中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
22期
67-70
,共4页
负压封闭引流%挤压伤%急性肾损伤%脓毒症%感染
負壓封閉引流%擠壓傷%急性腎損傷%膿毒癥%感染
부압봉폐인류%제압상%급성신손상%농독증%감염
Vacuum sealing drainage%Crush injury%Acute kidney injury%Sepsis%Infection
目的：观察负压封闭引流术(VSD)对四肢软组织严重挤压伤的治疗效果。方法选择哈尔滨医科大学附属第一医院2012年10月~2014年10月收治的62例GustiloⅢ型软组织挤压伤患者，根据清创术后选择VSD引流或常规换药治疗分为观察组(35例)和对照组(27例)，观察组清创术后安装VSD装置，对照组根据伤口情况每日换药1~2次。术后对患者行积极的全身治疗，并于术后48 h检测患者血浆白细胞(WBC)计数，血清钾离子(K+)、肌酐(Scr)、尿素氮(BUN)水平以及尿蛋白情况。观察患者出现急性肾损伤(AKI)、全身炎症反应综合征(SIRS)、脓毒症、多器官功能障碍综合征(MODS)并发症的发生率，并统计患者病死率。在患者出院时统计患者伤口闭合时间、血液净化次数、住院时间及截肢率等预后指标。结果观察组WBC[(13.25±3.16)×109/L]、K+[(5.04±1.07)mmol/L]、Scr [(163.43±53.27)μmol/L]、BUN [(6.92±2.61)mmol/L]、尿蛋白评分[(2.09±0.83)分]均优于对照组[WBC：(18.63±4.58)×109/L，K+：(5.93±1.42)mmol/L，Scr：(334.56±109.82)μmol/L，BUN：(10.35±3.48)mmol/L，尿蛋白评分：(2.67±1.12)分]，差异有统计学意义(P<0.05)。观察组出现AKF、SIRS、脓毒症、MODS并发症的发生率±次为42.9豫、60.0豫、48.6豫、11.4豫，低于对照组(70.4豫、85.2豫、77.8豫、33.3豫)，差异有统计学意义(P<0.05)。观察组伤口闭合时间[(14.26±4.32)d]、血液净化次数[(6.28±3.69)次]、住院时间[(27.38±6.75)d]均较对照组[伤口闭合时间院(19.73±5.47)d，血液净化次数：(8.74±4.23)次，住院时间：(35.49±10.18)d]降低，差异有统计学意义(P<0.05)。两组患者病死率及截肢率比较(2.86%、11.1%比5.9%、16.7%)，差异无统计学意义(P>0.05)。结论 VSD技术能够有效降低软组织损伤后局部有害物质的吸收，减轻全身中毒症状，提高治疗效果。
目的：觀察負壓封閉引流術(VSD)對四肢軟組織嚴重擠壓傷的治療效果。方法選擇哈爾濱醫科大學附屬第一醫院2012年10月~2014年10月收治的62例GustiloⅢ型軟組織擠壓傷患者，根據清創術後選擇VSD引流或常規換藥治療分為觀察組(35例)和對照組(27例)，觀察組清創術後安裝VSD裝置，對照組根據傷口情況每日換藥1~2次。術後對患者行積極的全身治療，併于術後48 h檢測患者血漿白細胞(WBC)計數，血清鉀離子(K+)、肌酐(Scr)、尿素氮(BUN)水平以及尿蛋白情況。觀察患者齣現急性腎損傷(AKI)、全身炎癥反應綜閤徵(SIRS)、膿毒癥、多器官功能障礙綜閤徵(MODS)併髮癥的髮生率，併統計患者病死率。在患者齣院時統計患者傷口閉閤時間、血液淨化次數、住院時間及截肢率等預後指標。結果觀察組WBC[(13.25±3.16)×109/L]、K+[(5.04±1.07)mmol/L]、Scr [(163.43±53.27)μmol/L]、BUN [(6.92±2.61)mmol/L]、尿蛋白評分[(2.09±0.83)分]均優于對照組[WBC：(18.63±4.58)×109/L，K+：(5.93±1.42)mmol/L，Scr：(334.56±109.82)μmol/L，BUN：(10.35±3.48)mmol/L，尿蛋白評分：(2.67±1.12)分]，差異有統計學意義(P<0.05)。觀察組齣現AKF、SIRS、膿毒癥、MODS併髮癥的髮生率±次為42.9豫、60.0豫、48.6豫、11.4豫，低于對照組(70.4豫、85.2豫、77.8豫、33.3豫)，差異有統計學意義(P<0.05)。觀察組傷口閉閤時間[(14.26±4.32)d]、血液淨化次數[(6.28±3.69)次]、住院時間[(27.38±6.75)d]均較對照組[傷口閉閤時間院(19.73±5.47)d，血液淨化次數：(8.74±4.23)次，住院時間：(35.49±10.18)d]降低，差異有統計學意義(P<0.05)。兩組患者病死率及截肢率比較(2.86%、11.1%比5.9%、16.7%)，差異無統計學意義(P>0.05)。結論 VSD技術能夠有效降低軟組織損傷後跼部有害物質的吸收，減輕全身中毒癥狀，提高治療效果。
목적：관찰부압봉폐인류술(VSD)대사지연조직엄중제압상적치료효과。방법선택합이빈의과대학부속제일의원2012년10월~2014년10월수치적62례GustiloⅢ형연조직제압상환자，근거청창술후선택VSD인류혹상규환약치료분위관찰조(35례)화대조조(27례)，관찰조청창술후안장VSD장치，대조조근거상구정황매일환약1~2차。술후대환자행적겁적전신치료，병우술후48 h검측환자혈장백세포(WBC)계수，혈청갑리자(K+)、기항(Scr)、뇨소담(BUN)수평이급뇨단백정황。관찰환자출현급성신손상(AKI)、전신염증반응종합정(SIRS)、농독증、다기관공능장애종합정(MODS)병발증적발생솔，병통계환자병사솔。재환자출원시통계환자상구폐합시간、혈액정화차수、주원시간급절지솔등예후지표。결과관찰조WBC[(13.25±3.16)×109/L]、K+[(5.04±1.07)mmol/L]、Scr [(163.43±53.27)μmol/L]、BUN [(6.92±2.61)mmol/L]、뇨단백평분[(2.09±0.83)분]균우우대조조[WBC：(18.63±4.58)×109/L，K+：(5.93±1.42)mmol/L，Scr：(334.56±109.82)μmol/L，BUN：(10.35±3.48)mmol/L，뇨단백평분：(2.67±1.12)분]，차이유통계학의의(P<0.05)。관찰조출현AKF、SIRS、농독증、MODS병발증적발생솔±차위42.9예、60.0예、48.6예、11.4예，저우대조조(70.4예、85.2예、77.8예、33.3예)，차이유통계학의의(P<0.05)。관찰조상구폐합시간[(14.26±4.32)d]、혈액정화차수[(6.28±3.69)차]、주원시간[(27.38±6.75)d]균교대조조[상구폐합시간원(19.73±5.47)d，혈액정화차수：(8.74±4.23)차，주원시간：(35.49±10.18)d]강저，차이유통계학의의(P<0.05)。량조환자병사솔급절지솔비교(2.86%、11.1%비5.9%、16.7%)，차이무통계학의의(P>0.05)。결론 VSD기술능구유효강저연조직손상후국부유해물질적흡수，감경전신중독증상，제고치료효과。
