發(fā)布時(shí)間：2018-05-16 04:30

  本文選題：壓瘡 + 皮瓣　； 參考：《南方醫(yī)科大學(xué)》2016年碩士論文

【摘要】：研究背景壓瘡,又稱褥瘡,是指局部組織長(zhǎng)時(shí)間受壓,血液循環(huán)障礙,局部持續(xù)缺血、缺氧、營(yíng)養(yǎng)不良而致的軟組織破損和壞死。引起壓瘡最基本、最重要的因素是壓力,故目前傾向于將壓瘡改稱為“壓力性潰瘍”。常見于癱瘓和長(zhǎng)期臥床患者,營(yíng)養(yǎng)不良、年齡大于70歲、身體衰弱、大小便失禁及石膏固定的患者均屬于高危人群。壓瘡多發(fā)生于受壓和缺乏脂肪組織保護(hù)、無(wú)肌肉包裹或肌層較薄的骨隆突處,并與臥位有密切的關(guān)系。平臥位,好發(fā)于枕部、肩胛、肘部、骶尾、足跟；俯臥位,好發(fā)于面頰、肩峰、膝部、足趾：側(cè)臥位,好發(fā)于耳部、肩峰、髖部、膝關(guān)節(jié)內(nèi)外側(cè)及內(nèi)外踝。美國(guó)全國(guó)壓瘡顧問小組2007年最新分期：可疑深部組織受損皮下軟組織受到壓力或剪切力的損害,局部皮膚完整但可出現(xiàn)顏色改變?nèi)缱仙蚝旨t色,或?qū)е鲁溲乃�。Ⅰ期：非蒼白性發(fā)紅皮膚完整,發(fā)紅,與周圍皮膚界限清楚,壓之不褪色,常局限于骨凸處。Ⅱ期：部分皮層受損部分表皮受損,皮膚表淺潰瘍,基底紅,無(wú)結(jié)痂,也可為完整或破潰的血泡。Ⅲ期：全層皮膚缺失全層皮膚缺失,但肌肉,肌腱和骨骼尚未暴露,可有結(jié)痂、皮下隧道。Ⅳ期：全層組織缺失全層皮膚缺失伴有肌肉,肌腱,和骨骼的暴露,常有結(jié)痂和皮下隧道。不能分期：全層皮膚或組織缺失,潰瘍底部被腐肉和/或焦痂完全覆蓋。傷口的真正深度需將腐肉或焦痂完全清除后才能確定。隨著社會(huì)人口老齡化,壓瘡的發(fā)病率逐年升高。臨床上發(fā)生在骶尾部、坐骨結(jié)節(jié)、股骨大轉(zhuǎn)子等臀部的位置最常見。臀部壓瘡作為一種難治性疾病不僅給患者帶來(lái)痛苦、影響生活質(zhì)量,給患者家庭帶來(lái)沉重的經(jīng)濟(jì)和社會(huì)負(fù)擔(dān),嚴(yán)重者發(fā)生系統(tǒng)感染危及患者生命。壓瘡的治療多種多樣,傳統(tǒng)換藥療法、中醫(yī)膏藥貼服療法、VSD引流、外科手術(shù)、干細(xì)胞和細(xì)胞因子的治療等眾多方法均在現(xiàn)代診療活動(dòng)中有所涉及。Ⅲ、Ⅳ期壓瘡自愈性差,需要手術(shù)用皮瓣來(lái)修復(fù)創(chuàng)面。臀部皮膚軟組織豐富并且移動(dòng)度相對(duì)較大,不同部位的壓瘡修復(fù)均有多種不同的局部皮瓣可選擇。常用的皮瓣有臀大肌皮瓣、股后皮神經(jīng)營(yíng)養(yǎng)血管皮瓣、闊筋膜張肌皮瓣及各種形式的筋膜皮瓣等。術(shù)后通常用紗布、棉墊、繃帶來(lái)包扎和固定。然而,術(shù)后護(hù)理困難,存在“動(dòng)”和“不動(dòng)”的矛盾。術(shù)后要求患者俯臥位限動(dòng),至少臀部限動(dòng)；壓瘡預(yù)防要求患者每2小翻身1次,翻身時(shí)包扎松散、敷料移位、皮瓣失去包扎作用,傷口易受牽拉裂開。故皮瓣修復(fù)術(shù)一次手術(shù)成功率不高,常出現(xiàn)傷口裂開、基底不粘連等并發(fā)癥。究其原因在于反復(fù)體位變化讓繃帶松動(dòng),失去包扎固定的作用；翻身時(shí)術(shù)區(qū)與周圍組織因相對(duì)運(yùn)動(dòng)導(dǎo)致剪切力產(chǎn)生影響傷口愈合；不同臥位姿勢(shì)臀部組織因重力和摩擦力的作用導(dǎo)致傷口張力增大,裂開。一些醫(yī)院術(shù)后用翻身床護(hù)理有較好的效果,但應(yīng)用翻身床費(fèi)時(shí)費(fèi)力、護(hù)理負(fù)擔(dān)大,對(duì)患者的干擾也大。還有一些醫(yī)院應(yīng)用懸浮床,懸浮床讓組織不受壓,患者可以不動(dòng),但費(fèi)用太貴,一般醫(yī)院也沒有。臨床上需要一種應(yīng)用便宜、操作簡(jiǎn)單,又解決了術(shù)后“動(dòng)”和“不動(dòng)”的矛盾,能提高一次手術(shù)成功率的方法。負(fù)壓創(chuàng)面治療技術(shù)(negative pressure Wound therapy, NPWT)是一種加快傷口愈合的方法,臨床應(yīng)用有20余年。用含有引流管的醫(yī)用海棉來(lái)覆蓋或填充皮膚軟組織缺損的創(chuàng)面,再用生物半透膜對(duì)之進(jìn)行封閉,使其成為一個(gè)密閉空間,最后把引流管接通負(fù)壓源,組成的高效引流系統(tǒng)。NPWT所用的醫(yī)用海綿主要有聚氨酯PU (Polyurethane)和聚乙烯醇酯PVA (Polyyinyl alcohol)兩種。以聚氨酯為負(fù)壓材料的技術(shù)稱為PU-VSD,以聚乙烯醇酯為負(fù)壓材料的技術(shù)稱為PVA-VSD。聚氨酯敷料生物相溶性好,無(wú)毒無(wú)刺激、透氣透水性能好、不會(huì)變干變硬,在國(guó)外應(yīng)用廣泛。聚乙烯醇酯內(nèi)面密布大量彼此相通的直徑0.2mm-1.0mm的空隙,具有很強(qiáng)的吸附機(jī)體分泌物的特性。缺點(diǎn)為失水會(huì)干燥變硬。2004年湖北武漢威斯第公司成功自主合成PVA后,PVA-VSD應(yīng)用在我國(guó)迅速推開,廣泛應(yīng)用臨床多個(gè)多科修復(fù)各種復(fù)雜的創(chuàng)面。針對(duì)引流存在堵管、負(fù)壓大小有差異等方面的問題,該技術(shù)也在不斷完善,第三代具有間歇性低負(fù)壓+雙壓力控制顯示+智能創(chuàng)面排阻+創(chuàng)面封閉式自動(dòng)沖洗功能的VSD已經(jīng)應(yīng)用在大面積軟組織缺損、關(guān)節(jié)腔感染切開引流、急慢性骨髓炎開窗引流、手術(shù)后傷口感染、糖尿病足、壓瘡等難治性創(chuàng)面。實(shí)驗(yàn)研究VSD技術(shù)促進(jìn)創(chuàng)面修復(fù)的機(jī)制：(1)提高創(chuàng)面微循環(huán)的血流速度,擴(kuò)張了微血管,從而增加了創(chuàng)面的血供;(2)及時(shí)吸引創(chuàng)面滲出物,減輕創(chuàng)面的水腫,有利于創(chuàng)面的修復(fù)；(3)密閉濕潤(rùn)的環(huán)境抑制細(xì)菌的繁殖,防止外界污染和感染。(4)機(jī)械的牽拉作用,機(jī)械應(yīng)力誘導(dǎo)組織細(xì)胞的生長(zhǎng)。