封闭式负压引流技术在“5·12”汶川大地震伤员创面中的早期应用疗效
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摘要
目的探讨封闭式负压引流(vacuum sealing drainage,VSD)技术在"5.12"汶川大地震伤员创面修复中的使用方法及早期疗效。方法2008年5月12日-6月12日,治疗52例伤员83处创面。男27例,女25例;年龄11～83岁,平均42岁。压榨伤22例,挫裂伤9例,挤压伤后行筋膜室切开减压17例,开放性截肢4例。创面部位:小腿37处,大腿13处,前臂17处,上臂11处,躯干5处。创面范围3cm×2cm～30cm×15cm。受伤至接受VSD技术治疗时间12h～18d。创面彻底清创后,VSD治疗覆盖创面,根据药物敏感实验结果选择抗生素治疗。创面感染控制、肉芽生长良好后行直接缝合、植皮或皮瓣移位修复创面。结果21例(40.4)伤员创面分泌物涂片阳性,以混合细菌为主:包括金黄色葡萄球菌、大肠埃希菌、变形杆菌等。首次治疗7例(20处)转外省医院治疗,33例(45处)、6例(10处)、2例(3处)及1例(1处)分别行1次、2次、3次及4次VSD治疗后,创面感染控制、肉芽生长良好,分别经直接缝合、植皮或皮瓣移位顺利修复创面。3例(4处)经10次VSD治疗后感染控制,病情稳定。结论VSD治疗能快速覆盖创面,减少污染,防止继发感染,利于后期创面修复;治疗期间无需频繁更换敷料,减少伤员痛苦及医务人员工作量,为地震伤员的救治提供了方便。
Objective To investigate the method of using vacuum sealing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic e ect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 wounds on the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from 3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or ap transposition was used to repair the wounds. Results In 21 cases (40.4), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia coli, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or ap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stability of condition. Conclusion VSD treatment can cover the wound promptly, eliminate contamination, prevent secondary infection and bene t late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can relieve the pain su ered by the injured and decrease the workload of medical stu ,thus facilitating the rescue work.
Objective To investigate the method of using vacuum sealing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic e ect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 wounds on the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from 3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or ap transposition was used to repair the wounds. Results In 21 cases (40.4), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia coli, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or ap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stability of condition. Conclusion VSD treatment can cover the wound promptly, eliminate contamination, prevent secondary infection and bene t late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can relieve the pain su ered by the injured and decrease the workload of medical stu ,thus facilitating the rescue work.
引文
1刘跃洪,江伟,刘树平,等.汶川地震596例骨折患者临床特点及早期治疗.中国修复重建外科杂志,2009,23(2):198-200.
2石应康,郑尚维.区域性国家级医院在汶川地震医疗救援中的战略支撑作用.中国循证医学杂志,2008,8(6):380-382.
3刘纪宁,王羽,刘云兵,等.四川地震疾病谱对医学救援的意义.中国急救医学,2008,28(6):513-514.
4徐家相.地震灾害的紧急医疗救援.中华急诊医学杂志,2005,14(7):557-558.
5彭碧波,仝青英,杨造成.印尼日惹地震救援中流动医院疾病谱分析.武警医学,2006,17(10):785-786.
6Roy N,Shah H,Patel V,et al.Surgical and psychosocial outcomes in the rural injured–a follow-up study of the2001earthquake victims.Injury,2005,36(8):927.
7喻爱喜,余国荣,邓凯,等.封闭负压吸引联合组织瓣移植治疗严重感染性骨外露.中华显微外科杂志,2006,29(3):219-220.
8曹勇,李勇,谭映军,等.“5.12”大地震医疗救治组织做法与体会.解放军医院管理杂志,2008,15(5):401-403.
9黄坚,姚元章,黄显凯,等.负压闭式引流加内固定治疗肢体开放性骨折.中国修复重建外科杂志,2003,17(6):456-458.
10姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-391.
