Analysis of factors influencing tension blister formation on the skin at the dressing edges in patients undergoing negative pressure wound therapy
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摘要:
目的 探讨使用负压伤口疗法（NPWT）患者敷料边缘皮肤张力性水疱形成的影响因素。 方法 该研究为回顾性病例对照研究。2020年9月—2023年8月,安徽医科大学附属阜阳市人民医院骨科收治187例符合入选标准的使用NPWT患者,其中男112例、女75例,年龄（52±17）岁。根据采用NPWT治疗3 d后NPWT填充敷料（以下简称敷料）边缘皮肤有无张力性水疱,将患者分为无水疱组（97例）、水疱组（90例）。比较2组患者的性别、年龄、入院当天收缩压、入院当天舒张压、体重指数、创面面积、创面清创手术时长、创面感染情况、合并骨折情况、创面冲洗情况、敷料使用部位、敷料处理方式等临床特征及入院后1 d生物化学指标。筛选187例患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成的独立影响因素。 结果 2组患者年龄、敷料使用部位、敷料处理方式比较,差异均有统计学意义（t=2.057,χ2值分别为5.589、27.686,P<0.05）；其余临床特征和入院后1 d所有生物化学指标比较,差异均无统计学意义（P>0.05）。单因素logistic回归分析结果显示,年龄、凡士林纱布处理敷料、切割处理敷料均为抑制患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成的保护因素（OR分别为0.983、0.130、0.381,95%CI分别为0.966~0.999、0.058~0.287、0.178~0.816,P<0.05）,而躯干为促进患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成的危险因素（OR=2.028,95%CI为1.125~3.655,P<0.05）。多因素logistic回归分析结果显示,躯干为促进患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成的独立危险因素（OR=2.566,95%CI为1.306~5.043,P<0.05）,凡士林纱布处理敷料、切割处理敷料均为抑制患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成的独立保护因素（OR分别为0.111、0.363,95%CI分别为0.048~0.257、0.165~0.797,P<0.05）。 结论 针对患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成,躯干为独立危险因素,凡士林纱布处理敷料、切割处理敷料为独立保护因素。 Abstract:Objective To investigate the factors that influence the formation of tension blisters on the skin at the dressing edges in patients undergoing negative pressure wound therapy (NPWT). Methods This study was a retrospective case-control study. From September 2020 to August 2023, 187 patients undergoing NPWT who met the inclusion criteria were admitted to the Department of Orthopedics of Fuyang People's Hospital Affiliated to Anhui Medical University, including 112 males and 75 females, aged (52±17) years. Based on the presence or absence of tension blisters on the skin at the edge of NPWT filling dressings (hereinafter referred to as dressings) after 3 days of NPWT, the patients were divided into no blister group (97 cases) and blister group (90 cases). The clinical characteristics (gender, age, systolic blood pressure on admission, diastolic blood pressure on admission, body mass index, wound area, duration of wound debridement, wound infection status, concomitant fractures, wound irrigation, dressing application site, and dressing management method) as well as biochemical indicators on day 1 after admission were compared between the two groups. The independent influencing factors for tension blister formation at the dressing edges in 187 patients after 3 days of NPWT were screened. Results There were statistically significant differences between the two groups of patients in terms of age, dressing application site, and dressing management method (t=2.057, with χ2 values of 5.589 and 27.686, respectively, P<0.05); there were no statistically significant differences in the other clinical characteristics or biochemical indicators on day 1 after admission (P>0.05). Univariate logistic regression analysis results showed that age, dressings treated with petrolatum jelly gauze and dressing trimming were protective factors against the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (with ORs of 0.983, 0.130, and 