第3點(diǎn)顯示VSD有包扎創(chuàng)面的作用；第4點(diǎn)機(jī)械的牽拉作用提示VSD有固定的功能。包扎和固定是手術(shù)的重要組成部分,其適當(dāng)與否,可直接影響手術(shù)的成敗。比如植皮術(shù),包扎固定欠妥,皮片就不能與基底組織建立血供導(dǎo)致皮片不能成活,手術(shù)失敗。VSD的生物半透膜讓創(chuàng)面與外界隔離起來(lái),提供有利于創(chuàng)面的愈合的環(huán)境,起到包扎作用；負(fù)壓形成后機(jī)械的牽拉力使敷料覆蓋的區(qū)域及周圍的皮膚固定變成一個(gè)整體。這個(gè)整體隨著體位變化有所變化,但里面的組織不發(fā)生移位：并且海綿對(duì)基底產(chǎn)生正向壓力。因材料的固有特性,PVA失水干燥變成和石膏一樣堅(jiān)硬,不適宜用在皮膚表面。PU-VSD才適合用來(lái)包扎和固定,外置的聚氨酯材料非常便宜。一些國(guó)內(nèi)外學(xué)者將皮片移植后用VSD加壓固定,發(fā)現(xiàn)與傳統(tǒng)的打包加壓包扎相比提高皮片的存活率。VSD同期應(yīng)用在皮瓣上的經(jīng)驗(yàn)較少。臨床中很多學(xué)者報(bào)道VSD與皮瓣聯(lián)合應(yīng)用的病例,VSD主要被用于組織瓣轉(zhuǎn)移前的創(chuàng)面準(zhǔn)備。國(guó)內(nèi)有學(xué)者將VSD海棉開“觀察窗”后同期應(yīng)用皮瓣表面,通過窗口觀察皮瓣的血運(yùn),發(fā)現(xiàn)應(yīng)VSD能促進(jìn)皮瓣的存活,但負(fù)壓的大小適宜值需要探討。臀部壓瘡皮瓣術(shù)后“動(dòng)”和“不動(dòng)”的矛盾,可以縮小范圍到臀部切口周圍組織的“動(dòng)”與“不動(dòng)”的矛盾。術(shù)后同期應(yīng)用PU-VSD固定皮瓣周圍組織是一個(gè)可行的解決方法。PU-VSD用于皮瓣表面時(shí)操作過程簡(jiǎn)單,無(wú)需反復(fù)搬動(dòng)患者。負(fù)壓形成后將皮瓣周圍的組織固定形成一個(gè)整體,不會(huì)因?yàn)榉矶l(fā)生移位：整體移位少,皮瓣切口受到牽拉力也變小。本研究先探討PU-VSD能不能減小其固定的臀部皮膚在不同體位受到牽拉力,再觀察PU-VSD同期應(yīng)用在臀部壓瘡皮瓣術(shù)后的效果,能否提高臀部皮瓣術(shù)后一次手術(shù)的成功率,降低并發(fā)癥。評(píng)估其臨床應(yīng)用價(jià)值。研究目的1、探討應(yīng)用PU-VSD固定的臀部皮膚作為“整體”在體位變化移動(dòng)時(shí)這個(gè)整體里面的皮膚受到牽拉力的變化。2、觀察PU-VSD輔助局部皮瓣修復(fù)臀部壓瘡的臨床效果,評(píng)估其臨床應(yīng)用價(jià)值。材料與方法材料：醫(yī)用聚氨酯海綿(山東創(chuàng)康)；醫(yī)用吸痰管；生物半透性薄膜(英國(guó)安舒妥公司)及可調(diào)的負(fù)壓源(天津醫(yī)療器械二廠)。紗塊、棉墊、繃帶。方法1：選擇2013年在我科住院的15名臀部皮膚無(wú)破損的患者作為志愿者。先俯臥位在患者尾骨上8cm作臀溝的垂直線,在直線上交點(diǎn)的兩側(cè)標(biāo)記兩點(diǎn),兩點(diǎn)間距離為18cm。測(cè)量各個(gè)志愿者在立位、左側(cè)臥位和右側(cè)臥位下臀部?jī)蓚�(gè)標(biāo)記點(diǎn)的直線距離。然后應(yīng)用VSD后2小時(shí)再次測(cè)量不同體位下兩標(biāo)記點(diǎn)間距離。將立位、左側(cè)臥位和右側(cè)臥位下臀部?jī)蓚�(gè)標(biāo)記點(diǎn)的直線距離分別與俯臥位比較,計(jì)算差值。比較固定前后不同體位的差值。方法2：選擇科室2012年8月‖2014年12月因臀部Ⅳ期壓瘡擬行局部皮瓣手術(shù)修復(fù)的患者隨機(jī)、雙盲分成2組。術(shù)前常規(guī)治療,術(shù)中皮瓣設(shè)計(jì)、主刀醫(yī)師均為同一位副主任醫(yī)師。術(shù)后觀察組16例,皮瓣表面應(yīng)用PU-VSD輔助固定,負(fù)壓值在-15kpa至-20kpa；對(duì)照組18例,切口內(nèi)置無(wú)菌紗塊后,用棉墊繃帶包扎固定。能自主活動(dòng)的患者不限制床上活動(dòng),活動(dòng)受限的患者由受過專業(yè)培訓(xùn)的陪護(hù)人員每2小時(shí)翻身1次。觀察組VSD持續(xù)負(fù)壓吸引,發(fā)現(xiàn)漏氣及時(shí)處理。對(duì)照組及時(shí)更換污染的敷料和及時(shí)重新固定松動(dòng)的敷料。術(shù)后5天觀察兩組一次手術(shù)成功的例數(shù),出現(xiàn)并發(fā)癥的原因。處理并發(fā)癥。觀察組繼續(xù)PU-VSD輔助固定1周,切口術(shù)后2周拆線。對(duì)照組繼續(xù)棉墊繃帶包扎固定,裂開傷口及時(shí)再次縫合。比較兩組一次手術(shù)成功率、并發(fā)癥發(fā)生率；創(chuàng)面治愈后比較患者創(chuàng)面愈合時(shí)間及住院時(shí)間。統(tǒng)計(jì)學(xué)分析：SPSS 16.0統(tǒng)計(jì)學(xué)軟件錄入分析上述數(shù)據(jù),計(jì)數(shù)資料率表示,計(jì)量資料均數(shù)±標(biāo)準(zhǔn)差表示,t檢驗(yàn),P0.05時(shí)差異有統(tǒng)計(jì)學(xué)意義。結(jié)果結(jié)果1、在不同的體位,志愿者臀部標(biāo)記的兩點(diǎn)間測(cè)量值不同,和俯臥位的差值明顯。PU-VSD應(yīng)用在臀部表面后,不同的體位標(biāo)記的兩點(diǎn)間測(cè)量值變化很小,差值在1cm內(nèi)。志愿者應(yīng)用PU-VSD前后的不同體位的差值,前者均比后者明顯,P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果2、兩組患者術(shù)后5天一次手術(shù)成功率及并發(fā)癥發(fā)生情況比較：觀察組一次手術(shù)成功率93.75%,對(duì)照組一次手術(shù)成功率61.11%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組16例患者中并發(fā)癥1例,控制感染后再次手術(shù)。對(duì)照組18例患者中并發(fā)癥6例,需再次手術(shù),其中感染1例、裂開3例、與基底未粘連2例。兩組并發(fā)癥發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。創(chuàng)面治愈后兩組創(chuàng)面愈合時(shí)間、住院時(shí)間比較：觀察組創(chuàng)面愈合時(shí)間、住院時(shí)間明顯短于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1、應(yīng)用PU-VSD固定臀部皮瓣周圍的皮膚作為“整體”在體位變化移動(dòng)時(shí),這個(gè)整體里的皮瓣切口受到的牽拉力減小。2、PU-VSD同期應(yīng)用在臀部壓瘡皮瓣術(shù)后能夠顯著提高一次手術(shù)成功率、減少并發(fā)癥、縮短創(chuàng)面愈合時(shí)間和住院時(shí)間,值得在臨床推廣。
