负压封闭引流在感染创面局部应用.docVIP

负压封闭引流在感染创面局部应用 　　[摘要]目的：评估负压封闭引流术（VSD）在感染创面局部应用的效果。方法：挑选18名创面感染患者，平均年龄(45±10)岁，其中11名男性，7名女性，感染创面部位：手部8例，小腿5例，臀部3例，骶部2例，创面使用100～125mmHg负压持续吸引2天，然后间歇吸引，平均负压吸引时间为（9±2）天，测量VSD治疗前后创面大小，随访平均时间为(11±6)个月。结果：创面平均吸引出100±50ml液体，组织水肿及创面引流得到解决，创面清洁干燥，其中15例患者通过运用抗生素及负压吸引术，创面已达到临床愈合，细菌培养阴性，通过负压治疗创面大小从(28±9)cm2减少至(12±8)cm2（P 　　[关键词]负压封闭引流；感染；创面 　　[中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2012）03-0382-02 　　 　　Use of vacuum sealing drainage in the topical treatment of wound infections 　　DENG Lin,ZHOU Ming 　　(Department of Hand Surgery,Jiangsu University Peoples Hospital,Zhenjiang 212001,Jiangsu,China) 　　 　　Abstract: Objective To evaluate the results of vacuum sealing drainage in the topical treatment of wound infections. Methods Vacuum therapy was performed in 18 patients (11males,7 females; mean age 45±10 years) using the VSD system (vacuum sealing drainage) for the treatment of wound infections.Infective wounds were in the hand (n=8), crus (n=5), croup (n=3), and sacrum (n=2).The wounds were treated with a negative pressure of 100～125 mmHg applied continuously for the first two days, and then intermittently for the following days. The mean duration of vacuum therapy was (9±2) days. Measure wound surface areas before and after vacuum therapy.The mean follow-up period was 11±6 months. Results The mean amount of discharge from the wound was (100±50)ml. Tissue edema and discharge problems were resolved in all the wounds and a hygienic and dry-looking surgical site was attained. In 15 patients, clinical and bacteriologic eradication of infections was achieved at the surgical site through antibiotic use and vacuum therapy. The mean wound area showed a significant reduction from (28±9)cm2 to (12±8)cm2 following vacuum therapy (P 　　2 讨论 　　2.1 负压封闭引流术在过去通常被人使用于表浅组织缺损，如轻、中度烧伤及压力性损伤，如今，已逐渐开始应用于软组织缺损伴外科感染及???瘤外科学中，通常这些损伤需要长期抗生素治疗和组织移植，治疗过程很复杂[1-2]，而负压封闭引流术的应用对临床提供了很大帮助。 　　2.2 通常深部损伤及广泛软组织坏死创面有很多渗出液，通过聚乙烯醇海绵及导管，在负压作用下能将创面渗出液排出。自粘性半透膜能将创面封闭，阻止外来细菌的进入，减少感染的机会，从而加速创面的愈合[3]。