Objective To observe the therapeutic effect of vacuum sealing drainage (VSD) on treating severe crush in-jury of limbs soft tissue. Methods From October 2012 to October 2014, in the First Affiliated Hospital of Harbin Med-ical University, 62 GustiloⅢ crush injured patients were chosen and divided into observed group (n =35)and control group (n = 27), according to using VSD or dressing change after debridement. After debridement, the observed group was installed VSD, the control group was used dressing change 1-2 times/d. With the positive therapy, all the patients were detected including white blood cell count (WBC), concentration of serum K+, levels of serum creatinine (Scr) and urea nitrogen (BUN), and urine protein quantity. The rates of complication were observed including acute kidney injury (AKI), systemic inflammatory response syndrome (SIRS), sepsis and multiple organ dysfunction syndrome (MODS), and both groups were calculated the mortality. At discharge, wound closure time, times of blood purification, hospital stays and ratio of amputation were measured as prognostic index. Results WBC [(13.25±3.16)í109/L], serum K+ [(5.04±1.07) mmol/L], Scr [(163.43±53.27) μmol/L], BUN [(6.92±2.61) mmol/L] and urine protein [(2.09±0.83) scores] in the ob-served group were better than those in the control group [WBC:(18.63±4.58)í109/L, serum K+:(5.93±1.42) mmol/L, Scr:(334.56±109.82) μmol/L, BUN: (10.35±3.48) mmol/L, urine protein:(2.67±1.12) scores], the differences were statistically significant (P< 0.05). The rates of com-plication AKF (42.9%), SIRS (60.0%), sepsis (48.6%), MODS (11.4%) in observed group were lower than those in the control group (70.4%, 85.2%, 77.8%, 33.3%), the dif-ferences were statistically significant (P < 0.05). Wound closure time [(14.26±4.32) d], times of blood purification [(6.28±3.69) times] and hospital stays [(27.38±6.75) d] in the observed group were less than those in the control group [(19.73±5.47) d, (8.74±4.23) times, (35.49±10.18) d], the differences were statistically significant (P< 0.05). However, the rates of mortality (2.86%) and amputation (11.1%) in observed group were compared with those in control group (5.9%, 16.7%), the differences were not statistically significant (P> 0.05). Conclusion The technique of VSD can re-duce the absorption of hazardous material after soft tissue injury effectively, alleviate the systemic toxemic symptoms and improve the therapeutic effect.
