负压吸引联合局部氧疗治疗压疮效果的研究

doi:10.3877/cma.j.issn.1673-9450.2018.01.009

目的

探讨负压吸引联合局部氧疗对压疮的治疗效果。

方法

将2015年1月至2016年12月于空军总医院烧伤整形科住院的60例Ⅲ期压疮患者按随机数字表法分为3组：常规换药组、负压吸引组、联合治疗组，每组各20例，常规换药组与负压吸引组分别给予常规换药法、负压伤口疗法治疗，联合治疗组采用负压吸引结合创面局部氧疗。观察入院后即刻，治疗后第1、2、3、4、5、6、7、8周创面最大长度、宽度、深度，渗出情况，组织类型及创面缩小程度。对数据进行单因素方差分析和LSD法。

结果

负压吸引组在压疮的长度、宽度、深度上较常规换药组均明显减小，联合治疗组的减小效果更为显著，差异均有统计学意义(P值均小于0.05)。治疗后第8周常规换药组压疮的长、宽、深度分别为(3.04±0.43)、(3.63±0.88)、(1.55±0.77) cm，负压吸引组分别为(2.14±0.71)、(2.65±1.27)、(1.05±0.62) cm，而联合治疗组为(1.17±0.28)、(1.39±2.37)、(0.58±0.45) cm。负压吸引组压疮的渗出明显减少，压疮肉芽组织生长明显增多，创面缩小程度更为显著，联合治疗组的以上治疗效果明显优于负压吸引组，差异均有统计学意义(P值均小于0.05)。

结论

负压吸引联合局部氧疗治疗Ⅲ期压疮能显著促进创面愈合，减少渗出，促进肉芽组织生长，效果优于单独负压吸引治疗，将来可以作为一种新的有效的治疗手段来推广应用。

关键词: 压力性溃疡, 负压伤口疗法, 氧, 伤口愈合

Objective

To study the effect of negative pressure wound therapy combined with local oxygen therapy on the treatment of pressure ulcers.

Methods

From January 2015 to December 2016, 60 patients with pressure ulcers over Ⅲ stage admitted in Department of Burns and Plastic Surgery, Air Force General Hospital, People′s Liberation Army, were divided into 3 groups according to the random number table method: conventional dressing change group, negative pressure wound therapy group and negative pressure wound therapy combined with local oxygen therapy group, 20 cases in each group. Conventional dressing change group and negative pressure wound therapy group were respectively given conventional dressing method, negative pressure wound treatment. Negative pressure wound therapy combined with local oxygen therapy group was given negative pressure to attract wounds with local oxygen therapy. Immediately after admission, at the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8th week after treatment, the maximum length, width, depth, exudation, tissue type and wound shrinkage were observed. Date were processed with analysis of variance and LSD test.

Results

The length, width and depth of pressure ulcers in the negative pressure wound therapy group were significantly decreased as compared to conventional dressing change group, while the decrease in negative pressure wound therapy combined with local oxygen therapy group was more significant, the differences were statistically significant (with P values below 0.05). The length, width and depth in conventional dressing group at the 8th week after treatment were (3.04±0.43), (3.63±0.88), and (1.55±0.77) cm, while in the negative pressure wound therapy group were (2.14±0.71), (2.65±1.27), and (1.05±0.62) cm, and in negative pressure wound therapy combined with local oxygen therapy group, there were (1.17±0.28), (1.39±2.37), and (0.58±0.45) cm. In the negative pressure wound therapy group, the exudation was reduced, the wound granulation tissue was increased, and the wound size was more reduced. All the above effect in the negative pressure wound therapy combined with local oxygen therapy group were obviously superior to negative pressure wound therapy group, the differences were statistically significant (with P values below 0.05).

Conclusion

Negative pressure wound therapy combined with local oxygen therapy can significantly promote wound healing, reduce exudation and promote the growth of granulation of pressure ulcers, it is better than the only use of negative pressure treatment, which can be applied as a new effective treatment method in the future.

