CAJ | 학술논문

目的探讨封闭负压引流( VSD)技术联合游离植皮术在深度烧伤治疗中的应用.方法根据治疗方法的不同对61例深度烧伤患者分组,VSD治疗组33例手术清创后采用VSD技术封闭创面,待创面肉芽组织新鲜后植皮,采用VSD技术加压植皮区；对照组28例采用传统换药方法,引流分泌物,去除坏死组织,促进肉芽组织生长,肉芽组织新鲜后植皮,加压包扎植皮区.结果在接受VSD技术治疗的33例中,无一例发生局部及全身过敏反应和异常出血情况.经过一次(7～ 10 d)封闭负压治疗,除2例因创面组织缺损较大,血运欠佳等原因,需再一次清创后继续负压闭式引流外,其余31例病例创面肉芽组织鲜红,其后采用植皮术,效果良好.VSD治疗组与对照组治疗至植皮所用时间、疼痛评分、局部治疗费用分别为(8±0.9)d和(14±1.2)d、(5.7±1.6)分和(3.1±1.1)分、(1.5±0.4)万元和(0.6±0.2)万元；植皮成活率、创面细菌培养率分别为6.5％和28.6％、97.0％和75.0％,差异具有统计学意义(P＜0.05).结论 VSD技术方法简便,易于掌握,能促进烧伤创面肉芽组织生长,降低烧伤创面感染率,可尽快植皮,提高植皮成活,并可减轻患者痛苦.因此,值得在深度创面治疗上进行推广.
목적 탐토봉폐부압인류( VSD)기술연합유리식피술재심도소상치료중적응용.방법 근거치료방법적불동대61례심도소상환자분조,VSD치료조33례수술청창후채용VSD기술봉폐창면,대창면육아조직신선후식피,채용VSD기술가압식피구；대조조28례채용전통환약방법,인류분비물,거제배사조직,촉진육아조직생장,육아조직신선후식피,가압포찰식피구.결과 재접수VSD기술치료적33례중,무일례발생국부급전신과민반응화이상출혈정황.경과일차(7～ 10 d)봉폐부압치료,제2례인창면조직결손교대,혈운흠가등원인,수재일차청창후계속부압폐식인류외,기여31례병례창면육아조직선홍,기후채용식피술,효과량호.VSD치료조여대조조치료지식피소용시간、동통평분、국부치료비용분별위(8±0.9)d화(14±1.2)d、(5.7±1.6)분화(3.1±1.1)분、(1.5±0.4)만원화(0.6±0.2)만원；식피성활솔、창면세균배양솔분별위6.5％화28.6％、97.0％화75.0％,차이구유통계학의의(P＜0.05).결론 VSD기술방법간편,역우장악,능촉진소상창면육아조직생장,강저소상창면감염솔,가진쾌식피,제고식피성활,병가감경환자통고.인차,치득재심도창면치료상진행추엄.
Objective To investigate the clinical therapeutic effect of the vacuum-sealing drainage (VSD) combining with skin graft in a deep burn wound.Methods Sixty one patients were divided into two groups according to treatment method.Thirty tree patients were assigned as the VSD treatment group,which was treated by VSD after debridement; their wounds were transplanted by the split thickness skins binding up by VSD when they were fitted.Twenty eight patients were assigned as the routine treatment group,which was treated by means of traditional regular dressing change to remove necrotic tissue and promote granulation tissue; their wounds were transplanted by the split thickness skins binding up by packing when they were fitted.Results After treatment by VSD,there are no systemic hypersensitivity reactions and abnormal bleeding.Thirty three cases of VSD treatment group were treated by VSD for 7 ～ 10 days,the other 2 cases were treated by VSD for another 7 ～ 10 days because of granulation tissue badly.Until their granulation was fresh,skin grafting technique was used and the skin survived well.The treatment time before skin grafts,the pain score,and the cost of ablative therapy for wound were ( 8 ± 0.9) day,(5.7 ± 1.6) point,and ( 1.5 ± 0.4) ten thousand yuan in VSD group vs.( 14 ± 1.2) day,(3.1 ± 1.1 ) point,and (0.6± 0.2)ten thousand yuan in control group.The survival rate and the wound germiculture positive rate were 97.0％ and 6.5％ in the VSD group vs 75.0％ and 28.6％ in the control group.The differences between groups were statistically significant ( P ＜ 0.05 ).Conclusions VSD is a simple method that is easy to grasp,and that can promote granulation tissue growth,reduces the wound germiculture positive rate,shortens the wound healing period,increases the survival rate of skin grafts,and relieves patients 'pain.It is worth popularizing and applying in the deep burn wound therapy.