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目的探讨封闭式负压引流(vacuum sealing drainage,VSD)技术在“5.12”汶川大地震伤员创面修复中的使用方法及早期疗效。方法2008年5月12日-6月12日,治疗52例伤员83处创面。男27例,女25例;年龄11～83岁,平均42岁。压榨伤22例,挫裂伤9例,挤压伤后行筋膜室切开减压17例,开放性截肢4例。创面部位:小腿37处,大腿13处,前臂17处,上臂11处,躯干5处。创面范围3cm×2cm～30cm×15cm。受伤至接受VSD技术治疗时间12h～18d。创面彻底清创后,VSD治疗覆盖创面,根据药物敏感实验结果选择抗生素治疗。创面感染控制、肉芽生长良好后行直接缝合、植皮或皮瓣移位修复创面。结果21例(40.4)伤员创面分泌物涂片阳性,以混合细菌为主:包括金黄色葡萄球菌、大肠埃希菌、变形杆菌等。首次治疗7例(20处)转外省医院治疗,33例(45处)、6例(10处)、2例(3处)及1例(1处)分别行1次、2次、3次及4次VSD治疗后,创面感染控制、肉芽生长良好,分别经直接缝合、植皮或皮瓣移位顺利修复创面。3例(4处)经10次VSD治疗后感染控制,病情稳定。结论VSD治疗能快速覆盖创面,减少污染,防止继发感染,利于后期创面修复;治疗期间无需频繁更换敷料,减少伤员痛苦及医务人员工作量,为地震伤员的救治提供了方便。
Objective To explore the method and early effect of closed vacuum drainage drainage (VSD) technique in wound repair of wounded people in “5.12 ” Wenchuan Earthquake. Methods From May 12 to June 12, 2008, 83 wounds were treated in 52 cases. 27 males and 25 females; aged 11 to 83 years, mean 42 years old. 22 cases of crush injury and 9 cases of contusion and laceration, 17 cases of decompression of fascia incision and 4 cases of open amputation. Wound areas: 37 calves, thighs 13, 17 forearms, 11 upper arm, trunk 5. Wound range 3cm × 2cm ~ 30cm × 15cm. Injured to VSD technology treatment time 12h ~ 18d. After complete debridement of the wound, the VSD treatment covers the wound and the antibiotic treatment is selected based on the results of the drug-sensitive experiment. Wound infection control, granulation good growth after direct suture, skin graft or flap displacement repair wounds. Results Twenty-one patients (40.4%) had wound smear positive, mainly mixed bacteria, including Staphylococcus aureus, Escherichia coli and Proteus. The first treatment of 7 cases (20) outside the provincial hospital treatment, 33 cases (45), 6 cases (10), 2 cases (3) and 1 case After VSD treatment for 4 times, wound infection control and granulation well grew. The wounds were repaired by direct suturing, skin grafting or skin flap respectively. Three patients (4) were infected after infection with 10 VSDs and were stable. Conclusion VSD treatment can quickly cover the wound, reduce the pollution and prevent secondary infection, which is beneficial to the wound repair in the later period. It is unnecessary to frequently change the dressing during the treatment, reduce the pain of the wounded and the medical staff workload, and provide convenience for the treatment of the earthquake victims.