Research Laboratory, Youjiang Medical College for Nationalities, Baise Guangxi
Received: Mar. 19th, 2021; accepted: Apr. 15th, 2021; published: Apr. 22nd, 2021
Objective: To investigate the application of negative pressure closed drainage (VSD) combined with intermittent rapid irrigation in the treatment of open fractures of lower limbs complicated with soft tissue defects. Methods: A total of 50 patients with open fractures of lower extremity combined with soft tissue defects admitted to the Department of Trauma and Orthopedics of our hospital from January 2020 to October 2020 were selected after VSD negative pressure drainage. The patients were divided into the experimental group (n = 25) and the control group (n = 25), who were rapidly and discontinuously irrigated with normal saline. The nursing effects of the two groups were compared respectively. The frequency of blockage of drainage tube, pain index score of patients, average treatment time with VSD, wound healing effect and curative effect appearance time, and satisfaction of discharged patients were recorded. Results: After VSD negative pressure drainage by intermittent flush with continuous irrigation to prevent drainage pipe blockage effect difference (P > 0.05), the experimental group level of pain is lower than the control group (P < 0.05), the experimental group used the VSD treatment time is shorter than the control group on average, the experimental group wound healing effect is better than that of control group (P < 0.05), the experimental group curative effect appears shorter than the control group (P < 0.05), the satisfaction degree of the experimental group is higher than control group (P < 0.05). Conclusion: The technique of negative pressure sealed drainage (VSD) combined with intermittent rapid irrigation can significantly promote the wound healing of lower extremity open fracture combined with soft tissue defect, reduce the pain degree of patients, shorten the treatment time and improve patient satisfaction, which is worthy of promotion and application.
Keywords:Negative Pressure Closed Drainage, VSD, Intermittent Quick Washing, Open Fractures of Lower Limbs, Soft Tissue Defect
Copyright © 2021 by author(s) and Hans Publishers Inc.
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近年来,随着经济和社会的快速发展,科学技术的不断进步和科技产品的广泛应用,人们在获得科技改变生活福利的同时,也给人们的日常生活带来了不少问题,特别是出行交通工具和机械设备的改变,给人们带来的意外交通事故和机械性致伤致残数量逐年递增。最新研究发现,这类患者中由于存在基础性疾病如2型糖尿病患者,其创面在临床上常发展成难愈性创面,不仅给临床治疗带来了困难,一定程度上也增加了患者的治疗费用 [
将我院创伤骨科2020年1月~2020年10月收治的50例下肢开放性骨折合并软组织缺损行VSD负压引流术后的患者,收治研究患者均无:(1) 膝关节、踝关节以及足部损伤者;(2) 营养不良者;(3) 糖尿病患者;(4) 有活动性出血的创面;(5) 凝血机制差;(6) 皮瓣移植后的创面。本研究采用随机抽取的方法将患者分为实验和对照两组,其中实验组25例(男13例,女12例),年龄33~55岁,平均年龄(43.25 ± 1.21)岁);其中对照组25例(男12例,女13例),年龄30~57岁,平均年龄(44.17 ± 1.12)岁。两组均为Ⅲ度创面。两组患者一般资料差异不明显,可分组比对(P > 0.05)。
