【摘要】：目的: 觀察、評價超聲波清創(chuàng)聯(lián)合負(fù)壓封閉引流（Vacuum sealing drainage,VSD）促進(jìn)慢性創(chuàng)面愈合的治療效果；尋找一種促進(jìn)慢性創(chuàng)面快速愈合的新方法。 方法： 選取自2012年9月至2014年1月鄭州大學(xué)第一附屬醫(yī)院急診外科收住院、伴有慢性創(chuàng)面的病人434例作為研究對象，隨機(jī)分為超聲波清創(chuàng)組206例與常規(guī)清創(chuàng)組228例，超聲波清創(chuàng)組病人以多功能超聲波清創(chuàng)儀清創(chuàng)后以VSD材料覆蓋創(chuàng)面，以后每7天清創(chuàng)1次并更換VSD材料，引流管被堵塞，封閉負(fù)壓失效時及時更換，，直至創(chuàng)面愈合或者創(chuàng)面肉芽新鮮、以縫合、植皮或者皮瓣修復(fù)消滅創(chuàng)面結(jié)束；常規(guī)清創(chuàng)組采用常規(guī)清創(chuàng)方法，即使用手術(shù)刀或者剪刀直接切除痂皮及壞死組織，創(chuàng)面以雙氧水及生理鹽水反復(fù)沖洗，鹽水紗布刷洗，至肉眼觀察創(chuàng)面肉芽紅潤為止，清創(chuàng)后同樣以VSD材料覆蓋，每7天清創(chuàng)1次并更換VSD材料，引流管被堵塞，封閉負(fù)壓失效時及時更換，直至創(chuàng)面愈合或者創(chuàng)面肉芽新鮮，以縫合、植皮或者皮瓣修復(fù)消滅創(chuàng)面結(jié)束。觀察、評價兩組創(chuàng)面的細(xì)菌清除率，創(chuàng)面愈合時間，手術(shù)時間，住院天數(shù)等指標(biāo)。 結(jié)果: 超聲波清創(chuàng)組在提高細(xì)菌清除率、縮短手術(shù)時間、加快創(chuàng)面愈合時間、縮短住院天數(shù)等方面均優(yōu)于常規(guī)清創(chuàng)組（P0.05）。 結(jié)論: 超聲波清創(chuàng)聯(lián)合VSD技術(shù)應(yīng)用于慢性創(chuàng)面使兩者優(yōu)勢疊加，能夠提高清創(chuàng)效率，改善清創(chuàng)效果，加速慢性創(chuàng)面的愈合，是一種較好的聯(lián)合治療慢性創(chuàng)面的新方法，值得推廣應(yīng)用。
[Abstract]:Objective: to observe and evaluate the therapeutic effect of ultrasonic debridement combined with negative pressure sealing drainage (Vacuum sealing drainage,VSD) on chronic wound healing and to find a new method to promote the rapid healing of chronic wound. Methods: from September 2012 to January 2014, 434 patients with chronic wound were randomly divided into ultrasonic debridement group (206 cases) and routine debridement group (228 cases). The patients in the ultrasonic debridement group were covered with VSD material after debridement with multifunctional ultrasonic debridement instrument. After that, the wound was debrided once every 7 days and the VSD material was replaced, the drainage tube was blocked, and the sealing negative pressure failed to be replaced in time. Until the wound is healed or the granulation of the wound is fresh, the wound ends with suture, skin grafting or flap repair. In the conventional debridement group, the scab and necrotic tissue were directly removed with scalpel or scissors, the wound was washed repeatedly with hydrogen peroxide and normal saline, the salt water gauze was brushed, and the granulation was observed with naked eyes. After debridement, the wound was also covered with VSD material, and the VSD material was replaced once every 7 days. The drainage tube was blocked. When the sealing negative pressure failed, it was replaced in time until the wound healed or the granulation of the wound was fresh to suture. End of skin graft or skin flap repair and exterminate wound. The bacterial clearance rate, wound healing time, operation time and hospital stay were observed and evaluated. Results: the ultrasonic debridement group was superior to the conventional debridement group in improving the bacterial clearance rate, shortening the operation time, accelerating the wound healing time and shortening the hospitalization days (P0.05). Conclusion: ultrasonic debridement combined with VSD can improve the efficiency of debridement, improve the effect of debridement and accelerate the healing of chronic wounds. It is a new method of combined treatment of chronic wounds. It is worth popularizing and applying.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R641

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