3种不同创基准备程序性治疗方法在慢性难愈性创面中的效果观察

Observation on effect of three different wound preparation procedures in chronic refractory wounds

摘要:

目的 探讨清创换药、负压引流、富血小板血浆治疗的创基准备程序性治疗在慢性难愈性创面中的效果。方法 回顾性分析2017年5月—2021年5月江南大学附属医院收治的83例创基准备程序性治疗的慢性难愈性创面患者的临床资料，根据治疗方法不同分为清创换药组25例、负压引流组35例、富血小板血浆组23例。比较3组患者创面愈合时间、创面完全愈合患者占比，临床疗效，治疗前后视觉模拟疼痛评分（VAS）差值、温哥华瘢痕评定量表（VSS）评分，治疗前后创面感染指标差值，创面细菌阳性率及复发情况。结果 富血小板血浆组创面愈合时间短于清创换药组和负压引流组（P <0.05），富血小板血浆组与清创换药组和负压引流组创面完全愈合患者占比比较，差异无统计学意义（P >0.05）；富血小板血浆组与清创换药组和负压引流组总有效率比较，差异无统计学意义（P >0.05）；富血小板血浆组治疗前后VAS评分差值高于清创换药组和负压引流组（P <0.05），富血小板血浆组VSS评分低于清创换药组和负压引流组（P <0.05）；富血小板血浆组治疗前后C反应蛋白差值、白细胞计数差值均高于清创换药组和负压引流组（P <0.05）；富血小板血浆组创面细菌阳性率，复发率均低于清创换药组和负压引流组（P <0.05）。结论 与清创换药、负压引流相比，富血小板血浆用于创基准备程序性治疗慢性难愈性创面可以加快创面愈合，减轻疼痛，提高创面愈合质量，减轻炎症反应。

Abstract:

Objective To explore the effect of wound foundation preparation procedure therapy of debridement, dressing change, negative pressure drainage, and platelet-rich plasma therapy in chronic refractory wounds.Methods The data of 83 patients with chronic refractory wounds who were admitted to the hospital from May 2017 to May 2021 were retrospectively analyzed, and they were divided into debridement and dressing group (n = 25 cases), negative pressure drainage group (n = 35 cases), and platelet-rich plasma group (n = 23 cases) according to different treatment methods. The wound healing time, percentage of patients with complete wound healing, clinical efficacy, difference of visual analogue scale (VAS) before and after treatment, wound healing quality score (VSS), difference of wound infection indicators before and after treatment, wound bacterial positive rate, and recurrence were compared among the three groups.Results The wound healing time in the platelet-rich plasma group was shorter than that in the debridement and dressing group and the negative pressure drainage group (P < 0.05). There was no significant difference in the percentage of patients with complete wound healing between the platelet-rich plasma group, the debridement dressing group and the negative pressure drainage group (P > 0.05). There was no significant difference in the total effective rate between the platelet-rich plasma group, the debridement dressing group, and the negative pressure drainage group (P > 0.05). The difference of VAS score before and after treatment in the platelet rich plasma group was higher than that in the debridement and dressing change group and negative pressure drainage group (P < 0.05), and the VSS score in the platelet rich plasma group was lower than that in the debridement and dressing change group and negative pressure drainage group (P < 0.05). The difference of C-reactive protein (CRP) and white blood cell count (WBC) in platelet rich plasma group before and after treatment were higher than those in debridement and dressing change group and negative pressure drainage group (P < 0.05). The positive rate and recurrence rate of wounds in the platelet-rich plasma group were lower than those in the debridement and dressing group and the negative pressure drainage group (P < 0.05).Conclusion Compared with debridement, dressing change and negative pressure drainage, platelet-rich plasma used for wound-base preparation, and procedural treatment of patients with chronic refractory wounds can accelerate wound healing, reduce pain, improve wound healing quality, and reduce inflammatory responses.