[Abstract]:Background pressure sore, also known as bedsore, refers to the long compression of local tissue, disturbance of blood circulation, local continuous ischemia, hypoxia, and malnutrition in soft tissue damage and necrosis. Pressure ulcers are the most basic and most important factor in pressure ulcers. Therefore, the pressure ulcers are often referred to as "stress ulcers". Patients with malnutrition, age more than 70 years old, debilitated, incontinence, incontinence and plaster fixation are all high-risk groups. Pressure sore occurs mostly in compression and lack of fat tissue protection, without muscle parcels or thinner bone protuberance, and has a close relationship with the supine position. Decubitus, good hair on cheek, acromion, knee, toe: lateral position, good hair in the ear, shoulder, hip, knee and outer and internal and external malleolus. The latest staging of National Pressure Ulcer Advisory Group of the United States in 2007: suspected deep tissue damaged subcutaneous soft tissues are damaged by pressure or shear force, local skin is complete but can appear color changes such as purple or brown. Red, or hyperemia blister. Stage 1: non pallid redness skin complete, redness, clear boundaries with surrounding skin, constant pressure, and often limited to bony protruding. Stage II: partial cortex damaged parts, superficial skin ulcers, basal red, scab, and complete or broken blisters. Stage III: full layer full layer skin deletion Lack of skin, but the muscles, tendons and bones have not yet been exposed and can have scab, subcutaneous tunnel. Stage IV: full layer deletion of full layer tissue in full layer tissue with muscle, tendon, and bone exposure, often scab and subcutaneous tunnel. No stages: full layer skin or tissue loss, full cover of the bottom of the ulcer and / or eschar. The true depth of the wound As the social population is aging, the incidence of pressure sores is increasing year by year. The position of the buttocks, such as sacrococcygeal, sciatic nodules and femur trochanter, is the most common. The hip pressure ulcer, as a refractory disease, not only brings pain to the patients, affects the quality of life, and gives the patient family Heavy economic and social burdens, serious infections endanger patients' lives. The treatment of pressure sores is varied. Traditional dressing therapy, traditional Chinese medicine plaster therapy, VSD drainage, surgery, stem cell and cytokine treatment are all involved in modern diagnosis and treatment activities. The skin flap is used to repair the wound. The soft tissue of the buttocks