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封闭负压治疗技术不同压力值对深度烧伤创面移植皮片成活影响的临床研究
封闭负压治疗技术不同压力值对深度烧伤创面移植皮片成活影响的临床研究
封闭负压治疗技术不同压力值对深度烧伤创面
移植皮片成活影响的临床研究
李 巍,陈 博,杜广刚
( 四川省医学科学院·四川省人民医院烧伤科,四川 成都 610072)
A clinical study on the effect of different pressure values of NPWT on the survival of skin
grafts for deep burn wounds LI Wei,CHEN Bo,DU Guang-Gang ( Department of Burns,Sichuan Acad-
emy of Medicine Sciences & Sichuan Provincial People’s Hospital,Chengdu 610072,China)
【 Abstract】 Objective To investigate the effect of negative pressure therapy with different intensities on the survival of trans-
planted skin after deep burn wound with skin flap grafting. Methods We divided 60 patients with deep burn wounds who needed skin
grafting therapy in our hospital into six groups. The patients received the degenerative surgery and dermatography after 2 to 3 days of ad-
mission. After the operation,the skin grafts were fixed with different fixed methods and different pressure strengths. The 7-days survival
rate of the skin grafts,the positive rate of bacterial culture of wound secretions,and the 14-days wound healing rate and healing time
were compared among the six groups. Results After burn wound with skin flap grafting,the 7-days survival rate of the skin grafts and
the 14-days wound healing rate and healing time in the negative pressure wound treatment ( NPWT) groups ( B to F) were better than
those in the traditional dressing treatment group ( group A) ,among which the results were the best in the groups of C,D and E ( P <
0. 05) . However,there was no significant difference in vascularization of the skin graft after 7 days of the operation between groups of A
and D ( P > 0. 05) . Conclusion Application of negative pressure occlusion and drainage after burn wound with skin flap grafting can
promote the skin wound healing. Especially,the pressure intensity at 75 ~ 125 mmHg is better.
【 Key words】 Deep burn;Skin grafts;NPWT;Pressure
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22 实用医院临床杂志 2018 年 9 月第 15 卷第 5 期
术后 7 天 术后 14 天创面 创面愈合时
组别 例数( n)
皮片成活率( % ) 创面分泌物细菌培养阳性例数( n) 愈合率( % ) 间( d)
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实用医院临床杂志 2018 年 9 月第 15 卷第 5 期 23
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24 实用医院临床杂志 2018 年 9 月第 15 卷第 5 期
负压产生的皮片下受皮创面所受的拉伸力;一种是 [3] Teng SC. Use of negative pressure wound therapy in burn patients
[ J] . Int Wound J,2016,13( Suppl 3) :15-18.
来自移植皮片上方的负压材料给予的正压力。 两种
[4] 柴家科,申传安. 重视负压伤口治疗技术在烧伤外科中的应用
力的负向影响左右了创面血供情况:出现这种现象 [ J] . 中华烧伤杂志,2015,31(2) :81-83.
的原因是当通过负压吸引使植皮创面受到的正压小 [5] 赵朋,吕国忠. 负压创面治疗分子机制的系统综述[ J] . 中华烧伤
杂志,2015,31(2) :97.