0.381, respectively, 95% CIs of 0.966-0.999, 0.058-0.287, and 0.178-0.816, respectively, P<0.05); trunk was the risk factor facilitating the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (OR=2.028, with 95% CI of 1.125-3.655, P<0.05). Multivariate logistic regression analysis results showed that trunk was the independent risk factor facilitating the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (OR=2.566, with 95% CI of 1.306-5.043, P<0.05); dressings treated with petrolatum jelly gauze and dressing trimming were independent protective factors against the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (with ORs of 0.111 and 0.363, respectively, 95% CIs of 0.048-0.257 and 0.165-0.797, respectively, P<0.05). Conclusions For patients who developed tension blisters on the skin at the dressing edges after 3 days of NPWT, the trunk is identified as the independent risk factor, whereas dressings treated with petrolatum jelly gauze, and dressing trimming are the independent protective factors. -
Key words:
- Negative-pressure wound therapy /
- Wound healing /
- Torso /
- Root cause analysis /
- Tension blisters /
- Dressings
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参考文献
(38) [1] 陈孝强,张伟,李学拥. 负压伤口疗法促进创面愈合的生物力学效应研究进展[J]. 中华烧伤杂志,2018,34(4):243-246.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.010. [2] 李勇, 付永彬, 宁涛, 等. “麻叶块”成形联合引流术治疗Morel-Lavallée损伤[J]. 中国矫形外科杂志, 2020,28(24):2299-2301.DOI: 10.3977/j.issn.1005-8478.2020.24.24. [3] 陈武林,阮成群,孙群周,等.外固定器结合封闭负压引流术降低开放性胫腓骨骨折术后感染效果及临床价值研究[J].中华医院感染学杂志,2019,29(7):1076-1079,1087. DOI: 10.11816/cn.ni.2019-180656. [4] ZaverV, MariettaM, KankanaluP. Negative pressure wound therapy[M/OL]. Treasure Island (FL): StatPearls Publishing, 2026[2026-05-09]. https://www.ncbi.nlm.nih.gov/books/NBK576388/. https://www.ncbi.nlm.nih.gov/books/NBK576388/ [5] EbeidI,EbeidA,ShalabyA,et al.Negative pressure wound therapy for the prevention of surgical site infections in orthopedic and trauma surgery: a systematic review and meta-analysis of RCTs[J].J Orthop Traumatol,2025,26(1):75.DOI: 10.1186/s10195-025-00889-0. [6] LutherL,MaxsonR,StinnerDJ.Negative pressure wound therapy in resource-limited environments: review and field guide[J].J Trauma Acute Care Surg,2025,99(3S Suppl 1):S143-S149.DOI: 10.1097/TA.0000000000004708. [7] AtkinsBZ,WootenMK,KistlerJ,et al.Does negative pressure wound therapy have a role in preventing poststernotomy wound complications?[J].Surg Innov,2009,16(2):140-146.DOI: 10.1177/1553350609334821. [8] LiuX,LiangJ,ZaoJ,et al.Vacuum sealing drainage treatment combined with antibiotic-impregnated bone cement for treatment of soft tissue defects and infection[J].Med Sci Monit,2016,22:1959-1965.DOI: 10.12659/msm.896108. [9] BernatchezSF.Current state of science in negative pressure wound therapy[J].Adv Wound Care (New Rochelle),2025,14(6):273-278.DOI: 10.1089/wound.2024.0180. [10] 唐光平,汤美玉,叶恒.封闭负压吸引技术临床运用的并发症[J].骨科,2012,3(3):156-158.DOI: 10.3969/j.issn.1674-8573.2012.03.019. [11] 张聪明,王谦,任程,等.改良负压封闭引流技术对局部水泡的影响[J].中华创伤骨科杂志,2017,19(3):203-206.DOI: 10.3760/cma.j.issn.1671-7600.2017.03.004. [12] 邓雅萍,邓呈亮.负压伤口疗法在游离皮瓣移植手术中的应用研究进展[J].中华烧伤与创面修复杂志,2024,40(9):885-890.DOI: 10.3760/cma.j.cn501225-20231106-00181. [13] ZhouJ, YuJ, HuT, et al. Functionalized collagen-based sponge dressing integrating negative pressure wound therapy and photothermal antibacterial treatment for advanced wound management[J/OL]. Biomater Sci,2026.