目的 探讨皮下引流管持续冲洗及负压吸引预防腹部Ⅳ类切口感染的应用价值.方法 选取2008年1月至2014年7月佛山市第一人民医院收治的123例腹部Ⅳ类切口患者进行前瞻性研究,采用随机、单盲对照法,通过随机数字表法将入组患者分为试验组和对照组.患者均行开腹手术,试验组患者术后采用皮下留置引流管,术后行持续冲洗及负压吸引的方法;对照组患者术后采用传统关腹方法,未留置皮下引流管.记录患者术前Hb,术前Alb,美国麻醉医师学会(ASA)分级,术后1、3、7dHb和Alb,观察术后患者切口感染及细菌培养情况.患者均于出院后定期门诊复诊,每2周复诊1次,复诊至切口拆线后3个月.记录拆线后3个月内有无并发症发生.正态分布的计量资料采用x-±s表示,组间比较采用t检验;偏态分布的计量资料采用M(Qn)表示,组间比较采用秩和检验.重复测量的资料采用重复测量的方差分析,计数资料比较采用x2检验.结果 123例患者纳入研究.65例试验组患者术后1、3、7dHb分别为(111±15)g/L、(107±18) g/L、(108±13) g/L;58例对照组患者分别为(112±13) g/L、(106±16) g/L、(106±12)g/L,两组趋势比较,差异无统计学意义(F=0.124,P＞0.05).试验组患者术后1、3、7 d Alb分别为30 g/L(26 g/L,32g/L)、31 g/L(28 g/L,33 g/L)、35 g/L(32g/L,37 g/L);对照组分别为30 g/L(25 g/L,32g/L)、32g/L(29g/L,33g/L)、37g/L(32g/L,38g/L),两组趋势比较,差异无统计学意义(F=0.007,P＞0.05).试验组术后4例患者发生切口感染;对照组12例患者发生切口感染,两组比较,差异有统计学意义(x2=2.723,P＜ 0.05).患者感染均发生在术后4～6d,感染均只限于皮下组织,未达肌肉层或以下组织,全部敞开引流后行清创缝合,均治愈.患者均未发生再次感染.未发生切口感染的患者,均于术后7～9d拆线.切口细菌培养结果:大肠埃希菌8例(其中大肠埃希菌合并粪肠球菌1例、大肠埃希菌合并肺炎克雷伯杆菌和铜绿假单胞菌1例),铜绿假单胞菌1例,肺炎克雷伯杆菌2例,鲍曼不动杆菌1例,阴沟肠杆菌1例,无细菌3例.所有患者切口愈合拆线后随访3个月,随访期间患者均生存,未发现再次感染、切口裂开、切口疝等并发症.结论 皮下留置引流管行持续冲洗及负压吸引操作简单,能有效降低腹部Ⅳ类切口患者术后切口感染率.
目的 探討皮下引流管持續遲洗及負壓吸引預防腹部Ⅳ類切口感染的應用價值.方法 選取2008年1月至2014年7月彿山市第一人民醫院收治的123例腹部Ⅳ類切口患者進行前瞻性研究,採用隨機、單盲對照法,通過隨機數字錶法將入組患者分為試驗組和對照組.患者均行開腹手術,試驗組患者術後採用皮下留置引流管,術後行持續遲洗及負壓吸引的方法;對照組患者術後採用傳統關腹方法,未留置皮下引流管.記錄患者術前Hb,術前Alb,美國痳醉醫師學會(ASA)分級,術後1、3、7dHb和Alb,觀察術後患者切口感染及細菌培養情況.患者均于齣院後定期門診複診,每2週複診1次,複診至切口拆線後3箇月.記錄拆線後3箇月內有無併髮癥髮生.正態分佈的計量資料採用x-±s錶示,組間比較採用t檢驗;偏態分佈的計量資料採用M(Qn)錶示,組間比較採用秩和檢驗.重複測量的資料採用重複測量的方差分析,計數資料比較採用x2檢驗.結果 123例患者納入研究.65例試驗組患者術後1、3、7dHb分彆為(111±15)g/L、(107±18) g/L、(108±13) g/L;58例對照組患者分彆為(112±13) g/L、(106±16) g/L、(106±12)g/L,兩組趨勢比較,差異無統計學意義(F=0.124,P＞0.05).試驗組患者術後1、3、7 d Alb分彆為30 g/L(26 g/L,32g/L)、31 g/L(28 g/L,33 g/L)、35 g/L(32g/L,37 g/L);對照組分彆為30 g/L(25 g/L,32g/L)、32g/L(29g/L,33g/L)、37g/L(32g/L,38g/L),兩組趨勢比較,差異無統計學意義(F=0.007,P＞0.05).試驗組術後4例患者髮生切口感染;對照組12例患者髮生切口感染,兩組比較,差異有統計學意義(x2=2.723,P＜ 0.05).患者感染均髮生在術後4～6d,感染均隻限于皮下組織,未達肌肉層或以下組織,全部敞開引流後行清創縫閤,均治愈.患者均未髮生再次感染.未髮生切口感染的患者,均于術後7～9d拆線.切口細菌培養結果:大腸埃希菌8例(其中大腸埃希菌閤併糞腸毬菌1例、大腸埃希菌閤併肺炎剋雷伯桿菌和銅綠假單胞菌1例),銅綠假單胞菌1例,肺炎剋雷伯桿菌2例,鮑曼不動桿菌1例,陰溝腸桿菌1例,無細菌3例.所有患者切口愈閤拆線後隨訪3箇月,隨訪期間患者均生存,未髮現再次感染、切口裂開、切口疝等併髮癥.結論 皮下留置引流管行持續遲洗及負壓吸引操作簡單,能有效降低腹部Ⅳ類切口患者術後切口感染率.
