Clinical efficacy of negative-pressure wound therapy combined with porcine acellular dermal matrix for repairing deep burn wounds in limbs
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摘要: 目的 观察负压伤口疗法(NPWT)联合猪ADM敷料修复非手术治疗患者四肢深度烧伤创面的效果。 方法 2012年6月—2015年12月,笔者单位收治符合入选标准的32例深Ⅱ~Ⅲ度四肢烧伤患者,根据随机数字表法并结合患者个人意愿分为NPWT组(应用间歇式负压吸引模式治疗,负压值为-16.6 kPa)10例、ADM组(应用猪ADM敷料治疗)7例和NPWT+ADM组(同前联合间歇式负压吸引与猪ADM敷料治疗)15例,治疗21 d后,残余创面采用磺胺嘧啶银常规换药处理。于治疗7、14、21 d,行创面大体观察、记录创面引流液量、计算创面愈合率;于治疗前和治疗21 d分别进行创面分泌物细菌学培养,统计细菌清除效果;记录创面愈合时间。对计量资料行重复测量方差分析、单因素方差分析、LSD检验;计数资料行
χ 2检验或Fisher确切概率法检验。 结果 (1)治疗7 d,NPWT组患者创面较治疗前明显缩小,ADM组患者创面较治疗前稍有缩小,NPWT+ADM组患者创面较治疗前明显缩小的同时散在形成皮岛。治疗14 d,NPWT组患者创面较治疗7 d稍有缩小,ADM组患者创面较治疗7 d缩小明显,NPWT+ADM组患者创面较治疗7 d明显缩小且创面皮岛增多或融合。治疗21 d,NPWT组患者部分创面愈合;ADM组患者创面较治疗14 d稍有缩小,大部分创面未愈合;NPWT+ADM组患者大多数创面愈合。(2)治疗7 d,NPWT组、NPWT+ADM组患者创面引流液量明显多于ADM组(P 值均小于0.01)。治疗14 d,NPWT组患者创面引流液量明显多于ADM组(P <0.01),ADM组、NPWT+ADM组患者创面引流液量相近(P >0.05)。治疗21 d,NPWT组、NPWT+ADM组患者创面引流液量明显少于ADM组(P 值均小于0.01);治疗7~21 d,NPWT+ADM组患者创面引流液量均明显少于NPWT组(P 值均小于0.01)。(3)治疗7 d,ADM组、NPWT+ADM组患者创面愈合率明显低于NPWT组(P <0.05或P <0.01),NPWT+ADM组患者创面愈合率明显高于ADM组(P <0.01)。治疗14、21 d,NPWT+ADM组患者创面愈合率明显高于NPWT组、ADM组(P 值均小于0.01),NPWT组患者创面愈合率明显高于ADM组(P 值均小于0.01)。(4)治疗前,NPWT组、ADM组、NPWT+ADM组患者分别有18、11、23处创面检出细菌;治疗21 d,NPWT组、ADM组、NPWT+ADM组患者分别有2、8、2处创面检出细菌。NPWT组、NPWT+ADM组患者创面细菌清除效果明显优于ADM组(P 值均小于0.01),NPWT+ADM组患者创面细菌清除效果与NPWT组相近(P =1.00)。(5)NPWT+ADM组患者创面愈合时间为(18.7±1.2)d,明显短于NPWT组[(23.9±1.5)d]、ADM组[(28.4±1.8)d],P 值均小于0.01;其中NPWT组患者创面愈合时间明显短于ADM组(P <0.01)。 结论 NPWT联合猪ADM敷料治疗深Ⅱ度以上烧伤创面能有效清除创面细菌、减少创面渗出、促进创面愈合,临床疗效优于单纯NPWT或猪ADM敷料治疗,适用于非手术治疗患者。Abstract: Objective To observe the clinical efficacy of negative pressure wound therapy (NPWT) in combination with porcine acellular dermal matrix (ADM) dressing for repairing deep burn wounds in limbs of patients with non-surgical treatment. Methods Thirty-two patients with deep partial-thickness burn to full-thickness burn on the limbs admitted to our ward from June 2012 to December 2015, conforming to the inclusion criteria, were divided into group NPWT (n =10, treated with interval negative pressure drainage at -16.6 kPa), group ADM (n =7, treated with porcine ADM dressing), and group NPWT+ ADM (n =15, treated with interval negative pressure drainage and porcine ADM dressing as above) according to the random number table and patient′s consent. After being treated for 21 d, residual wounds were cured by routine dressing change using sulfadiazine silver. On post treatment day (PTD) 7, 14, and 21, wound gross observation was conducted, wound drainage fluid volume was recorded, and wound healing rate was calculated. Wound secretion was collected for bacterial culture before treatment and on PTD 21, and bacterial clearance effect was recorded. The wound healing time was also recorded. Measurement data were processed with analysis of variance for repeated measurement, one-way analysis of variance, and LSD test. Eenumeration data were processed with chi-square test or Fisher′s exact test. Results (1) On PTD 7, the wounds of patients in group NPWT and group NPWT+ ADM were significantly shrinked as compared with those before treatment. Skin paddle scattered on the wounds of patients in group NPWT+ ADM on PTD 7. The wounds of patients in group ADM were slightly shrinked on PTD 7 as compared with those before treatment. On PTD 14, the wounds of patients in group