鲁玉桂　蔡小林　尤弘霞等

[摘要] 目的 探讨弹力绷带在胸壁结核清除术后的应用效果。 方法 将156例胸壁结核病灶清除术后患者随机分为两组，观察组（80例）采用弹力绷带加普通胸带加压包扎，对照组（76例）采用普通胸带加压包扎，包扎时间均为3～4周，均采用标准化疗方案正规抗痨治疗6～9个月，比较两组的疗效。 结果 观察组与对照组的治愈率分别为97.50%和81.58%，皮下积液发生率分别为3.75%和18.42%，复发率分别为2.50%和18.42%，平均住院时间分别为（10.30±1.63） d和（13.50±1.77） d，平均住院费用为（10437.1±1016.4）元和（12034.0±1514.4）元，两组比较差异有统计学意义（P<0.05）。 结论 普通胸带加弹力绷带应用于胸壁结核清除术后患者的效果显著，值得临床推广应用。

[关键词] 弹力绷带；胸壁结核清除术；管理

[中图分类号] R655.1 [文献标识码] A [文章编号] 1674-4721（2014）04（a）-0050-03

[Abstract] Objective To investigate application effect of elastic bandage after chest wall tuberculosis dissection. Methods 156 patients after chest wall tuberculosis dissection were randomly divided into two groups，the elastic bandage and common thoracic compression bandage were used in observation group（80 cases），normal chest compression bandage was used in control group（76 cases），bandage time of all patients were 3 to 4 weeks.Two groups of patients were treated with standard chemotherapy regular anti-tuberculosis treatment for 6 to 9 months.The effect of two groups was compared. Results The cure rate of observation group and control group was 97.50% and 81.58% respectively，the incidence rate of postoperative seroma of observation group and control group was 3.75% and 18.42% respectively，the recurrence rate of observation group and control group was 2.50% and 18.42% respectively，the average hospitalization time was（10.30±1.63）d and（13.50±1.77）d respectively，the average cost of hospitalization was（10437.1±1016.4）yuan and（12034.0±1514.4）yuan respectively，with statistical difference（P<0.05）. Conclusion The effect of elastic bandage and common thoracic compression bandage applied in patient after chest wall tuberculosis dissection is remarkable.It is worthy of promotion and application in clinic.

[Key words] Elastic bandage；Chest wall tuberculosis dissection；Management

胸壁结核是一种常见的肺外结核，多继发于胸内结核，如肺结核、胸膜结核、纵隔淋巴结核等，其病变可能侵犯胸壁软组织、肋骨、肋软骨及胸骨，常见于青壮年和年老体弱者。近年来，胸壁结核发病率呈上升趋势，如果处理不当，常复发，甚至迁延不愈，有些患者经历多次手术，给其带来严重创伤[1]。胸壁结核是全身性结核病的局部表现，治疗必须在全身抗结核基础上，施行病灶清除术。病灶清除术是胸壁结核治疗最主要的方法，彻底清除的关键是清除病灶内坏死组织[2]，为了防止残腔积血、积液，故创面要适当加压包扎，但加压包扎的方式、压迫的强度和时间对消灭残腔、促进愈合、防止复发起关键性的作用。术后一般加压包扎3～4周，张力要适中，达到既尽可能压闭残腔、又不能影响切口周围组织血供为宜。……