is rich and the mobility is relatively large. There are many different local flaps in the repair of pressure sores in different parts. The common flaps are the gluteal musculocutaneous flap, the posterior femoral cutaneous nerve nutrient vessel flap, the fascia lata flaps and various forms of fasciocutaneous flaps. Cloth, cotton pad, bandage to be bandaged and fixed. However, the postoperative care is difficult, there is a "move" and "move" contradictions. After the operation, the patient's prone position is limited, at least the hip limit is required; pressure sore prevention requires the patient to turn over every 2 small 1 times, the body is loose, the dressing is displaced, the skin flap loses the binding effect, and the wound is easily pulled and pulled apart. Therefore skin flap repair is easy to repair. The success rate of one operation was not high, and there were often complications such as wound dehiscence and non adhesion on the base. The reason was the loosening of the bandage, the loss of the bandage and the fixation of the bandage, and the effect of the shear force on the wound healing caused by the relative movement of the surgical area and the surrounding tissue; the hip tissues in different position positions were caused by gravity and friction. The effect of the force causes the wound tension to increase and split. Some hospitals have good effect on the bed care after the operation, but the use of the body turn bed is time-consuming and laborious, the burden of nursing is great and the patient is disturbed too. There are some hospitals using the suspended bed, the suspension bed makes the tissue not pressed, the patient can not move, but the cost is too expensive, and the general hospital is also not. Negative pressure Wound therapy (NPWT) is a method to accelerate wound healing. It should be used for more than 20 years. The wound of the skin soft tissue defect is filled with the biological semi permeable membrane, making it a closed space, and finally connecting the drainage tube to the negative pressure source, and the medical sponges used in the high efficiency drainage system.NPWT are two kinds of polyurethane PU (Polyurethane) and polythyl alcohol ester PVA (Polyyinyl alcohol). The technology of material is called PU-VSD, and the technology of polyvinyl alcohol ester as negative pressure material is called PVA-VSD. polyurethane dressing with good biocompatibility, nontoxic and non irritating, good permeability and pervious performance, no dry and hard, widely used in foreign countries. The gap of the diameter of 0.2mm-1.0mm with a large number of each other interlinked with polyvinyl alcohol ester has a strong adsorption body. The characteristics of the secretions. The shortcoming is that after the loss of water will be dry and hardened in.2004, Wuhan, Hubei, after the successful self synthesis of PVA, the application of PVA-VSD in our country quickly pushes open and widely applies