Key words: Pressure ulcer, Negative-pressure wound therapy, Oxygen, Wound healing

表1 常规换药组、负压吸引组和联合治疗组创面长度、宽度、深度的变化(cm, ±s)

组别	例数	长度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药组	20	8.25±2.37	8.14±2.62	7.57±2.42	7.17±1.47	6.37±1.78
负压吸引组	20	8.37±2.34	8.11±2.57	7.43±2.12	7.05±2.38	6.28±2.14
联合治疗组	20	8.18±2.57	8.12±2.14	7.37±2.23	6.85±2.41	6.16±2.21
F值	?	0.0313	0.0008	0.0412	0.1150	0.0527
P值	?	0.9692	0.9992	0.9596	0.8916	0.9487
组别	例数	长度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	5.15±1.42	4.02±1.46	3.17±0.65	3.04±0.43
负压吸引组	20	4.82±1.36^a	3.71±1.04^a	2.84±0.49^a	2.14±0.71^a
联合治疗组	20	4.79±1.54^a	3.25±1.08^ab	2.14±0.68^ab	1.17±0.28^ab
F值	?	2.3838	5.0564	14.7538	68.3842
P值	?	0.0483	0.0183	<0.05	<0.05
组别	例数	宽度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	6.43±1.97	6.41±2.24	6.25±2.31	5.84±1.45	5.65±1.77
负压吸引组	20	6.26±1.85	6.22±2.15	6.09±2.33	5.77±1.48	5.45±1.69
联合治疗组	20	6.63±2.34	6.25±1.97	6.11±1.87	5.63±1.39	5.28±1.66
F值	?	0.1610	0.0463	0.0320	0.1102	0.2353
P值	?	0.8516	0.9548	0.9685	0.8958	0.7911
组别	例数	宽度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	5.37±1.42	4.95±2.07	4.31±1.28	3.63±0.88
负压吸引组	20	5.22±1.72	4.09±1.55^a	3.44±1.33^a	2.65±1.27^a
联合治疗组	20	4.15±1.22^ab	3.65±2.37^ab	2.33±2.37^ab	1.39±2.37^ab
F值	?	4.1091	2.4319	6.5484	9.4520
P值	?	0.0215	0.0480	0.0028	0.0003
组别	例数	深度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	4.57±2.28	4.46±2.11	4.18±2.15	4.02±1.67	3.78±1.38
负压吸引组	20	4.36±2.15	4.35±2.71	4.12±2.03	3.98±2.26	3.65±1.38
联合治疗组	20	4.58±1.76	4.46±2.35	4.19±2.58	3.73±2.38	3.59±1.42
F值	?	0.0717	0.0140	0.0056	0.1093	0.0972
P值	?	0.9309	0.9861	0.9944	0.8967	0.9076
组别	例数	深度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	3.35±2.07	2.75±1.32	2.26±1.12	1.55±0.77
负压吸引组	20	3.26±2.17	2.24±1.42^a	1.86±1.16^a	1.05±0.62^a
联合治疗组	20	2.75±1.23^ab	1.86±1.33^ab	1.37±0.63^ab	0.58±0.45^ab
F值	?	1.9879	3.1647	3.9781	11.9664
P值	?	0.0487	0.0341	0.0241	<0.05

表1 常规换药组、负压吸引组和联合治疗组创面长度、宽度、深度的变化(cm, ±s)

