沈晨　郭大志

[摘要] 目的 探讨负压封闭引流技术（VSD）结合高压氧治疗难治性压疮的临床效果。 方法 回顾性分析2016年1月～2017年12月北京市丰盛中医骨伤专科医院和海军总医院收治的37例Ⅲ、Ⅳ度压疮创面患者的临床资料，其中VSD治疗（VSD组）20例，VSD结合高压氧治疗（VSD结合高压氧组）17例，兩组患者基础护理方案相同。分别取两组患者VSD治疗后2、3周和1个月的创面标本，采用链霉亲和素-生物素复合物（SABC）法进行CD34免疫组化，高倍显微镜下检测血管交叉的数目作为毛细血管密度值，以评价创面血管生成和组织肉芽生长情况。通过肉眼观察创面愈合情况进行临床疗效评价。 结果 VSD结合高压氧组患者创面的毛细血管密度值在各时间点均高于VSD组，差异有统计学意义（P < 0.05）。与VSD组患者比较，VSD结合高压氧组患者的有效率更高，平均治疗有效时间更短，差异有统计学意义（P < 0.05）。 结论 VSD结合高压氧治疗可有效促进新生肉芽组织迅速生长，疗效好、疗程短，为临床治疗难治性压疮提供了一种新策略。

[关键词] 负压封闭引流技术；高压氧；难治性压疮；效果

[中图分类号] R605 [文献标识码] A [文章编号] 1673-7210（2018）11（b）-0106-04

[Abstract] Objective To investigate the efficacy of vacuum sealing drainage （VSD） combined with hyperbaric oxygen in treating refractory bedsore. Methods From January 2016 to December 2017， in Beijing Fengsheng Special Hospital of Traditional Medical Traumatology and Orthopaedics and Navy General Hospital， the clinical data of 37 patients with Ⅲ and Ⅳ degree bedsores was retrospectively analyzed， 20 cases were treated with VSD only （regarded as VSD group）， 17 cases were treated with VSD combined with hyperbaric oxygen （regarded as VSD combined with HBO group）， patients of both groups had the same basic nursing plan. At 2 weeks， 3 weeks， 1 month after treatment， specimens of wound from two groups were taken respectively， the CD34 immunohistochemistry was performed by streptavidine-biotin complex （SABC）， the number of wild vascular cross was observed as capillary density value under high magnification microscope to assess the hyperplasia of granulation tissues of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy. Results The capillary density of VSD combined with HBO group was higher than that of VSD group at each time point， the differences were statistically significant （P < 0.05）. Compared with the VSD group， the VSD combined with HBO group had higher effective rate and less average time， the differences were statistically significant （P < 0.05）. Conclusion VSD combined with hyperbaric oxygen can effectively promote the rapid growth of new granulation tissue. It has good curative effect and short course of treatment， and provides a new strategy for clinical treatment of refractory bedsore.

[Key words] Vacuum sealing drainage； Hyperbaric oxygen； Refractory bedsore； Effect

压疮常发生于下肢不能活动、长期卧床、意识障碍患者，尤其是Ⅲ、Ⅳ期压疮，因受压皮肤全层组织破溃，慢性窦道形成，且深及肌腱、骨骼，并发骨髓炎、骨坏死、感染和大量营养丢失的风险大大增加，创面更加难以愈合[1]。目前指南推荐使用负压封闭引流技术（VSD）等方法治疗创面大且深的难治性压疮[2]。本文通过比较VSD技术结合高压氧治疗与单纯采用VSD技术治疗对难治性压疮创面的毛细血管密度值、肉芽组织生长和创面愈合情况的影响，评价其临床疗效。

1 资料与方法

1.1 一般资料

回顾性分析2016年1月～2017年12月在北京市丰盛中医骨伤专科医院和海军总医院住院治疗压疮的37例临床资料。……