负压创面治疗技术在烧伤科创面治疗中的并发症分析
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摘要
目的探讨研究负压创面治疗技术(NPWT)在烧伤科创面治疗过程中常见的并发症,并分析出现并发症的可能原因、表现及相应的防治措施。方法回顾分析2015年2月-2017年11月于成都市第二人民医院烧伤整形科住院,并使用NPWT治疗创面的病例资料110例。结果 NPWT治疗期间,110病例中出现并发症35例,约占总病例数31.8%,其中装置漏气、漏液约占14例,引流通道堵塞11例,泡沫敷料植入5例,创面感染3例,创面出血2例,5病例出现两种或两种以上的并发症,约占总病例数4.5%。结论通过采取有效的预防和治疗措施,可以降低NPWT治疗期间并发症发生率,充分发挥其在辅助创面治疗中的优势,为创面修复创造良好的条件,提高创面的愈合速度和质量。
Objective To explore the common complications of negative-pressure wound therapy(NPWT) in the treatment of wounds at the Department of Burn, and to analyze the possible reasons, performance and the corresponding control measures. Methods Clinical data of 110, who were treated wounds with NPWT in the Burns and Plastic Surgery Department of the Second People's Hospital of Chengdu from February 2015 to November 2017, were retrospectively analyzed. Results During NPWT treatment, there were 35 complications in 110 cases, accounting for about 31.8% of the total cases, including devices with air leakage or liquid leakage in 14 cases, drainage channel blockage in 11 cases, implantation of foam dressings in 5 cases, wound infection in 3 cases, wound bleeding 2 cases and 5 cases had two or more complications, accounting for about 4.5% of the total cases. Conclusion By adopting effective prevention and treatment measures, the incidence of complications during NPWT treatment can be reduced, and its advantages in auxiliary treatment of wounds can be fully utilized to create favorable conditions for the wound repair and improve the healing speed and quality of wounds.
Objective To explore the common complications of negative-pressure wound therapy(NPWT) in the treatment of wounds at the Department of Burn, and to analyze the possible reasons, performance and the corresponding control measures. Methods Clinical data of 110, who were treated wounds with NPWT in the Burns and Plastic Surgery Department of the Second People's Hospital of Chengdu from February 2015 to November 2017, were retrospectively analyzed. Results During NPWT treatment, there were 35 complications in 110 cases, accounting for about 31.8% of the total cases, including devices with air leakage or liquid leakage in 14 cases, drainage channel blockage in 11 cases, implantation of foam dressings in 5 cases, wound infection in 3 cases, wound bleeding 2 cases and 5 cases had two or more complications, accounting for about 4.5% of the total cases. Conclusion By adopting effective prevention and treatment measures, the incidence of complications during NPWT treatment can be reduced, and its advantages in auxiliary treatment of wounds can be fully utilized to create favorable conditions for the wound repair and improve the healing speed and quality of wounds.
引文
[1]中华医学会烧伤外科学分会.负压封闭引流技术在烧伤外科应用的全国专家共识(2017版)[J].中华烧伤杂志,2017,3(33):129-135.DOI:10.3760/cma.j.issn.1009-2587.2017.03.001.
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[5]伍国胜,陈郑礼,朱世辉,等.深Ⅱ度烧伤创面植皮术后应用负压封闭引流技术的效果[J].中华烧伤杂志,2015,31(2):102-104.DOI:10.3760/cma.j.issn.1009-2587.2015.02.006.
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[9]NAKAYAMA M.Variations of Negative Pressure Wound Therapy[J].Journal of Surgical Technique and Case Report,2011,3(1):12.DOI:10.4103/2006-8808.78464.
[10]方亮.负压创伤治疗的循证推荐(压力水平、创面填充物、接触材料)——迈向达成国际共识的一步[J].中华普通外科学文献(电子版),2012,(4):346-355.DOI:10.3969/j.issn.1674-0793.2012.04.018.
[11]LESIAK AC,SHAFRITZ AB.Negative-pressure w o u n d t h e r a p y[J].T h e J o u r n a l o f h a n d surgery,2013,38(9):1828-1832.DOI:10.1016/j.jhsa.2013.04.029.
[12]JEFFERY S.The use of an antimicrobial primary wound contact layer as liner and filler with NPWT[J].Journal of wound care,2018,23(Sup8):S3-s14.DOI:10.12968/jowc.2014.23.Sup8.S1.
[13]GE D.The Safety of Negative-Pressure Wound Therapy on Surgical Wounds:An Updated Meta-analysis of 17Randomized Controlled Trials[J].Advances in skin&wound care,2018,31(9):421-428.DOI:10.1097/01.ASW.0000542530.71686.5c.
[14]ORGILL D P,BAYER L R.Negative pressure wound therapy:past,present and future[J].International wound journal,2013,10(Suppl 1):15-19.DOI:10.1111/iwj.12170.
[15]REN H,LI Y.Severe complications after negative pressure wound therapy in burned wounds:two case reports[J].Therapeutics and clinical risk management,2014,10(513-516).DOI:10.2147/TCRM.S66117.
[16]KANTAK N A,MISTRY R,VARON D E,et al.Negative Pressure Wound Therapy for Burns[J].Clinics in plastic surgery,2017,44(3):671-677.DOI:10.1016/j.cps.2017.02.023.
[17]HOELLER M,SCHINTLER M V,PFURTSCHELLER K,et al.A retrospective analysis of securing autologous split-thickness skin grafts with negative pressure wound therapy in paediatric burn patients[J].Burns:journal of the International Society for Burn Injuries,2014,40(6):1116-1120.DOI:10.1016/j.burns.2013.12.007.