将材料:使用0.9% N.S 500 ML/瓶;普通输液器分离头皮针后,输液管接头直接与冲洗管接口进行连接;壁式负压装置;吸引瓶容量为1000 ML。具体实施方法如下:术后至拔管期间,各接口冲洗间隔时间均为Q2h,冲洗时将输液调节器的莫菲式滴管开尽,滴速呈现最快,引出澄清液即可关闭调节器;期间严格按照负压封闭引流(VSD)术后护理常规进行护理。实验用到的试剂购自四川科伦药业股份有限公司。
所用材料同实验组,具体实施方法如下:术后至24小时各接口冲洗滴速为60 gtt/min;术后1天后至术后第三天,各接口冲洗滴速为40 gtt/min;术后第三天以后至拔管期间,各接口冲洗滴速为20 gtt/min;期间严格按照负压封闭引流(VSD)术后护理常规进行护理。
分别对比实验组和对照组患者干预一个月的伤口创面愈合情况:① 疼痛指数评分 [
采用SPSS 20.0软件进行数据处理,计数资料采用X2检验;计量资料以均数±标准差( x ¯ ± s )表示,采用t检验。P < 0.05表示差异有统计学意义。
治疗过程中实验组与对照组引流管堵塞次数比较差异无统计学意义(P > 0.05)。见表1。
组别 | (例) (n) | 管道堵塞次数 |
---|---|---|
实验组(n = 50) | 25 | 0 |
对照组(n = 52) | 25 | 0 |
t值 | - | - |
P值 | - | >0.05 |
表1. 实验组、对照组VSD管道堵塞次数比较
治疗过程中实验组疼痛评分均低于对照组,差异有统计学意义(P < 0.05)。见表2。
组别 | (例) (n) | 疼痛评分 |
---|---|---|
实验组 | 25 | 3.03 ± 1.17 |
对照组 | 25 | 5.07 ± 1.23 |
t值 | - | −5.3172 |
P值 | - | <0.05 |
表2. 实验组、对照组疼痛评分比较( x ¯ ± s )
治疗过程中实验组使用VSD平均治疗时间均少于对照组,差异有统计学意义(P < 0.05)。见表3。
组别 | (例) (n) | 使用VSD平均治疗时间(天) |
---|---|---|
实验组 | 25 | 6.74 ± 1.12 |
对照组 | 25 | 8.41 ± 1.14 |
t值 | - | −4.735 |
P值 | - | <0.05 |
表3. 实验组、对照组使用VSD平均治疗时间比较( x ¯ ± s )
实验组明显高于对照组,差异有统计学意义(P < 0.05)。见表4。
组别 | (例) (n) | 痊愈 | 显效 | 有效 | 无效 | 总有效 |
---|---|---|---|---|---|---|
实验组 | 25 | 9 | 10 | 5 | 1 | 24 |
对照组 | 25 | 3 | 7 | 11 | 4 | 21 |
X2 | - | 5.23 | 2.65 | 4.27 | 5.31 | 3.60 |
P | - | <0.05 | <0.05 | <0.05 | <0.05 | <0.05 |
表4. 实验组、对照组临床疗效比较( x ¯ ± s )
两组患者治疗后有效、显效、痊愈各阶段所需时间(d/天数)比较,差异有统计学意义(P < 0.05),见表5。
组别 | (例) (n) | 痊愈 | 显效 | 有效 |
---|---|---|---|---|
实验组 | 25 | 23.7 ± 4.5 | 8.9 ± 2.4 | 4.9 ± 1.7 |
对照组 | 25 | 27 ± 2.9 | 11.1 ± 3.0 | 5.8 ± 2.1 |
t | - | 5.13 | 7.25 | 4.68 |
P | - | <0.05 | <0.05 | <0.05 |
表5. 实验组、对照组疗效显现时间比较( x ¯ ± s .d)
实验组满意度高于对照组,差异有统计学意义(P < 0.05),见表6。
组别 | (例)(n) | 非常满意 | 满意 | 不满意 | 满意率(%) |
---|---|---|---|---|---|
实验组 | 25 | 18 | 6 | 1 | 96 |
对照组 | 25 | 7 | 12 | 6 | 76 |
X2值 | - | 11.205 | |||
P值 | - | <0.05 |
表6. 实验组、对照组出院患者满意度比较( x ¯ ± s )
1) 开放性骨折合并较大软组织缺损的病人在创伤骨科中很常见,发生外露骨和肌腱的频率更高,最大威胁是发展成感染和骨髓炎,甚至出现截肢从而危及生命。为减少相关并发症的发生,促进骨折周围软组织愈合,需积极治疗伤口。VSD能够较好符合临床治疗要求,在清创后的治疗过程中,显著降低并发症,缩短愈合及疗效显现时间。罗明星等 [
2) 负压封闭引流技术是在一个相对密闭的环境内进行工作,临床上可以通过采用具有良好透气、透氧性能的生物贴膜进行患处密封,这样就可以有效防止外界细菌入侵,从而降低交叉感染风险。同时给予患者有效的负压,不仅可以有效促进患处毛细血管的增生,而且创面血运也得以进一步改善,促进患者创面愈合。
3) 用生理盐水持续冲洗VSD管道,虽使伤口处在湿性环境,但易引起新生肉牙组织的水肿。改用生理盐水快速间断冲洗创面既能维持创面在湿性环境,又能在一定程度上防止肉牙组织水肿。本次研究实验组使用VSD平均治疗时间均少于对照组。
4) 综上所述,负压封闭引流(VSD)联合间断快速冲洗技术能显著促进下肢开放性骨折合并软组织缺损创面的愈合,降低患者的疼痛程度,提高患者满意度,值得推广应用。
本研究经我院伦理委员会审批通过(符合伦理)。
龙奇军,杨梅春,杨 娟,黄丽珍,张钰婷. 负压封闭引流(VSD)联合间断快速冲洗技术在下肢开放性骨折合并软组织缺损中的应用研究Study on the Application of Negative Pressure Sealed Drainage (VSD) Combined with Intermittent Rapid Irrigation in the Treatment of Open Fractures of Lower Limbs Complicated with Soft Tissue Defects[J]. 临床医学进展, 2021, 11(04): 1132-1137. https://doi.org/10.12677/ACM.2021.114253