NPWT were slightly shrinked as compared with those on PTD 7, while those in group NPWT+ ADM were significantly shrinked as compared with those on PTD 7. Skin paddle on the wounds of patients in group NPWT+ ADM on PTD 14 were increased and fused. The wounds of patients in group ADM were significantly shrinked on PTD 14 as compared with those on PTD 7. On PTD 21, partial wounds of patients in group NPWT were healed, while the wounds of patients in group ADM were slightly shrinked in comparison with those on PTD 14 and most of wounds were not healed. Most of wounds of patients in group NPWT+ ADM were healed. (2) On PTD 7, the wound drainage fluid volumes of patients in group NPWT and group NPWT+ ADM were obviously more than the wound drainage fluid volume of patients in group ADM (withP values below 0.01). On PTD 14, the wound drainage fluid volume of patients in group NPWT was significantly more than that in group ADM (P <0.01); while that between group ADM and group NPWT+ ADM was close (P >0.05). On PTD 21, the wound drainage fluid volume of patients in group NPWT and group NPWT+ ADM was significantly less than that in group ADM (withP values below 0.01). From PTD 7 to 21, the wound drainage fluid volumes of patients in group NPWT+ ADM were significantly reduced as compared with those in group NPWT (withP values below 0.01). (3) On PTD 7, the wound healing rates of patients in group ADM and group NPWT+ ADM were significantly lower than the wound healing rate of patients in group NPWT (P <0.05 orP <0.01), and the wound healing rate of patients in group NPWT+ ADM was significantly higher than that in group ADM (P <0.01). On PTD 14 and 21, the wound healing rates of patients in group NPWT+ ADM were significantly higher than those in group NPWT and group ADM (withP values below 0.01), and the wound healing rates of patients in group NPWT were significantly higher than those in group ADM (withP values below 0.01). (4) Before treatment, the bacteria were respectively detected in 18, 11, and 23 wounds of patients in group NPWT, group ADM, and group NPWT+ ADM. On PTD 21, the bacteria were respectively detected in 2, 8, and 2 wounds of patients in group NPWT, group ADM, and group NPWT+ ADM. The bacterial clearance of wounds of patients in group NPWT and group NPWT+ ADM was significantly better than that of patients in group ADM (withP values below 0.01). The bacterial clearance of wounds of patients in group NPWT+ ADM was close to that in group NPWT (P =1.00). (5) The wound healing time of patients in group NPWT+ ADM was (18.7±1.2) d, which was significantly shorter than that in group NPWT [(23.9±1.5) d] and group ADM [(28.4±1.8) d], withP values below 0.01. The wound healing time of patients in group NPWT was significantly shorter than that in group ADM (P <0.01). Conclusions NPWT combined with porcine ADM dressing can effectively remove wound bacteria, reduce wound exudation, and promote wound healing in repairing deep partial-thickness burn wounds and full-thickness burn wounds. Its clinical effect is better than NPWT or porcine ADM dressing alone, and this method may be suitable for patients with non-surgical treatment.-
Key words:
- Burns /
- Negative-pressure wound therapy /
- Biological dressings /
- Extremities /
- Biomechanics /
- Re-epithelization
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