摘要
目的观察负压伤口疗法（NPWT）联合猪ADM敷料修复非手术治疗患者四肢深度烧伤创面的效果。方法2012年6月—2015年12月，笔者单位收治符合入选标准的32例深Ⅱ～Ⅲ度四肢烧伤患者，根据随机数字表法并结合患者个人意愿分为NPWT组（应用间歇式负压吸引模式治疗，负压值为－16.6 kPa）10例、ADM组（应用猪ADM敷料治疗）7例和NPWT＋ADM组（同前联合间歇式负压吸引与猪ADM敷料治疗）15例，治疗21 d后，残余创面采用磺胺嘧啶银常规换药处理。于治疗7、14、21 d，行创面大体观察、记录创面引流液量、计算创面愈合率；于治疗前和治疗21 d分别进行创面分泌物细菌学培养，统计细菌清除效果；记录创面愈合时间。对计量资料行重复测量方差分析、单因素方差分析、LSD检验；计数资料行χ2检验或Fisher确切概率法检验。
结果（1）治疗7 d，NPWT组患者创面较治疗前明显缩小，ADM组患者创面较治疗前稍有缩小，NPWT＋ADM组患者创面较治疗前明显缩小的同时散在形成皮岛。治疗14 d，NPWT组患者创面较治疗7 d稍有缩小，ADM组患者创面较治疗7 d缩小明显，NPWT＋ADM组患者创面较治疗7 d明显缩小且创面皮岛增多或融合。治疗21 d，NPWT组患者部分创面愈合；ADM组患者创面较治疗14 d稍有缩小，大部分创面未愈合；NPWT＋ADM组患者大多数创面愈合。（2）治疗7 d，NPWT组、NPWT＋ADM组患者创面引流液量明显多于ADM组（P值均小于0.01）。治疗14 d，NPWT组患者创面引流液量明显多于ADM组（P〈0.01），ADM组、NPWT＋ADM组患者创面引流液量相近（P〉0.05）。治疗21 d，NPWT组、NPWT＋ADM组患者创面引流液量明显少于ADM组（P值均小于0.01）；治疗7～21 d，NPWT＋ADM组患者创面引流液量均明显少于NPWT组（P值均小于0.01）。（3）治疗7 d，ADM组、NPWT＋ADM组患者创面愈合率明显低于NPWT组（P〈0.05或P〈0.01
Objective To observe the clinical efficacy of negative pressure wound therapy （NPWT） in combination with porcine acellular dermal matrix （ADM） dressing for repairing deep burn wounds in limbs of patients with non-surgical treatment. Methods Thirty-two patients with deep partial-thickness burn to full-thickness burn on the limbs admitted to our ward from June 2012 to December 2015, conforming to the inclusion criteria, were divided into group NPWT （ n = 10, treated with interval negative pressure drainage at - 16.6 kPa） , group ADM （ n = 7, treated with porcine ADM dressing） , and group NPWT ＋ ADM （ n = 15, treated with interval negative pressure drainage and porcine ADM dressing as above） ac- cording to the random number table and patient＇s consent. After being treated for 21 d, residual wounds were cured by routine dressing change using sulfadiazine silver. On post treatment day （PTD） 7, 14, and 21, wound gross observation was conducted, wound drainage fluid volume was recorded, and wound healing rate was calculated. Wound secretion was collected for bacterial culture before treatment and on PTD 21, and bacterial clearance effect was recorded. The wound healing time was also recorded. Measurement data were processed with analysis of variance for repeated measurement, one-way analysis of variance, and LSD test. Eenumeration data were processed with chi-square test or Fisher＇s exact test. Results （ 1 ） On PTD 7, the wounds of patients in group NPWT and group NPWT ＋ ADM were significantly shrinked as compared with those before treatment. Skin paddle scattered on the wounds of patients in group NPWT ＋ ADM on PTD 7. The wounds of patients in group ADM were slightly shrinked on PTD 7 as compared with those before treat- ment. On PTD 14, the wounds of patients in group NPWT were slightly shrinked as compared with those on PTD 7, while those in group NPWT ＋ ADM were significantly shrinked as compared with those on PTD 7. Skin paddle on the wounds of patients in group NPWT ＋ ADM
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2016年第6期356-362,共7页
Chinese Journal of Burns
基金
海南省医药卫生科研项目（14A200075）
关键词
烧伤
负压伤口疗法
生物敷料
四肢
生物力学
再上皮化
Burns
Negative-pressure wound therapy
Biological dressings
Extremities
Biomechanics
Re-epithelization
