人体生物敷料在腹腔开放治疗中的临床疗效
인체생물부료재복강개방치료중적림상료효
Clinical efficacy of allogeneic cross-linked dermal dressing for the treatment of enteroatmospheric fistula in patients with open abdomen
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2014年 12期 951-955 ,共5页

    毛琦%王剑%孔文成%李幼生%黎介寿

    모기%왕검%공문성%리유생%려개수

    腹腔开放%人体生物敷料%肠道空气瘘%临时关腹技术 腹腔開放%人體生物敷料%腸道空氣瘺%臨時關腹技術
    복강개방%인체생물부료%장도공기루%림시관복기술
    Open abdomen%Allogeneic cross-linked dermal dressing%Enteroatmospheric fistula%Temporary abdominal closure
    目的 探讨人体生物敷料(灭活的同种异体皮肤)作为腹腔开放临时覆盖物的临床疗效.方法 回顾性分析2011年1月至2014年1月南京军区南京总医院收治的44例因外伤行腹腔开放治疗患者的临床资料.所有患者腹腔开放后以改良三明治法作为临时关腹技术.2011年1月至2012年12月共33例行腹腔开放治疗患者采用凡士林纱布为腹腔临时覆盖物,设为凡士林纱布组(33例);2013年1月至2014年1月共11例行腹腔开放治疗患者采用人体生物敷料为腹腔临时覆盖物,设为人体生物敷料组(11例).采用门诊和电话随访,随访时间截至2014年10月.比较两组患者肠道空气瘘发生率、植皮时间、术前和术后2周内血液感染学指标(WBC、中性粒细胞所占比例、降钙素原及C反应蛋白),住院时间、住院费用以及总体预后.计量资料比较采用独立样本t检验和重复测量方差分析;率或构成比的比较采用Fisher确切概率法.结果 凡士林纱布组患者中,肠道空气瘘发生率为42.4％(14/33),人体生物敷料组患者中无一例出现肠道空气瘘,两组比较,差异有统计学意义(P＜0.05).凡士林纱布组植皮时间为(15±6)d,人体生物敷料组为(11±3)d,两组比较,差异有统计学意义(t =2.10,P＜0.05).凡士林纱布组患者术前、术后第1、3、7、14天降钙素原分别为(1.20±0.60) μg/L、(2.50±0.90) μg/L、(1.70±0.30) μg/L,(1.90±0.40) μg/L、(2.70±0.60)μg/L,显著高于人体生物敷料组的(0.90 ±0.30) μg/L、(1.80±0.60) μg/L、(1.30 e0.50) μg/L、(0.60±0.20) μg/L、(0.30±0.07) μg/L,两组比较,差异有统计学意义(F=8.50,P＜0.05);两组患者WBC、中性粒细胞所占比例和C反应蛋白分别由术前的(13.8±2.4)×109/L和(12.9±2.1)×109/L、0.90±0.09和0.88 ±0.06、(81±19) mg/L和(136±28) mg/L变化为术后第14天的(16.2±3.3)×109/L和(7.9±3.0)×109/L、0.85 ±0.12和0.79 ±0.09、(131±30) mg/L和(59±22) mg/L,两组比较,差异无统计学意义(F=3.10,0.50,1.20,P＞0.05).凡士林纱布组患者住院时间为(137±32)d,人体生物敷料组患者住院时间为(82±44)d,两组比较,差异有统计学意义(t=3.60,P＜0.05).凡士林纱布组患者住院费用为(638 831±113 670)元,人体生物敷料组患者住院费用为(474 839±78 543)元,两组比较,差异有统计学意义(t=4.43,P＜0.05).凡士林纱布组患者随访29 ～ 38个月,总体生存率为81.8％ (27/33),人体生物敷料组患者随访10～20个月,总体生存率为90.9％(10/11),两组比较,差异无统计学意义(P＞0.05).结论 人体生物敷料能有效预防行腹腔开放治疗患者发生肠道空气瘘,作为腹腔开放临时覆盖物临床疗效较好.
    목적 탐토인체생물부료(멸활적동충이체피부)작위복강개방림시복개물적림상료효.방법 회고성분석2011년1월지2014년1월남경군구남경총의원수치적44례인외상행복강개방치료환자적림상자료.소유환자복강개방후이개량삼명치법작위림시관복기술.2011년1월지2012년12월공33례행복강개방치료환자채용범사림사포위복강림시복개물,설위범사림사포조(33례);2013년1월지2014년1월공11례행복강개방치료환자채용인체생물부료위복강림시복개물,설위인체생물부료조(11례).채용문진화전화수방,수방시간절지2014년10월.비교량조환자장도공기루발생솔、식피시간、술전화술후2주내혈액감염학지표(WBC、중성립세포소점비례、강개소원급C반응단백),주원시간、주원비용이급총체예후.계량자료비교채용독립양본t검험화중복측량방차분석;솔혹구성비적비교채용Fisher학절개솔법.결과 범사림사포조환자중,장도공기루발생솔위42.4％(14/33),인체생물부료조환자중무일례출현장도공기루,량조비교,차이유통계학의의(P＜0.05).범사림사포조식피시간위(15±6)d,인체생물부료조위(11±3)d,량조비교,차이유통계학의의(t =2.10,P＜0.05).범사림사포조환자술전、술후제1、3、7、14천강개소원분별위(1.20±0.60) μg/L、(2.50±0.90) μg/L、(1.70±0.30) μg/L,(1.90±0.40) μg/L、(2.70±0.60)μg/L,현저고우인체생물부료조적(0.90 ±0.30) μg/L、(1.80±0.60) μg/L、(1.30 e0.50) μg/L、(0.60±0.20) μg/L、(0.30±0.07) μg/L,량조비교,차이유통계학의의(F=8.50,P＜0.05);량조환자WBC、중성립세포소점비례화C반응단백분별유술전적(13.8±2.4)×109/L화(12.9±2.1)×109/L、0.90±0.09화0.88 ±0.06、(81±19) mg/L화(136±28) mg/L변화위술후제14천적(16.2±3.3)×109/L화(7.9±3.0)×109/L、0.85 ±0.12화0.79 ±0.09、(131±30) mg/L화(59±22) mg/L,량조비교,차이무통계학의의(F=3.10,0.50,1.20,P＞0.05).범사림사포조환자주원시간위(137±32)d,인체생물부료조환자주원시간위(82±44)d,량조비교,차이유통계학의의(t=3.60,P＜0.05).범사림사포조환자주원비용위(638 831±113 670)원,인체생물부료조환자주원비용위(474 839±78 543)원,량조비교,차이유통계학의의(t=4.43,P＜0.05).범사림사포조환자수방29 ～ 38개월,총체생존솔위81.8％ (27/33),인체생물부료조환자수방10～20개월,총체생존솔위90.9％(10/11),량조비교,차이무통계학의의(P＞0.05).결론 인체생물부료능유효예방행복강개방치료환자발생장도공기루,작위복강개방림시복개물림상료효교호.
