张朦 章磊 杜琳

[摘要]目的：觀察负压封闭引流技术（Vacuum-assisted closure，VAC）联合邮票植皮修复早期不当处理形成的难愈性创面的疗效。方法：选取笔者医院2016年2月-2020年2月因早期不当处理致创面加深患儿60例为研究对象，依据非随机临床同期对照研究及患儿家属自愿原则分为观察组（n=32）、对照组（n=28），观察组予以VAC+邮票植皮技术治疗，对照组采用传统打包结合邮票植皮技术治疗，比较两组植皮优良率、治疗结果（手术时间、术后换药次数、住院时间、创面愈合时间）、植皮成活率、治疗前后血清炎症因子[白介素-1（IL-1）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]、血管内皮生长因子（VEGF）水平及患儿家属满意度。结果：观察组植皮优良率高于对照组，差异有统计学意义（P<0.05）。观察组的手术时间、住院时间、创面愈合时间及术后换药次数均较对照组少，差异有统计学意义（P<0.05）。观察组治疗后7d、14d植皮成活率高于对照组，差异有统计学意义（P<0.05）。观察组治疗后血清IL-1、IL-6、TNF-α水平明显低于对照组，而VEGF水平较对照组高，差异有统计学意义（P<0.05）。观察组患儿家属治疗后满意度高于对照组，差异有统计学意义（P<0.05）。结论：早期不当处理致创面加深后运用VAC联合邮票植皮疗效较好，可明显提高植皮成活率，减少手术时间和术后换药次数，并下调炎症因子水平，有利于创面愈合。

[关键词]难愈性创面;负压封闭引流技术;邮票植皮;疗效;炎症因子;血管内皮生长因子

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2020）12-0082-04

Study on the Effect of VAC Combined with Stamp Skin Grafting on Refractory Wounds in Children

ZHANG Meng，ZHANG Lei，DU Lin

（Department of Burn and Plastic Surgery，Children's Hospital Affiliated to Nanjing Medical University，Nanjing 210000，Jiangsu，China）

Abstract： Objective  To observe the effect of vacuum-assisted closure（VAC） combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage. Methods  Sixty children with refractory wounds caused by improper treatment in the early stage in the hospital between February 2016 and February 2020 were selected as the research subjects. They were divided into the observation group （n=32） and the control group （n=28） according to the non-randomized clinical concurrent control study and childrens family members voluntary principles. The observation group was treated with VAC combined with stamp skin grafting， and the control group was treated with traditional packaging combined with stamp skin grafting. The excellent and good rate of skin grafting， treatment outcomes （operation time， frequency of postoperative dressing change， hospital stay， wound healing time）， survival rate of skin grafts， levels of serum inflammatory factors [interleukin-1 （IL-1）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）] and vascular endothelial growth factor （VEGF） before and after treatment， and satisfaction of childrens family members were compared between the two groups. Results  The excellent and good rate of skin grafting in the observation group was higher than that in the control group， the difference was statistically significant （P<0.05）. The operation time， hospital stay and wound healing time of the observation group were shorter than those of the control group， and the frequency of postoperative dressing change was less than the control group （P<0.05）. The survival rates of skin grafts in the observation group at 7 days and 14 days after treatment were higher than those in the control group （P<0.05）. After treatment， levels of serum IL-1， IL-6 and TNF-α in the observation group were significantly lower than those in the control group， while the level of VEGF was higher than that in the control group （P<0.05）. The satisfaction of family members of the observation group after treatment was higher than those of the control group （P<0.05）. Conclusion  The application of VAC combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage can improve the survival rate of skin grafts significantly， reduce the operation time and the frequency of postoperative dressing change， and down regulate the levels of inflammatory factors， which is beneficial to wound healing.

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