本文關(guān)鍵詞： 燒傷 皮膚移植 削痂 負(fù)壓創(chuàng)面治療技術(shù)　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的在燒傷創(chuàng)面削痂清創(chuàng)術(shù)聯(lián)合郵票皮片或大張皮植皮術(shù)后,包扎換藥成為常規(guī)的后續(xù)創(chuàng)面治療。這種治療常引起創(chuàng)面的感染、局部水腫以及皮片成活率低及創(chuàng)面愈合不理想等不良反應(yīng)�，F(xiàn)負(fù)壓創(chuàng)面治療技術(shù)(vacuum sealing drainage,VSD)被應(yīng)用于臨床削痂植皮術(shù)后的治療。本研究旨在量化對(duì)比廣泛深度燒傷(extensive deep burns,EDB)后的患者行削痂植皮術(shù)(tangential excision and skin grafting,TESG)聯(lián)合VSD技術(shù)治療與削痂植皮術(shù)聯(lián)合傳統(tǒng)治療對(duì)創(chuàng)面愈合過程中皮片愈合及預(yù)后質(zhì)量的影響,分析探討其影響因素。以期為臨床應(yīng)用VSD技術(shù)的可行性提供一定的臨床參考。方法回顧性調(diào)查2014年3月至2016年12月山東大學(xué)附屬濟(jì)南市中心醫(yī)院燒傷科連續(xù)收治的35例深Ⅱ度～Ⅲ度燒傷行削痂植皮術(shù)聯(lián)合VSD技術(shù)治療(A組),以及43例深Ⅱ度～Ⅲ度燒傷行削痂植皮術(shù)聯(lián)合傳統(tǒng)治療(B組)患者的資料。通過單因素方差分析與卡方檢驗(yàn)比較A、B組兩種不同的后續(xù)治療方法在首次植皮成功率、術(shù)后14d植皮成活率、創(chuàng)面愈合時(shí)間、愈合質(zhì)量、換藥次數(shù)以及住院費(fèi)用上的差異。結(jié)果(1)A組共35例38次手術(shù)納入研究,男17例,女18例,年齡(31.74土30.67)歲,燒傷總面積(6.83±5.95)%TBSA,深Ⅱ度面積(4.37±5.24)%TBSA,Ⅲ度面積(2.46±1.77)%TBSA;B組共43例49次手術(shù)納入研究,男25 例,女 18 例,年齡(35.44±23.69)歲,燒傷總面積(8.09±7.45)%TBSA,深Ⅱ度面積(5.12±6.40)%TBSA,Ⅲ度面積(2.98±1.99)%TBSA。兩組患者以上資料經(jīng)單因素方差分析及卡方檢驗(yàn)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)結(jié)果無影響。(2)A組35例病人有3例須再次行植皮手術(shù);B組43例病人有6例須再次行植皮手術(shù)。A組術(shù)后14d植皮成活率(87.43± 19.79)%TBSA、B組術(shù)后14d植皮成活率(75.00±25.10)%TBSA;A組愈合時(shí)間為(22.06±10.79)d,B組愈合時(shí)間為(28.74±13.37)d;A組換藥次數(shù)為(5.77±3.17)次,B組換藥次數(shù)為(9.53±4.05)次;A組愈合質(zhì)量有21例優(yōu),10例良,3例良,1例差。B組愈合質(zhì)量有13例優(yōu),17例良,7例中,6例差;A組住院費(fèi)用為(40282.49± 17464.59)元,B 組住院費(fèi)用為(35301.60±30587.53)元。兩組患者以上資料經(jīng)單因素方差分析及卡方檢驗(yàn)比較,其中首次植皮成功率、住院費(fèi)用無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后14d植皮成活率、愈合時(shí)間、愈合質(zhì)量有統(tǒng)計(jì)學(xué)意義(P0.05)。換藥次數(shù)有緊密的統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論對(duì)廣泛深度燒傷創(chuàng)面采用削痂植皮術(shù)聯(lián)合負(fù)壓創(chuàng)面治療技術(shù)與傳統(tǒng)治療相比,有效縮短了殘余創(chuàng)面的愈合時(shí)間,提高了術(shù)后14d植皮成活率,提高了愈合質(zhì)量,明顯地減少了平均換藥次數(shù)。盡管治療組的住院費(fèi)用平均數(shù)高于傳統(tǒng)組,但在統(tǒng)計(jì)學(xué)上并無明顯差異。在手術(shù)次數(shù)上,兩種治療方法的首次植皮成功率都很高,在統(tǒng)計(jì)學(xué)上無明顯差異�？赡苡捎诳s短了住院時(shí)間,所以其在住院費(fèi)用上并沒有明顯高于傳統(tǒng)治療方法,總體上來說值得在臨床推廣應(yīng)用。
[Abstract]:Objective after burn wound debridement combined with stamp skin grafts or large skin grafting bandaging and dressing change become routine follow-up wound treatment. This treatment often causes wound infection. Local edema, low survival rate of skin grafts and poor wound healing were all adverse reactions. Vacuum sealing drainage was used to treat the wound under negative pressure. VSD) has been used in clinical escharectomy and skin grafting. The purpose of this study was to quantitatively compare extensive deep burn with extensive deep burns. The patients were treated with tangential excision and skin grafting after escharectomy and skin grafting. Effects of VSD combined with scab removal and skin grafting combined with traditional treatment on skin graft healing and prognosis during wound healing. To provide some clinical reference for the feasibility of clinical application of VSD technique. Methods A retrospective investigation was conducted from March 2014 to December 2016 in the center of Jinan affiliated to Shandong University. 35 cases of deep 鈪，

本文編號(hào)：1445123