multiple clinical multiple families to repair a variety of complicated wounds. The three generation of VSD with intermittent low negative pressure + double pressure control display + Intelligent wound drainage and closed automatic flushing of wound surface has been used in large area soft tissue defect, incision and drainage of joint cavity infection, acute and chronic osteomyelitis open window drainage, postoperative wound infection, diabetic foot, pressure sore and other refractory wounds. Experimental study of VSD technology promotion The mechanism of wound repair: (1) improve the blood flow velocity of microcirculation of the wound, expand the microvascular, increase the blood supply of the wound; (2) attract the wound exudation in time, reduce the edema of the wound, and help the repair of the wound; (3) the closed and humid environment inhibits the propagation of bacteria and prevents the external pollution and infection. (4) mechanical traction, machinery Stress induced the growth of tissue cells. Third points show that VSD has the effect of wrapping the wound; fourth point mechanical traction suggests that VSD has a fixed function. Binding and fixation are important parts of the operation. It can directly affect the success or failure of the operation. For example, skin grafting, binding and fixation are not appropriate, and the skin can not be established with the basal tissue. The blood supply causes the skin to not survive. The surgical failure of the.VSD's biological semi permeable membrane makes the wound isolated from the outside, provides the healing environment for the wound, and plays a binding role. The mechanical traction force after the negative pressure forms the area and the surrounding skin of the dressings into a whole. This whole changes with the position of the body. But the tissue inside does not shift: and the sponge has positive pressure on the base. Because of the intrinsic properties of the material, the PVA dehydration drying becomes as hard as plaster, it is not suitable to be used on the skin surface.PU-VSD for binding and fixing. The external polyurethane material is very cheap. Some domestic and foreign scholars use VSD to pressurize the skin after transplantation. Fixed, the survival rate of the skin slice was improved compared with the traditional packing pressure bandage..VSD was less experienced on the skin flap during the same period. Many scholars reported the case of combined use of VSD and skin flap in clinic. VSD was mainly used for the preparation of wound surface before tissue flap transfer. Some scholars used the "observation window" of the VSD sea cotton to use the skin flap in the same period. Through the window observation of the blood flow of the skin flap, it is found that VSD can promote the survival of the skin flap, but the appropriate value of the negative pressure needs to be discussed. The contradiction between "movement" and "movement" after the operation