组别	例数	长度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药组	20	8.25±2.37	8.14±2.62	7.57±2.42	7.17±1.47	6.37±1.78
负压吸引组	20	8.37±2.34	8.11±2.57	7.43±2.12	7.05±2.38	6.28±2.14
联合治疗组	20	8.18±2.57	8.12±2.14	7.37±2.23	6.85±2.41	6.16±2.21
F值	?	0.0313	0.0008	0.0412	0.1150	0.0527
P值	?	0.9692	0.9992	0.9596	0.8916	0.9487
组别	例数	长度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	5.15±1.42	4.02±1.46	3.17±0.65	3.04±0.43
负压吸引组	20	4.82±1.36^a	3.71±1.04^a	2.84±0.49^a	2.14±0.71^a
联合治疗组	20	4.79±1.54^a	3.25±1.08^ab	2.14±0.68^ab	1.17±0.28^ab
F值	?	2.3838	5.0564	14.7538	68.3842
P值	?	0.0483	0.0183	<0.05	<0.05
组别	例数	宽度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	6.43±1.97	6.41±2.24	6.25±2.31	5.84±1.45	5.65±1.77
负压吸引组	20	6.26±1.85	6.22±2.15	6.09±2.33	5.77±1.48	5.45±1.69
联合治疗组	20	6.63±2.34	6.25±1.97	6.11±1.87	5.63±1.39	5.28±1.66
F值	?	0.1610	0.0463	0.0320	0.1102	0.2353
P值	?	0.8516	0.9548	0.9685	0.8958	0.7911
组别	例数	宽度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	5.37±1.42	4.95±2.07	4.31±1.28	3.63±0.88
负压吸引组	20	5.22±1.72	4.09±1.55^a	3.44±1.33^a	2.65±1.27^a
联合治疗组	20	4.15±1.22^ab	3.65±2.37^ab	2.33±2.37^ab	1.39±2.37^ab
F值	?	4.1091	2.4319	6.5484	9.4520
P值	?	0.0215	0.0480	0.0028	0.0003
组别	例数	深度
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	4.57±2.28	4.46±2.11	4.18±2.15	4.02±1.67	3.78±1.38
负压吸引组	20	4.36±2.15	4.35±2.71	4.12±2.03	3.98±2.26	3.65±1.38
联合治疗组	20	4.58±1.76	4.46±2.35	4.19±2.58	3.73±2.38	3.59±1.42
F值	?	0.0717	0.0140	0.0056	0.1093	0.0972
P值	?	0.9309	0.9861	0.9944	0.8967	0.9076
组别	例数	深度
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	3.35±2.07	2.75±1.32	2.26±1.12	1.55±0.77
负压吸引组	20	3.26±2.17	2.24±1.42^a	1.86±1.16^a	1.05±0.62^a
联合治疗组	20	2.75±1.23^ab	1.86±1.33^ab	1.37±0.63^ab	0.58±0.45^ab
F值	?	1.9879	3.1647	3.9781	11.9664
P值	?	0.0487	0.0341	0.0241	<0.05

表2 常规换药组、负压吸引组和联合治疗组创面渗出情况和组织类型评分的变化(分，±s)

组别	例数	渗出情况
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	2.96±0.37	2.63±0.61	2.32±0.41	2.17±0.62	1.97±0.38
负压吸引组	20	3.00±0.00	2.71±0.57	2.26±0.52	1.81±0.38^a	1.63±0.24^a
联合治疗组	20	2.93±0.26	2.69±0.44	2.31±0.33	1.85±0.42^a	1.56±0.31^a
F值	?	0.3619	0.1168	0.1133	3.3125	9.6813
P值	?	0.6980	0.8900	0.8931	0.0436	0.0002
组别	例数	渗出情况
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	1.63±0.43	1.42±0.48	1.27±0.45	1.05±0.47
负压吸引组	20	1.15±0.47^a	1.03±0.26^a	0.91±0.62^a	0.74±0.69^a
联合治疗组	20	1.21±0.52^a	0.82±0.25^ab	0.54±0.73^ab	0.27±0.52^ab
F值	?	6.0692	15.4286	7.1388	9.5658
P值	?	0.0041	0.0000	0.0017	0.0003
组别	例数	组织类型
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	3.00±0.00	2.92±1.04	2.75±0.81	2.53±1.12	2.36±0.78
负压吸引组	20	2.96±1.61	2.94±0.76	2.79±0.63	2.61±0.42	2.05±0.29^a
联合治疗组	20	3.00±0.00	2.87±0.47	2.71±0.87	2.57±0.49	1.98±0.62^a
F值	?	0.0123	0.0415	0.0530	0.0575	2.4188
P值	?	0.9877	0.9594	0.9484	0.9442	0.0478
组别	例数	组织类型
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	2.21±0.43	2.18±0.37	2.01±0.48	1.92±0.68
负压吸引组	20	1.92±0.52^a	1.79±0.56^a	1.64±0.62^a	1.55±1.27^a
联合治疗组	20	1.63±0.22^ab	1.51±0.41^ab	1.32±0.38^ab	1.12±2.37^ab
F值	?	10.0179	10.9829	9.4231	5.2504
P值	?	0.0002	0.0001	0.0003	0.0091

