颉黄峰 陈骅 戴如冰 许冈跃 浦春宁

[摘要]目的：探讨削痂植皮术联合负压封闭引流技术（Vacuum sealing drainage，VSD）治疗中度烧伤患者的临床效果及安全性。方法：选取2015年10月-2019年10月笔者医院收治的中度烧伤患者90例，随机数字表法分为观察组和对照组。对照组（n=41）采用削痂植皮术治疗，观察组（n=49）采用削痂植皮术聯合VSD技术治疗。比较两组皮片成活时间、皮片成活率、换药次数及住院时间;观察治疗前后两组创面愈合时间与创面愈合质量;采用生活能力量表（Activity of daily living，ADL）、焦虑自评量表（Self-rating anxiety scale，SAS）及长海痛尺评估患者预后质量。结果：观察组皮片成活时间、换药次数、住院时间、并发症发生率与创面愈合时间均小于对照组，差异有统计学意义（P<0.05）。观察组ADL评分高于对照组和治疗前，SDS评分与长海痛尺评分低于对照组和治疗前，差异均有统计学意义（P<0.05）。结论：削痂植皮术联合VSD治疗中度烧伤创面治疗效果显著，可提高创面愈合质量，显著改善患者预后。

[关键词]烧伤;负压封闭引流;削痂植皮术;生活质量;预后

[中图分类号]R644    [文献标志码]A    [文章编号]1008-6455（2022）06-0070-03

Clinical Effects of Tangential Excision and Skin Grafting Combined with Vacuum Sealing Drainage in the Treatment of Moderate Burn Wounds

JIE Huangfeng，CHEN Hua，DAI Rubing，XU Gangyue，PU Chunning

[Department of Surgery Ⅲ （Burn and Plastic Surgery），Armed Police Marine Police Corps Hospital，Jiaxing 314000，Zhejiang，China]

Abstract： Objective  To investigate the clinical effect and safety of tangential excision and skin grafting combined with VSD in the treatment of patients with moderate burn. Methods  Ninety patients with moderate burn admitted to the hospital between October 2015 and October 2019 were selected and randomly divided into the observation group and the control group. The control group （n=41） were treated with tangential excision and skin grafting， while the observation group （n=49） were treated with tangential excision and skin grafting combined with VSD. The survival time and survival rate of skin flaps， frequency of dressing change and hospital stay were compared between the two groups. The time and quality of wound healing were observed， and the prognosis was assessed with the Activity of daily living （ADL）， Self-rating anxiety scale （SAS） and Changhai pain rating scale. Results  The skin graft survival time， dressing change times， hospital stay， complication rate and wound healing time in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. The ADL score of the observation group was higher than those of the control group and before treatment， and the SDS score and Changhai pain rating score were lower than those of the control group and before treatment （P<0.05）. Conclusion  Tangential excision and skin grafting combined with VSD is effective in the treatment of moderate burn wounds， which can improve the quality of wound healing and significantly improve the prognosis of patients.

Key words： burn; vacuum sealing drainage（VSD）; tangential excision and skin grafting; quality of life; prognosis

烧伤是临床上常见的外科问题，其诱因较多（高温、电流、腐蚀性液体），临床特点为皮肤与黏膜受损严重、创面易感染，危害深部血管及神经系统，严重者累及全身多系统，引起器官衰竭死亡[1]。目前对烧伤最主流的治疗手段为削痂或切痂术联合植皮术封闭创面，但术后易引起植皮感染、坏死，较难保障手术预后效果[2]。负压封闭引流技术（Vacuum sealing drainage，VSD）作为一种新型引流技术，研究表明其可利用特制敷料覆盖创面并对坏死组织进行深部负压装置引流，确保创面在负压环境下保持清洁，对降低患者感染风险有积极意义[3]。……