于 36. 52 mmHg 时,可引起植皮创面下局部血流量
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实用医院临床杂志 2018 年 9 月第 15 卷第 5 期 25
高压氧治疗突发性聋伴耳鸣随机对照试验的
系统评价
彭小岭1 ,陈胡萍1 ,谢清明2 ,曾宪容1
(1. 四川省医学科学院·四川省人民医院高压氧治疗中心,四川 成都 610072;2. 成都军区机关医院内二科,四川 成都 610000 )
Hyperbaric oxygen treatment for sudden deafness with tinnitus: a systematic evaluation of
randomized controlled trials PENG Xiao-ling1 , CHEN Hu-ping1 , XIE Qing-ming2 , ZENG Xian-rong1
(1. Center of Hyperbaric Oxygen Treatment, Sichuan Academy of Medical Science & Sichuan Provincial
People’s Hospital,Chengdu 610072,China;2. The Second Department of Medicine,The Official Hospital of
Chengdu Military Region,Chengdu 610014,Chengdu)
【 Corresponding author】 ZENG Xian-rong
【 Abstract】 Objective To systemically assess the efficacy of hyperbaric oxygen treatment ( HBO) for patients with sudden
deafness and tinnitus. Methods Randomized controlled trials ( RCTs) about hyperbaric oxygen treatment with placebo or open control
for patients with sudden deafness and tinnitus were comprehensively retrieved in data-base such as PubMed,OVID,EBSCO,wanfang,
CBM,CNKI and VIP. The retrieval was started from data-base set-up until to January 2017. Two reviewers independently screened the
quality of literatures. Then,meta-analysis was performed using RevMan 5. 2. Results A total of 9 randomized non-placebo controlled
trials involving 533 patients were included. The effect evaluation was performed according to tinnitus symptom relief after HBO treatment
and then the Meta analysis was performed by using binary variable method. The results showed that the improvement of tinnitus in the
HBO group was better than that in the control group ( RR = 1. 63,95% CI = 1. 47,1. 80) . The results also showed that the improvement
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in the process of infected wounds treated by vacuum-assisted closure: 封闭引流技术的效果[ J] . 中华烧伤杂志,2015,31(2) :102-104.
an experimental study[ J] . Int Wound J,2013,10(5) :508-515. [13] Nease C. Using low pressure, NPWT for wound preparation & the
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using negative pressure therapy:the effect of varied pressure on skin wound[ J] . Ostomy Wound Manage,2009,55(6) :32-42.
graft incorporation[ J] . Wounds,2013,25(4) :89-93. [14] Jufri NF,Mohamedali A,Avolio A,et al. Mechanical stretch:physio-
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blood flow during negative-pressure wound therapy: examining the cells[ J] . Vasc Cell,2015,18:7-8.
effects of pressures from-10 to-175 mmHg[ J] . Plast Reconstr Surg, [15] 郑敏,殷学利,简华刚,等. 封闭负压引流技术干预四肢植皮创面
2010,125(2) :502-509. 量效关系研究[ J] . 重庆医科大学学报,2016,41(2) :209-213.
[9] Tsuruhito T, Nirmal P, Yoshifumi I, et al. Negative pressure wound [16] 陈波,贲道锋,夏照帆. 负压创面治疗技术的研究应用进展[ J] .
therapy induces early wound healing by increased and accelerated ex- 中华损伤与修复杂志( 电子版) ,2014,9(2) :198-202.
pression of vascular endothelial growth factor receptors [ J ] . Eur J [17] 方亮,Birke-Sorensen H,Malmsjo M,等. 负压创伤治疗的循证推
Plast Surg,2016,39:247-256. 荐( 压力水平、创面填充物、接触材料) ———迈向达成国际共识
[10]刘君,刘兴邦,陶圣祥,等. 封闭负压引流技术对创面血管化的影 的一步[ J] . 中华普通外科学文献( 电子版) ,2012,6(4) :53-59.
响[ J] . 中华实验外科杂志,2012,29(11) :2280-2282. [18] Wang J,Lu D,Mao D,et al. Mechanomics:an emerging field between
[11] Ma Z,Shou K,Li Z,et al. Negative pressure wound therapy promotes biology and biomechanics[ J] . Protein Cell,2014,5(7) :518-531.
vessel destabilization and maturation at various stages of wound heal- [19] 吕国忠. 重申负压伤口治疗技术规范合理应用的重要性[ J] . 中
ing and thus influences wound prognosis[ J] . Exp Ther Med,2016, 华烧伤杂志,2015,31(2) :84-85.
11(4) :1307-1317. ( 收稿日期:2018-01-12;修回日期:2018-04-22)
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