張朦 章磊 杜琳

[摘要]目的：觀察負(fù)壓封閉引流技術(shù)（Vacuum-assisted closure，VAC）聯(lián)合郵票植皮修復(fù)早期不當(dāng)處理形成的難愈性創(chuàng)面的療效。方法：選取筆者醫(yī)院2016年2月-2020年2月因早期不當(dāng)處理致創(chuàng)面加深患兒60例為研究對(duì)象，依據(jù)非隨機(jī)臨床同期對(duì)照研究及患兒家屬自愿原則分為觀察組（n=32）、對(duì)照組（n=28），觀察組予以VAC+郵票植皮技術(shù)治療，對(duì)照組采用傳統(tǒng)打包結(jié)合郵票植皮技術(shù)治療，比較兩組植皮優(yōu)良率、治療結(jié)果（手術(shù)時(shí)間、術(shù)后換藥次數(shù)、住院時(shí)間、創(chuàng)面愈合時(shí)間）、植皮成活率、治療前后血清炎癥因子[白介素-1（IL-1）、白介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）]、血管內(nèi)皮生長(zhǎng)因子（VEGF）水平及患兒家屬滿意度。結(jié)果：觀察組植皮優(yōu)良率高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組的手術(shù)時(shí)間、住院時(shí)間、創(chuàng)面愈合時(shí)間及術(shù)后換藥次數(shù)均較對(duì)照組少，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組治療后7d、14d植皮成活率高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組治療后血清IL-1、IL-6、TNF-α水平明顯低于對(duì)照組，而VEGF水平較對(duì)照組高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患兒家屬治療后滿意度高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：早期不當(dāng)處理致創(chuàng)面加深后運(yùn)用VAC聯(lián)合郵票植皮療效較好，可明顯提高植皮成活率，減少手術(shù)時(shí)間和術(shù)后換藥次數(shù)，并下調(diào)炎癥因子水平，有利于創(chuàng)面愈合。

[關(guān)鍵詞]難愈性創(chuàng)面;負(fù)壓封閉引流技術(shù);郵票植皮;療效;炎癥因子;血管內(nèi)皮生長(zhǎng)因子

[中圖分類號(hào)]R622? ? [文獻(xiàn)標(biāo)志碼]A? ? [文章編號(hào)]1008-6455（2020）12-0082-04

Study on the Effect of VAC Combined with Stamp Skin Grafting on Refractory Wounds in Children

ZHANG Meng，ZHANG Lei，DU Lin

（Department of Burn and Plastic Surgery，Children's Hospital Affiliated to Nanjing Medical University，Nanjing 210000，Jiangsu，China）

Abstract： Objective? To observe the effect of vacuum-assisted closure（VAC） combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage. Methods? Sixty children with refractory wounds caused by improper treatment in the early stage in the hospital between February 2016 and February 2020 were selected as the research subjects. They were divided into the observation group （n=32） and the control group （n=28） according to the non-randomized clinical concurrent control study and childrens family members voluntary principles. The observation group was treated with VAC combined with stamp skin grafting， and the control group was treated with traditional packaging combined with stamp skin grafting. The excellent and good rate of skin grafting， treatment outcomes （operation time， frequency of postoperative dressing change， hospital stay， wound healing time）， survival rate of skin grafts， levels of serum inflammatory factors [interleukin-1 （IL-1）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）] and vascular endothelial growth factor （VEGF） before and after treatment， and satisfaction of childrens family members were compared between the two groups. Results? The excellent and good rate of skin grafting in the observation group was higher than that in the control group， the difference was statistically significant （P<0.05）. The operation time， hospital stay and wound healing time of the observation group were shorter than those of the control group， and the frequency of postoperative dressing change was less than the control group （P<0.05）. The survival rates of skin grafts in the observation group at 7 days and 14 days after treatment were higher than those in the control group （P<0.05）. After treatment， levels of serum IL-1， IL-6 and TNF-α in the observation group were significantly lower than those in the control group， while the level of VEGF was higher than that in the control group （P<0.05）. The satisfaction of family members of the observation group after treatment was higher than those of the control group （P<0.05）. Conclusion? The application of VAC combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage can improve the survival rate of skin grafts significantly， reduce the operation time and the frequency of postoperative dressing change， and down regulate the levels of inflammatory factors， which is beneficial to wound healing.

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[收稿日期]2020-03-30

本文引用格式：張朦，章磊，杜琳.VAC聯(lián)合郵票植皮修復(fù)兒童難愈性創(chuàng)面療效探討[J].中國(guó)美容醫(yī)學(xué)，2020，29（12）：82-86.