摘要
目的分析慢性创面感染的病原学特点及持续灌洗负压封闭引流(VSD)局部治疗的临床疗效。方法以2015年5月至2017年3月安徽省立医院烧伤整形外科的58例慢性创面感染患者为研究对象,对患者入院时创面分泌物的细菌培养及药敏结果进行回顾性分析,并对经过持续灌洗VSD治疗患者的感染控制情况、治疗次数、创面清洁时间、创面面积、并发症、预后情况进行评价。结果 58例患者共培养出68株病原菌,其中4例患者细菌培养为阴性,创面感染率93.10%。革兰氏阳性菌28株(41.18%),革兰氏阴性菌40株(58.82%),主要细菌为金黄色葡萄球菌(25.00%)、铜绿假单胞菌(20.59%)、大肠埃希菌(13.24%)。55例患者接受持续灌洗VSD治疗后,创面感染得到控制,接受1、2、3、4次治疗的例数分别为36、13、4、2例;创面清洁时间6~43 d,平均(14.40±8.93)d;治疗后创面面积缩小平均值为(8.91±3.17)cm2;无明显堵管及严重并发症出现。持续灌洗VSD治疗后,17例患者一期愈合,38例患者经二期植皮或皮瓣修复,仅1例游离皮瓣出现坏死,其余全部存活;无创面进一步恶化或者复发感染患者。治疗优良率达98.18%。结论慢性创面感染的病原菌主要为金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌。创面局部持续灌洗VSD治疗可有效控制感染,缩小创面面积,促进肉芽组织生长。
Objective Analyze the pathogenic distribution of infections in chronic wounds and the clinical efficacy of topical vacuum sealing drainage(VSD)with continuous irrigation.Methods 58 cases of chronic wounds were selected from May 2015 to March 2017 in Anhui provincial hospital as the objects of study.A retrospective statistical analysis was performed on the results of the bacterial culture and drug sensitivity of the first wound secretions of hospitalization.Evaluate the infection control situation,times of treatment,wound cleaning time,wound area,complications and prognosis of the patients who underwent topical VSD with continuous irrigation treatment.Results 68 strains of pathogenic bacteria were cultured in 58 cases,of which 4 cases were negative,and the infection rate was 93.10%.There were 28 gram positive bacteria,accounting for 41.18%,and 40 gram negative bacteria,accounting for 58.82%.The main bacteria were distributed in Staphylococcus aureus(25%),Pseudomonas aeruginosa(20.59%),Escherichia coli(13.24%).55 patients received topical VSD with continuous irrigation treatment.Infection symptoms were controlled;The number of patients receiving 1,2,3,and 4 treatments were 36,13,4,and 2,respectively;The cleaning time of wound was 6~43 days,average(14.40+8.93)days.After treatment,the average area of the wound was reduced(8.91+3.17)cm 2;No obvious obstruction and serious complications occurred;After VSD removal,17 patients had primary healing,and 38 patients underwent two stage skin grafting or flap repair.Only one free flaps showed postoperative necrosis,and the rest of them survived.No cases developed further deterioration or recurrence infections of the wound;The excellent and good rate of treatment was 98.2%.Conclusion The main pathogens of infections in chronic wounds are Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli.Topical VSD with continuous irrigation treatment can effectively control infection,reduce wounds surface area and promote granulation tissue growth.
作者
郎中亮
王明刚
钟晓红
LANG Zhongliang;WANG Minggang;ZHONG Xiaohong(Department of Plastic Surgery,Affiliated Provincal Hospital of Anhui Medical University,Hefei 230001,China)
出处
《安徽医学》
2018年第4期396-400,共5页
Anhui Medical Journal
基金
安徽省公益性技术应用研究联动计划项目(项目编号:1604f0804020)
关键词
慢性创面感染
病原菌
持续灌洗
负压封闭引流
Chronic wound
Infection
Pathogenic bacteria
Irrigation
Vacuum sealing drainage