11潘振宇,喻爱喜,余国荣,等.封闭式负压引流联合前臂皮神经营养血管皮瓣修复手掌皮肤缺损.中国修复重建外科杂志,2008,22(5):633-634.
12王洪,罗怀灿,杨述华,等.封闭式负压吸引技术治疗四肢骨筋膜室综合征.中华创伤骨科杂志,2003,5(4):342-343.
13侯爱利,钱远宇.介绍一种中心负压吸引持续引流的方法.中国医药导报,2008,5(5):150.
14赵琳,宋建星.创面敷料的研究现状与进展.中国组织工程研究与临床康复,2007,11(9):1724-1726.
15沈波,廖苏平,吴波.韧厚皮片结合封闭式负压吸引治疗感染性大面积皮肤缺损.临床外科杂志,2007,15(7):497-498.
16何飞,张春强,殷亮,等.封闭吸引结合腓肠神经皮瓣治疗小腿中下段开放性骨折.昆明医学院学报,2007,28(5):52-55.
17聂兰军,宋辉,蔡薇,等.负压创面治疗技术的研究进展.感染、炎症、修复,2008,9(3):191-192.
18李永忠,胡晓东,Moris Topaz,等.简易封闭式负压引流治疗35例汶川地震伤员创面的效果分析.中国循证医学杂志,2009,9(3):279-282.
2石应康,郑尚维.区域性国家级医院在汶川地震医疗救援中的战略支撑作用.中国循证医学杂志,2008,8(6):380-382.
3刘纪宁,王羽,刘云兵,等.四川地震疾病谱对医学救援的意义.中国急救医学,2008,28(6):513-514.
4徐家相.地震灾害的紧急医疗救援.中华急诊医学杂志,2005,14(7):557-558.
5彭碧波,仝青英,杨造成.印尼日惹地震救援中流动医院疾病谱分析.武警医学,2006,17(10):785-786.
6Roy N,Shah H,Patel V,et al.Surgical and psychosocial outcomes in the rural injured–a follow-up study of the2001earthquake victims.Injury,2005,36(8):927.
7喻爱喜,余国荣,邓凯,等.封闭负压吸引联合组织瓣移植治疗严重感染性骨外露.中华显微外科杂志,2006,29(3):219-220.
8曹勇,李勇,谭映军,等.“5.12”大地震医疗救治组织做法与体会.解放军医院管理杂志,2008,15(5):401-403.
9黄坚,姚元章,黄显凯,等.负压闭式引流加内固定治疗肢体开放性骨折.中国修复重建外科杂志,2003,17(6):456-458.
10姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-391.
11潘振宇,喻爱喜,余国荣,等.封闭式负压引流联合前臂皮神经营养血管皮瓣修复手掌皮肤缺损.中国修复重建外科杂志,2008,22(5):633-634.
12王洪,罗怀灿,杨述华,等.封闭式负压吸引技术治疗四肢骨筋膜室综合征.中华创伤骨科杂志,2003,5(4):342-343.
13侯爱利,钱远宇.介绍一种中心负压吸引持续引流的方法.中国医药导报,2008,5(5):150.
14赵琳,宋建星.创面敷料的研究现状与进展.中国组织工程研究与临床康复,2007,11(9):1724-1726.
15沈波,廖苏平,吴波.韧厚皮片结合封闭式负压吸引治疗感染性大面积皮肤缺损.临床外科杂志,2007,15(7):497-498.
16何飞,张春强,殷亮,等.封闭吸引结合腓肠神经皮瓣治疗小腿中下段开放性骨折.昆明医学院学报,2007,28(5):52-55.
17聂兰军,宋辉,蔡薇,等.负压创面治疗技术的研究进展.感染、炎症、修复,2008,9(3):191-192.
18李永忠,胡晓东,Moris Topaz,等.简易封闭式负压引流治疗35例汶川地震伤员创面的效果分析.中国循证医学杂志,2009,9(3):279-282.
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