    Objective To investigate the clinical efficacy of allogeneic cross-linked dermal dressing (ACLD) for the treatment of enteroatmospheric fistula (EAF) in patients with open abdomen (OA).Methods The clinical data of 44 patients with experienced trauma who received OA at Nanjing General Hospital of Nanjing Military Command from January 2011 to January 2014 were retrospectively analyzed.All patients received temporary abdominal closure (TAC) by modified sandwich-vacuum package (MSVP).From January 2011 to December 2012,33 patients with OA received vaseline gauze as abdominal cover layer (VG group),and from January 2013 to January 2014,11 patients with OA received allogeneic cross-linked dermal dressing as abdominal cover layer (ACLD group).Patients were followed up via outpatient examination or telephone interview till October 2014.The incidence of EAF,time for skin-grafting,hematologic indexes in 2 weeks after surgery (white blood cell counts,percentage of neutrophil,the mean value of procalcitonin and C reactive protein),the duration of postoperative hospital stay,hospital expenses and survival rates in the 2 groups were analyzed using t-test,repeated measures analysis of variance and Fisher's exact test.Results The incidence of EAF in the VG group and ACLD group was 42.4％ (14/33) and 0,respectively,with a significant difference between the 2 groups (P ＜ 0.05).The duration of skin-grafting was (15 ±6) days in the VG group and (11 ±3)days in the ACLD group,with a significant difference between the 2 groups (t =2.10,P ＜ 0.05).The mean values of preoperative procalcitonin and postoperative procalcitonin at day 1,3,7,14 in the VG group were (1.20 ± 0.60)pg,/L and (2.50-± 0.90)pg,/L,(1.70 ± 0.30) pg/L,(1.90 ± 0.40) μg/L and (2.70 ± 0.60) μg/L,which were significantly higher than that of (0.90 ± 0.30) μg/L and (1.80 ± 0.60) μg/L,(1.30 ± 0.50) μg/L,(0.60 ± 0.20) μg/L and (0.30 ± 0.07) μg/L in the ACLD group (F =8.50,P ＜ 0.05).The white blood cell counts and percentage of neutrophil and the percentage of C reactive protein between the 2 groups were changed from (13.8 ±2.4) × 109/L,(12.9 ± 2.1) × 109/L,0.90±0.09,0.88 ±0.06,(81 ± 19)mg/L,(136 ±28)mg/L to (16.2 ±3.3) × 109/L,(7.9 ± 3.0) x 109/L,0.85 ±0.12,0.79 ±0.09,(131 ±30)mg/L,(59 ±22)mg/L at postoperative day 14,showing no significant difference between the 2 groups (F =3.10,0.50,1.20,P ＞ 0.05).Duration of hospital stay and hospital expenses in the VG group and ACLD group were (137 ±32)days,(638 831 ± 113 670) yuan and (82 ± 44)days,(474 839 ± 78 543)yuan,respectively,with a significant difference between the 2 groups (t =3.60,4.43,P ＜ 0.05).The time of follow-up and overall survival rate in the VG group and ACLD group were 29 to 38 months and 81.8％ (27/33),and 10 to 20 months and 90.9％ (10/11),respectively,with no significant difference (P ＞ 0.05).Conclusion Allogeneic cross-linked dermal dressing as abdominal cover layer can effectively decrease EAF in patients with open abdomen.
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