of the hip pressure ulcer flap can reduce the contradiction between "movement" and "immobility" around the hips around the incision. After the operation, the skin flap around the flap is used around the same period. Tissue is a feasible solution to the skin flap, the operation process is simple, it does not need to move the patient repeatedly. After the negative pressure is formed, the tissue around the skin flap is fixed to form a whole, and it will not shift because of the flaps: the whole displacement is less, and the skin flap incision is reduced by the pull force. This study first explores whether the PU-VSD can be reduced. The effect of PU-VSD applied to hip pressure sore flap in the same period was observed, and the success rate of the first operation after the hip flap operation was improved and the complications were reduced. The clinical application value of the hip skin flap was evaluated. Objective 1 to explore the application of PU-VSD fixed hip skin as a "whole" body. The changes in the skin of the whole skin were changed.2, the clinical effect of PU-VSD assisted local flap for the repair of hip pressure sores was observed and its clinical application value was evaluated. Materials and methods: medical polyurethane sponge (Shandong Chuang Kang), medical sputum suction tube, raw material semi permeable membrane (UK annulas) and adjustable Negative pressure source (Tianjin medical instrument factory two). Gauze, cotton pad, bandage. Method 1: select 15 undamaged hips in our hospital in 2013 as volunteers. First, the prone position on the patient's tail bone is the vertical line of the hip groove on 8cm, and the two sides of the intersection are marked on the straight line, and the distance between two points is 18cm.. The distance between the two mark points of the buttocks at the left lateral position and the right lateral position. Then the distance between the two marking points under different body positions was measured again after VSD 2 hours. The linear distance between the upright position, the left lying position and the two mark points in the buttocks was compared with the prone position, and the difference was calculated. The difference between the different positions before and after the fixed position was compared. Method 2: the patients were randomly divided into 2 groups, which were repaired by local flap in August 2012 due to stage IV pressure sores in the buttocks. They were divided into 2 groups. The preoperative routine treatment, the design of the skin flap, the chief surgeon were the same deputy chief physician. The postoperative observation group was 16 cases, the surface of the skin flap was fixed with PU-VSD and the negative pressure was from -15kpa to -20kpa In the control group, 18 cases, after the incision was built with the sterile yarn, were fixed with a cotton pad bandage. The patients who were able to operate independently were not restricted in bed, and the patients with limited activity were turned over 1 times every 2 hours by the trained escort. The observation group VSD continued negative pressure attraction, and found the leakage and timely treatment. The control group changed the contaminated dressings and timely. Refix the loosened dressings. 