表2 常规换药组、负压吸引组和联合治疗组创面渗出情况和组织类型评分的变化(分，±s)

组别	例数	渗出情况
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	2.96±0.37	2.63±0.61	2.32±0.41	2.17±0.62	1.97±0.38
负压吸引组	20	3.00±0.00	2.71±0.57	2.26±0.52	1.81±0.38^a	1.63±0.24^a
联合治疗组	20	2.93±0.26	2.69±0.44	2.31±0.33	1.85±0.42^a	1.56±0.31^a
F值	?	0.3619	0.1168	0.1133	3.3125	9.6813
P值	?	0.6980	0.8900	0.8931	0.0436	0.0002
组别	例数	渗出情况
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	1.63±0.43	1.42±0.48	1.27±0.45	1.05±0.47
负压吸引组	20	1.15±0.47^a	1.03±0.26^a	0.91±0.62^a	0.74±0.69^a
联合治疗组	20	1.21±0.52^a	0.82±0.25^ab	0.54±0.73^ab	0.27±0.52^ab
F值	?	6.0692	15.4286	7.1388	9.5658
P值	?	0.0041	0.0000	0.0017	0.0003
组别	例数	组织类型
组别	例数	入院后即刻	治疗后1周	治疗后2周	治疗后3周	治疗后4周
常规换药祖	20	3.00±0.00	2.92±1.04	2.75±0.81	2.53±1.12	2.36±0.78
负压吸引组	20	2.96±1.61	2.94±0.76	2.79±0.63	2.61±0.42	2.05±0.29^a
联合治疗组	20	3.00±0.00	2.87±0.47	2.71±0.87	2.57±0.49	1.98±0.62^a
F值	?	0.0123	0.0415	0.0530	0.0575	2.4188
P值	?	0.9877	0.9594	0.9484	0.9442	0.0478
组别	例数	组织类型
组别	例数	治疗后5周	治疗后6周	治疗后7周	治疗后8周
常规换药祖	20	2.21±0.43	2.18±0.37	2.01±0.48	1.92±0.68
负压吸引组	20	1.92±0.52^a	1.79±0.56^a	1.64±0.62^a	1.55±1.27^a
联合治疗组	20	1.63±0.22^ab	1.51±0.41^ab	1.32±0.38^ab	1.12±2.37^ab
F值	?	10.0179	10.9829	9.4231	5.2504
P值	?	0.0002	0.0001	0.0003	0.0091

图1 常规换药组、负压吸引组及联合治疗组入院后即刻、治疗后1、2、3、4、5、6、7、8周创面体积变化。^a示与常规换药组比较，差异有统计学意义(P<0.05)；^b示与负压吸引组比较，差异有统计学意义(P<0.05)

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Effect of negative pressure wound therapy combined with local oxygen therapy on the treatment of pressure ulcers

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Effect of negative pressure wound therapy combined with local oxygen therapy on the treatment of pressure ulcers