목적 탐토피하인류관지속충세급부압흡인예방복부Ⅳ류절구감염적응용개치.방법 선취2008년1월지2014년7월불산시제일인민의원수치적123례복부Ⅳ류절구환자진행전첨성연구,채용수궤、단맹대조법,통과수궤수자표법장입조환자분위시험조화대조조.환자균행개복수술,시험조환자술후채용피하류치인류관,술후행지속충세급부압흡인적방법;대조조환자술후채용전통관복방법,미류치피하인류관.기록환자술전Hb,술전Alb,미국마취의사학회(ASA)분급,술후1、3、7dHb화Alb,관찰술후환자절구감염급세균배양정황.환자균우출원후정기문진복진,매2주복진1차,복진지절구탁선후3개월.기록탁선후3개월내유무병발증발생.정태분포적계량자료채용x-±s표시,조간비교채용t검험;편태분포적계량자료채용M(Qn)표시,조간비교채용질화검험.중복측량적자료채용중복측량적방차분석,계수자료비교채용x2검험.결과 123례환자납입연구.65례시험조환자술후1、3、7dHb분별위(111±15)g/L、(107±18) g/L、(108±13) g/L;58례대조조환자분별위(112±13) g/L、(106±16) g/L、(106±12)g/L,량조추세비교,차이무통계학의의(F=0.124,P＞0.05).시험조환자술후1、3、7 d Alb분별위30 g/L(26 g/L,32g/L)、31 g/L(28 g/L,33 g/L)、35 g/L(32g/L,37 g/L);대조조분별위30 g/L(25 g/L,32g/L)、32g/L(29g/L,33g/L)、37g/L(32g/L,38g/L),량조추세비교,차이무통계학의의(F=0.007,P＞0.05).시험조술후4례환자발생절구감염;대조조12례환자발생절구감염,량조비교,차이유통계학의의(x2=2.723,P＜ 0.05).환자감염균발생재술후4～6d,감염균지한우피하조직,미체기육층혹이하조직,전부창개인류후행청창봉합,균치유.환자균미발생재차감염.미발생절구감염적환자,균우술후7～9d탁선.절구세균배양결과:대장애희균8례(기중대장애희균합병분장구균1례、대장애희균합병폐염극뢰백간균화동록가단포균1례),동록가단포균1례,폐염극뢰백간균2례,포만불동간균1례,음구장간균1례,무세균3례.소유환자절구유합탁선후수방3개월,수방기간환자균생존,미발현재차감염、절구렬개、절구산등병발증.결론 피하류치인류관행지속충세급부압흡인조작간단,능유효강저복부Ⅳ류절구환자술후절구감염솔.
Objective To investigate the application value of continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal type Ⅳ incision infection.Methods A prospective,single-blind, randomized, controlled study was conducted based on the clinical data of 123 patients with abdominal type Ⅳ incision infection who were admitted to the First People's Hospital of Foshan between January 2008 and July 2014.Patients were divided into the experimental group and the control group based on the random number table and received open surgery.Patients in the experimental group were placed subcutaneous drainage tube with postoperative continuous irrigation and vacuum suction, while patients in the control group adopted the method of traditional abdominal closure without subcutaneous drainage tube.The levels of preoperative hemoglobin (Hb) and albumin (Alb), severity grading according to the American Society of Anesthetheologists (ASA), levels of Hb and Alb at postoperative day 1, 3, 7 were recorded and postoperative incision infection and bacteria culture were observed.Patients received bi-weekly regular return visit by outpatient evamination after discharged up to 3 months after suture removal.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed by t test.Measurement data with skew distribution were presented as M (Qn) and comparison between groups were analyzed by rank sum test.Repeated measures data were analyzed by the repeated measures ANOVA.Count data were analyzed by the chi-square test.Results One hundred and twenty-three patients were screened for eligibility, and 65 were allocated into the experimental group and 58 into the control group.The levels of Hb and Alb at postoperative day 1, 3, 7 were (111 ± 15) g/L, (107 ± 18) g/L, (108 ± 13) g/L and 30 g/L (26 g/L,32 g/L), 31 g/L(28 g/L,33 g/L), 35 g/L(32 g/L,37 g/L) in the experimental group and (112 ± 13)g/L, (106 ±16)g/L, (106 ± 12)g/L and 30 g/L(25 g/L,32 g/L), 32 g/L(29 g/L,33 g/L), 37 g/L (32 g/L,38 g/L) in the control group, with no significant difference in the changing trends of the above indexes between the 2 groups (F =0.124, 0.007, P ＞ 0.05).There were 4 patients with incision infection in the experimental group and 12 patients in the control group, showing a significant difference (x2=2.723, P ＜ 0.05).The infections occurred at postoperative 4-6 days confined to subcutaneous tissues and unreached to muscular and below layers, and then were cured by incision open drainage without recurrence.Patients without incision infection were removed the stitches at postoperative 7-9 days.Incision bacteria cultures showed that Escherichia coli was detected in 8 cases (including 1 complicated with Enterococcus faecalis and 1 complicated with Klebsiella pneumonia and Pseudomonas aeruginosa), Pseudomonas aeruginosa in 1 case, Klebsiella pneumonia in 2 cases, Acinetobacter baumanii in 1 case, Enterobacter cloacae in 1 case and no bacteria in 3 cases.All the patients were followed up for 3 months after incision healing and survived well without recurrence and complications such as incision split and incision fistula.Conclusion Continuous irrigation and vacuum suction by subcutaneous drainage tube can be operated easily and effectively reduce the postoperative infection rate in abdominal type Ⅳ incision.