5 days after the operation, the number of successful cases in two groups was observed, and the complications were observed. The complications were treated. The observation group continued PU-VSD assisted fixation for 1 weeks, and the incision was taken 2 weeks after the incision. The control group continued to bandage the cotton pad bandage and split the wound in time. The success rate of the one operation in the two groups and the complications were compared. Ratio of birth rate; wound healing time and hospitalization time after the wound healing. Statistical analysis: SPSS 16 statistics software recorded the above data, the counting data rate expressed, the measurement data were mean, t test, P0.05 difference was statistically significant. Results the results were 1, in different postures, two points marked on the hip of volunteers were two points. The difference between the measured values and the prone position was obvious after the.PU-VSD application on the hips surface. The difference between the two points marked by different positions was small and the difference was in the 1cm. The difference values of the different body positions before and after PU-VSD were significantly higher than the latter, and the P0.05 had statistical significance. The results were 2, and the two groups were successfully operated on 5 days after operation. Rate and complication: the success rate of the first operation in the observation group was 93.75%, the success rate of the one operation in the control group was 61.11%, the difference between the two groups was statistically significant (P0.05). There were 1 cases in the 16 cases of the observation group and the reoperation after the control of the infection. 18 cases in the control group were diagnosed as 6 cases, including 1 cases of infection and 3 cases of cracking. The incidence of complications in the two groups was compared with 2 cases. The difference was statistically significant (P0.05). The healing time of the two groups after the wound healing and the time of hospitalization were compared: the time of wound healing in the observation group was significantly shorter than that in the control group (P0.05). Conclusion: 1, using PU-VSD to fix the skin around the buttocks flap. As the "whole" moved in position change, the pulling force of the flap incision in the whole area decreased by.2, and PU-VSD was applied to the buttocks simultaneously.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R632.1

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1 程鵬;PU-VSD輔助局部皮瓣修復(fù)臀部壓瘡的臨床研究[D];南方醫(yī)科大學(xué);2016年

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本文編號(hào)：1895469