(2026-04-29)[2026-05-09].https://pubmed.ncbi.nlm.nih.gov/42052720/.DOI:10.1039/d6bm00297h. [published online ahead of print]. [14] 郭晓峰,金柱成,邓鑫鑫,等.抗生素骨水泥联合负压封闭引流治疗糖尿病并发坏死性筋膜炎的临床效果[J].中华烧伤与创面修复杂志,2023,39(12):1158-1162.DOI: 10.3760/cma.j.cn501225-20231030-00151. [15] 钟宇惠, 崔旭, 周思拓, 等. 抗生素骨水泥与VSD联合游离股前外侧穿支嵌合肌皮瓣序贯治疗糖尿病性跟骨骨髓炎创面的临床效果[J]. 中华烧伤与创面修复杂志, 2026,42(3):225-233.DOI: 10.3760/cma.j.cn501225-20251129-00493. [16] KeenanC, ObaidiN, NeelonJ, et al. Negative pressure wound therapy: challenges, novel techniques, and future perspectives[J].Adv Wound Care (New Rochelle),2025,14(1):33-47.DOI: 10.1089/wound.2023.0157. [17] 季超,肖仕初.负压伤口疗法在创面治疗中的临床应用及其相关研究进展[J].中华烧伤与创面修复杂志,2022,38(6):585-589.DOI: 10.3760/cma.j.cn501120-20210511-00179. [18] 栾夏刚, 张伟, 张卫东, 等. 颈项部复杂创面的修复策略与临床效果[J]. 中华烧伤与创面修复杂志, 2025,41(5):454-462. DOI: 10.3760/cma.j.cn501225-20241201-00471. [19] 张旭艳,王中京,丁胜,等.封闭负压引流治疗糖尿病足溃疡的疗效及对VEGF、MMP-2及TIMP-1的影响[J].中国老年学杂志,2018,38(6):1289-1291.DOI: 10.3969/j.issn.1005-9202.2018.06.004. [20] 徐清平,宋登峰,王金,等.胫腓骨开放性骨折患者术后感染病原菌分布及VSD治疗对微循环与相关血清细胞因子指标水平的影响[J].中华医院感染学杂志,2017,27(24):5642-5645.DOI: 10.11816/cn.ni.2017-172743. [21] FleischmannW, StreckerW, BombelliM, et al. Vacuum sealing as treatment of soft tissue damage in open fractures[J]. Unfallchirurg, 1993,96(9):488-492. [22] 赵久红,吕叶辉,雷翊涵.创面修复机制研究领域的热点和演化趋势的可视化分析[J].中华烧伤与创面修复杂志,2024,40(5):433-442.DOI: 10.3760/cma.j.cn501225-20240118-00022. [23] 王爱,马文国,王成德,等.自体富血小板血浆凝胶联合负压封闭引流技术治疗难愈性创面的临床效果[J].中华烧伤杂志,2021,37(1):42-48.DOI: 10.3760/cma.j.cn501120-20200105-00004. [24] NuhijiE.Trends and innovation in negative pressure wound therapy: a review of burn wound management[J].Adv Wound Care (New Rochelle),2024,13(8):391-399.DOI: 10.1089/wound.2023.0114. [25] ArundelC,MandefieldL,FairhurstC,et al.Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2): an open-label, multicentre, parallel-group, randomised controlled trial[J].Lancet,2025,405(10490):1689-1699.DOI: 10.1016/S0140-6736(25)00143-6. [26] DuH,JiangT,MaoR,et al.The role of negative pressure therapy in diabetic foot ulcer: a meta-analysis[J].J Diabetes,2026,18(4):e70226.DOI: 10.1111/1753-0407.70226. [27] CollingeC,ReddixR.The incidence of wound complications related to negative pressure wound therapy power outage and interruption of treatment in orthopaedic trauma patients[J].J Orthop Trauma,2011,25(2):96-100.DOI: 10.1097/BOT.0b013e3181de0134. [28] PortouM,BernaertsK,BassettoF,et al.Negative pressure wound therapy made simple: expert panel recommendations[J].J Wound Care,2026,35(4):292-298.DOI: 10.12968/jowc.2025.0149. [29] SaramagoP,GkekasA,ArundelCE,et al.Negative pressure wound therapy for surgical wounds healing by secondary intention is not cost-effective[J].Br J Surg,2025,112(5): znaf077.DOI: 10.1093/bjs/znaf077. [30] VarelaCD,VaughanTK,CarrJB,et al.Fracture blisters: clinical and pathological aspects[J].J Orthop Trauma,1993,7(5):417-427.DOI: 10.1097/00005131-199310000-00004. [31] KuoFC,HsuCW,TanTL,et al.Effectiveness of different wound dressings in the reduction of blisters and periprosthetic joint infection after total joint arthroplasty: a systematic review and network meta-analysis[J].J Arthroplasty,2021,36(7):2612-2629.DOI: 10.1016/j.arth.2021.02.047. [32] StrebelSJ,BurbankKM,TullarJM,et al.A retrospective analysis of the aspiration of fracture blisters[J].J Clin Orthop Trauma,2020,11(Suppl 1):S171-S173.DOI: 10.1016/j.jcot.2019.11.002. [33] CoskerT,ElsayedS,GuptaS,et al.Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients[J].J Wound Care,2005,14(1):27-29.DOI: 10.12968/jowc.2005.14.1.26722. [34] SharmaG,LeeSW,AtanacioO,et al.In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis[J].Int Orthop,2017,41(7):1295-1305.DOI: 10.1007/s00264-017-3484-4. [35] MorykwasMJ,ArgentaLC,Shelton-BrownEI,et al.Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation[J].Ann Plast Surg,1997,38(6):553-562.DOI: 10.1097/00000637-199706000-00001. [36] ChauWW,LoKC,LauLC,et al.Single use Negative Pressure Wound Therapy (NPWT) system in the management of knee arthroplasty[J].BMC Musculoskelet Disord,2023,24(1):351.DOI: 10.1186/s12891-023-06470-2. [37] ZhangC,WangQ,WangZ,et al.Modified negative-pressure wound therapy for linear blister formation prevention around foam dressings: technical note and case series[J].J Orthop Surg Res,2021,16(1):602.DOI: 10.1186/s13018-021-02759-x. [38] NingT, GuoH, SongQ, et al. A modified negative pressure wound therapy reduces the occurrence of tension blisters around negative pressure dressings[J]. Altern Ther Health Med, 2023,29(8):540-544. -
Table 1. 2组使用NPWT患者临床特征比较
组别 例数 性别（例） 年龄（岁, 入院当天收缩压（mmHg, 入院当天舒张压（mmHg, 体重指数（kg/m2, 创面面积[cm2,M（Q1,Q3）] 男 女 无水疱组 97 54 43 54±18 129±21 75±13 23±4 150.00（82.50,217.00） 水疱组 90 58 32 49±17 127±18 76±12 24±4 150.00（123.75,375.00） 统计量值 χ2=1.496 t=2.057 t=0.422 t=-0.669 t=-1.153 Z=-0.918 P值 0.221 0.041 0.673 0.504 0.250 0.359 注：NPWT为负压伤口疗法；根据采用NPWT治疗3 d后NPWT填充敷料（简称敷料）边缘皮肤有无张力性水疱,将患者分为无水疱组、水疱组；1 mmHg=0.133 kPa；凡士林纱布处理为于敷料边缘垫入宽约2 cm凡士林纱布,切割处理为将敷料边缘切割为45°角 
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Table 2. 2组使用NPWT患者入院后1 d生物化学指标比较
组别 例数 白细胞计数[×109/L,M（Q1,Q3）] 中性粒细胞（ 血红蛋白（g/L, 肌酐[μmol/L,M（Q1,Q3）] 尿素氮[mmol/L,M（Q1,Q3）] 无水疱组 97 8.70（5.74,12.22） 0.75±0.15 118±22 55.00（44.25,65.95） 5.70（4.45,6.70） 水疱组 90 8.88（6.03,12.58） 0.76±0.12 120±21 57.25（47.88,66.88） 5.45（4.60,7.20） 统计量值 Z=-0.717 t=-0.475 t=-0.477 Z=-0.664 Z=-0.457 P值 0.474 0.635 0.634 0.507 0.648 注：NPWT为负压伤口疗法；根据采用NPWT治疗3 d后NPWT填充敷料（简称敷料）边缘皮肤有无张力性水疱,将患者分为无水疱组、水疱组
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Table 3. 影响187例患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成因素的单因素logistic回归分析结果
自变量 OR 95%CI P值 性别（以男性为参照） 0.693 0.385~1.248 0.222 年龄（岁） 0.983 0.966~0.999 0.043 躯干（以手足为参照） 2.028 1.125~3.655 0.019 创面面积（cm2） 1.001 0.999~1.002 0.377 合并感染（以无感染为参照） 0.697 0.380~1.253 0.227 合并骨折（以无骨折为参照） 1.233 0.673~2.257 0.498 创面清创手术时长（h） 1.019 0.855~1.215 0.831 创面冲洗（以无冲洗为参照） 0.668 0.362~1.232 0.197 敷料处理方式 凡士林纱布处理与不处理比较 0.130 0.058~0.287 <0.001 切割处理与不处理比较 0.381 0.178~0.816 0.013 注：NPWT为负压伤口疗法；凡士林纱布处理为于NPWT填充敷料（简称敷料）边缘垫入宽约2 cm凡士林纱布,切割处理为将敷料边缘切割为45°角
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Table 4. 影响187例患者采用NPWT治疗3 d后敷料边缘皮肤张力性水疱形成因素的多因素logistic回归分析结果
自变量 OR 95%CI P值 年龄（岁） 0.989 0.970~1.007 0.233 躯干（以手足为参照） 2.566 1.306~5.043 0.006 敷料处理方式 凡士林纱布处理与不处理比较 0.111 0.048~0.257 <0.001 切割处理与不处理比较 0.363 0.165~0.797 0.012 注：NPWT为负压伤口疗法；凡士林纱布处理为于NPWT填充敷料（简称敷料）边缘垫入宽约2 cm凡士林纱布,切割处理为将敷料边缘切割为45°角
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