【摘要】：目的:通過比較封閉負(fù)壓引流(vaccum sealing drainage,VSD)與常規(guī)切開引流于頜面部間隙感染(maxillofacial space infection,MSI)治療中患者的疼痛程度、治療時(shí)間、抗生素使用時(shí)間、換藥次數(shù)及好轉(zhuǎn)率等來評(píng)估VSD的臨床療效。方法:收集大連醫(yī)科大學(xué)附屬第一醫(yī)院口腔科病房自2015年2月至2017年1月期間住院的MSI患者30例,其中感染部位位于口底多間隙的患者23例、位于頜下間隙的患者3例、位于咬肌間隙的患者2例以及位于頰間隙的患者2例。將這些患者隨機(jī)分為對(duì)照組和實(shí)驗(yàn)組,其中對(duì)照組20例患者行傳統(tǒng)的切開引流術(shù)治療,實(shí)驗(yàn)組10例患者采用VSD治療。30例MSI患者入院后除了要進(jìn)行常規(guī)的檢查及檢驗(yàn)來排除手術(shù)禁忌癥之外,均先經(jīng)驗(yàn)性應(yīng)用抗生素行抗炎治療并取膿汁做細(xì)菌培養(yǎng)加藥敏試驗(yàn),當(dāng)檢驗(yàn)的結(jié)果出來之后給予敏感抗生素治療,兩組患者均已穿刺并抽出膿液,滿足切開引流指征并行口外切口的膿腫切開局部清創(chuàng)手術(shù)治療。所有實(shí)驗(yàn)數(shù)據(jù)均采用SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,根據(jù)數(shù)據(jù)的特點(diǎn)進(jìn)行T檢驗(yàn)和卡方檢驗(yàn),統(tǒng)計(jì)資料以表格的形式進(jìn)行描述分析。通過比較患者的疼痛程度、治療時(shí)間、抗生素使用時(shí)間、換藥次數(shù)及好轉(zhuǎn)率等來評(píng)估VSD的臨床療效。結(jié)果:1、兩組患者治療過程疼痛情況對(duì)比,對(duì)照組治療之前的疼痛程度值為(6.500±0.512),實(shí)驗(yàn)組治療之前的疼痛程度值為(6.800±0.632),兩組比較差異無統(tǒng)計(jì)學(xué)意義(P=0.1063)。對(duì)照組治療過程中的疼痛程度值為(5.500±0.607),實(shí)驗(yàn)組治療過程中的疼痛程度值為(3.500±0.527),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P＜0.001),對(duì)照組治療之后的疼痛程度值為(1.350±0.671),實(shí)驗(yàn)組治療之后的疼痛程度值為(0.500±0.527),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P=0.0005)。2、兩組患者治療時(shí)間、抗生素使用時(shí)間、換藥次數(shù)及好轉(zhuǎn)率對(duì)比,對(duì)照組平均治療時(shí)間為(11.850±2.207)天,實(shí)驗(yàn)組平均治療時(shí)間為(9.700±2.406)天,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P=0.0150)。對(duì)照組抗生素平均使用天數(shù)(8.650±2.033)天,實(shí)驗(yàn)組抗生素平均使用天數(shù)(6.800±1.687)天,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P=0.0076),對(duì)照組換藥次數(shù)為(9.200±2.262)次,實(shí)驗(yàn)組換藥次數(shù)為(3.900±0.738)次,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P＜0.001)。對(duì)照組好轉(zhuǎn)率為50%,實(shí)驗(yàn)組好轉(zhuǎn)率為70%,兩組比較差異無統(tǒng)計(jì)學(xué)意義(P=0.242)。結(jié)論:1、VSD與傳統(tǒng)切開引流方法在治療MSI的療效上相比較其創(chuàng)口愈合時(shí)間相對(duì)較短、患者疼痛減輕、住院日降低,并且醫(yī)生工作量明顯減輕。2、VSD是治療MSI的一種較好的治療手段,可推廣使用。
[Abstract]:Objective: to evaluate the clinical efficacy of VSD by comparing the pain degree, time of treatment, time of antibiotic use, times of dressing change and the rate of improvement in the treatment of (maxillofacial space infection in maxillofacial space by comparing the treatment of (vaccum sealing drainage with closed negative pressure drainage (vaccum sealing drainage) and conventional incision and drainage. Methods: from February 2015 to January 2017, 30 patients with MSI in the Department of Stomatology of the first affiliated Hospital of Dalian Medical University were collected. Two patients were located in the masseter space and two in the buccal space. These patients were randomly divided into two groups: the control group and the experimental group, in which 20 patients in the control group were treated with traditional incision and drainage. In the experimental group, 10 patients were treated with VSD. 30 patients with MSI were treated with antibiotics after admission to hospital. In addition to routine examination and test to eliminate contraindications, antibiotics were first used for anti-inflammatory therapy and pus was taken for bacterial culture and drug sensitivity test. When the results of the test were treated with sensitive antibiotics, the patients in both groups had been punctured and extracted the pus, which satisfied the indication of incision and drainage and local debridement of the abscess with external incision. All the experimental data are analyzed by SPSS 20.0 statistical software, T test and chi-square test are carried out according to the characteristics of the data, and the statistical data are described and analyzed in the form of tables. The clinical efficacy of VSD was evaluated by comparing the degree of pain, the time of treatment, the time of antibiotic use, the times of dressing change and the rate of improvement. Results the pain level of the two groups was (6.500 鹵0.512) before treatment and (6.800 鹵0.632) before treatment in the experimental group. There was no significant difference between the two groups (P0. 1063). The pain degree of the control group was (5.500 鹵0.607), and that of the experimental group was (3.500 鹵0.527). The difference between the two groups was statistically significant (P < 0.001). After treatment, the pain degree of the control group was (1.350 鹵0.671), and that of the experimental group was (1.350 鹵0.671). The degree of pain in the two groups was (0.500 鹵0.527), the difference was statistically significant (P0. 0005). The average treatment time of the control group was (11.850 鹵2.207) days, the average treatment time of the experimental group was (9.700 鹵2.406) days, the difference between the two groups was statistically significant (P0.0150). The average days of antibiotic use were (8.650 鹵2.033) days in the control group and (6.800 鹵1.687) days in the experimental group. The difference between the two groups was statistically significant (P0. 0076). The number of changes of antibiotics in the control group was (9.200 鹵2.262) times, and that in the experimental group was (3.900 鹵0.738) times. The difference between the two groups was statistically significant (P < 0.001). The improvement rate of the control group was 50 and that of the experimental group was 70. There was no significant difference between the two groups (P0. 242). Conclusion compared with the traditional incision and drainage method, the wound healing time is relatively short, the pain is alleviated, the hospitalization days are reduced, and the workload of the doctor is obviously reduced. It is a better treatment method to treat MSI. It can be popularized.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782.3
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本文編號(hào)：2197709