[18]殷炜,胡官鸿,朱振洪,等.探讨负压封闭引流技术在烧伤整形术中的应用效果[J].中国医疗美容,2016,7(6):18-19.DOI:10.19593/j.issn.2095-0721.2016.07.009
[19]柴家科,申传安.重视负压伤口治疗技术在烧伤外科中的应用[J].中华烧伤杂志,2015:81-83.DOI:10.3760/cma.j.issn.1009-2587.2015.02.001.
[20]刘辉霞,申美平.持续负压封闭引流术在修复老年深度烧伤患者创面中的临床价值[J].中国老年学杂志,2013,7(33):1522-1523.DOI:10.3969/j.issn.1005-9202.2013.07.015.
[2]SINHA K,CHAUHAN V,MAHESHWARI R,et al.Vacuum Assisted Closure Therapy versus Standard Wound Therapy for Open Musculoskeletal Injuries[J].Adv Orthop,2013,2013:245940.DOI:10.1155/2013/245940.
[3]SUISSA D,DANINO A,NIKOLIS A.Negative-pressure therapy versus standard wound care:a meta-analysis of randomized trials[J].Plastic and reconstructive surgery,2011,128(5):498e-503e.DOI:10.1097/PRS.0b013e31822b675c.
[4]SAAIQ M,HAMEED-UD-DIN N,KHAN M,et al.Vacuumassisted closure therapy as a pretreatment for split thickness skin grafts[J].J Coll Physicians Surg Pak,2010,20(10):675-679.DOI:04.2010/JCPSP.675679.
[5]伍国胜,陈郑礼,朱世辉,等.深Ⅱ度烧伤创面植皮术后应用负压封闭引流技术的效果[J].中华烧伤杂志,2015,31(2):102-104.DOI:10.3760/cma.j.issn.1009-2587.2015.02.006.
[6]DESSY L A,SERRATORE F,CORRIAS F,et al.Retention of polyurethane foam fragments during VAC therapy:a complication to be considered[J].International wound journal,2015,12(2):132-136.DOI:10.1111/iwj.12062.
[7]刘政军,林才.封闭负压引流技术在烧伤创面的应用进展[J].中华烧伤杂志,2008,4(24):313-315.DOI:10.3760/cma.j.issn.1009-2587.2008.04.033.
[8]HUANG C,LEAVITT T,BAYER L R,et al.Effect of negative pressure wound therapy on wound healing[J].Current problems in surgery,2014,51(7):301-331.DOI:10.1067/j.cpsurg.2014.04.001.
[9]NAKAYAMA M.Variations of Negative Pressure Wound Therapy[J].Journal of Surgical Technique and Case Report,2011,3(1):12.DOI:10.4103/2006-8808.78464.
[10]方亮.负压创伤治疗的循证推荐(压力水平、创面填充物、接触材料)——迈向达成国际共识的一步[J].中华普通外科学文献(电子版),2012,(4):346-355.DOI:10.3969/j.issn.1674-0793.2012.04.018.
[11]LESIAK AC,SHAFRITZ AB.Negative-pressure w o u n d t h e r a p y[J].T h e J o u r n a l o f h a n d surgery,2013,38(9):1828-1832.DOI:10.1016/j.jhsa.2013.04.029.
[12]JEFFERY S.The use of an antimicrobial primary wound contact layer as liner and filler with NPWT[J].Journal of wound care,2018,23(Sup8):S3-s14.DOI:10.12968/jowc.2014.23.Sup8.S1.
[13]GE D.The Safety of Negative-Pressure Wound Therapy on Surgical Wounds:An Updated Meta-analysis of 17Randomized Controlled Trials[J].Advances in skin&wound care,2018,31(9):421-428.DOI:10.1097/01.ASW.0000542530.71686.5c.
[14]ORGILL D P,BAYER L R.Negative pressure wound therapy:past,present and future[J].International wound journal,2013,10(Suppl 1):15-19.DOI:10.1111/iwj.12170.
[15]REN H,LI Y.Severe complications after negative pressure wound therapy in burned wounds:two case reports[J].Therapeutics and clinical risk management,2014,10(513-516).DOI:10.2147/TCRM.S66117.
[16]KANTAK N A,MISTRY R,VARON D E,et al.Negative Pressure Wound Therapy for Burns[J].Clinics in plastic surgery,2017,44(3):671-677.DOI:10.1016/j.cps.2017.02.023.
[17]HOELLER M,SCHINTLER M V,PFURTSCHELLER K,et al.A retrospective analysis of securing autologous split-thickness skin grafts with negative pressure wound therapy in paediatric burn patients[J].Burns:journal of the International Society for Burn Injuries,2014,40(6):1116-1120.DOI:10.1016/j.burns.2013.12.007.
[18]殷炜,胡官鸿,朱振洪,等.探讨负压封闭引流技术在烧伤整形术中的应用效果[J].中国医疗美容,2016,7(6):18-19.DOI:10.19593/j.issn.2095-0721.2016.07.009
[19]柴家科,申传安.重视负压伤口治疗技术在烧伤外科中的应用[J].中华烧伤杂志,2015:81-83.DOI:10.3760/cma.j.issn.1009-2587.2015.02.001.
[20]刘辉霞,申美平.持续负压封闭引流术在修复老年深度烧伤患者创面中的临床价值[J].中国老年学杂志,2013,7(33):1522-1523.DOI:10.3969/j.issn.1005-9202.2013.07.015.