| ObjectiveTo investigate the clinical efficacy of negative pressure wound therapy technology combined with surgical repair and simple surgical repair in stage 3 and 4 pressure injuries.MethodA total of 131 patients with stage 3 and 4 pressure injuries were admitted from the Department of Burn and Skin Wound Restorative Surgery of Bethune First Hospital of Jilin University from November 2014 to October 2022,with a total of 131 wounds,and were divided into negative pressure group(57 places)and non-negative pressure group(74 places)according to whether negative pressure wound treatment was used.The surgical scheme of the negative pressure group is as follows: After the first stage of debridement,negative pressure wound therapy is performed and when fresh granulation tissue is formed on the wound,the second stage of wound repair surgery is performed;The surgical scheme for the non-negative pressure group is as follows: primary wound repair surgery is performed directly after debridement.The general data of patients,such as age,sex,etiology,underlying diseases,and nutritional status,were included in the analysis.The baseline,preoperative,intraoperative,postoperative and outcome data of the two groups were compared.The pressure ulcer scale for healing(PUSH scale)was used to evaluate the healing of pressure injuries,and the differences between the two treatments in operation duration,intraoperative blood loss,postoperative drainage tube indwelling time,postoperative complication rate,secondary surgical repair rate and primary surgical repair healing rate were analyzed.ResultA total of 131 wounds were included in 125 patients,ranging from 14 to 96 years,with an average age of 57.6±17.62 years;Among them,there were more men than women,with a total of 85 cases,accounting for 64.9%.Spinal cord injury and cerebrovascular accident are the two main causes in this study,along with fractures or postoperative bed rest,craniocerebral diseases,neurodegenerative diseases,impaired consciousness,vegetative state,and advanced age.Diabetes was the main underlying disease,with 36 cases,accounting for27.5%,followed by hypertension.The average length of stay was 38.55±10.17 days,the longest was 78 days,the hospitalization cost was 51331.63±27740.41 yuan,and the maximum cost was 135619.47 yuan.There were 78 cases(59.5%)with hemoglobin less than 120 g/L,79 cases(60.3%)with total protein less than 65 g/L,125 cases(95.4%)with albumin less than 40 g/L,and 50 cases(38.2%)with cholinesterase less than 4000 g/L.In this study,56(42.7%)PIs occurred in the sacrococcygeal region,followed by 58(44.3%)ischial tubercles,16(12.2%)greater trochanter,and 1(0.8%)scapula.There were 103 PIs in stage 4(78.6%)and 28(21.4%)in stage 3.The average area of the 131 wounds in this study was 74.03±96.44 cm~2,and the maximum was 600 cm~2.The first PUSH score averaged was15.44±1.76,with a minimum of 9 and a maximum of 17.The average discharge PUSH score was 0.53±1.98,with a minimum of 0 and a maximum of 12.The average PUSH score difference is 14.91±2.66,with a minimum of 5 and a maximum of 17.The detection rate of microorganisms was 84.7%,and 29(22.1%)of two or more species were detected,among which the most common pathogenic microorganism was Escherichia coli,with a total of 50(45%),followed by Enterococcus faecalis with a total of 15(13.5%),followed by Acinetobacter baumannii 14(12.6%),Klebsiella pneumoniae 14(12.6%),Pseudomonas aeruginosa 13(11.7%),etc.The general baseline data of the two groups,such as age,sex,underlying disease,etiology,wound formation time,wound position,PI stage,wound area,PUSH score and other indicators,were not statistically significant between the groups(P>0.05),which were comparable.There were significant differences between the two groups in terms of duration of repair surgery(P =0.005),intraoperative blood loss(P<0.001),complication rate(P=0.005),secondary/ multiple repair rate(P =0.008),and repair operation-healing time(P=0.009),but there was no significant difference between groups in terms of whether to use drainage tubes,drainage tube use time,length of hospitalization,hospital cost,surgery cost and total cure rate(P >0.05).At discharge,there were 53 complete healings(92.9%)in the negative pressure group and 68(91.9)in the non-negative pressure group,with no significant difference between the two groups(P =0.816),44(83.0%)places in the negative pressure group and 42(61.8%)in the non-negative pressure group,and the difference between the two groups was statistically significant(P =0.037).There was no significant difference between VSD and SVSD groups in terms of length of hospitalization,hospitalization cost,surgical cost,shorter operation time,and blood loss(P >0.05),while there were significant differences between the two groups in terms of the number of negative pressure device replacements(P <0.001),secondary repair rate(P <0.001),and complication rate(P =0.022).Binary logistic regression analysis found that age,sex,and whether negative pressure wound treatment was used were independent influencing factors affecting the healing rate of primary repair.Conclusion(1)The location,stage and wound pathogenic microorganism species of pressure injury are helpful for the formulation of local treatment plans,and the PUSH score plays a certain role in evaluating the healing effect of pressure injury;(2)Surgical repair is the main treatment plan for stage 3 and 4 pressure injuries.Surgical repair combined with negative pressure wound treatment can reduce postoperative complications and improve the rate of one-time surgical repair;(3)VSD is more effective than SVSD in reducing complications and increasing healing rates;In addition,we believe that SVSD technology can be used as an alternative treatment for some patients with poor economic conditions because of its lower cost and high practicality.(4)Spinal cord injury is one of the main causes of pressure injury.40-80 years old is one of the age group with high incidence of pressure injury,which often accompanied by underlying diseases and effective management of underlying diseases has certain significance for the treatment of pressure injuries;(5)Most patients with pressure injury have poor nutritional status due to long-term bed rest and weakened digestive function.The detection of laboratory indicators,such as hemoglobin,albumin,total protein,cholinesterase and so on,can quantify the nutritional status of patients to a certain extent,is benefit to develop personalized nutritional support programs;(6)We summarize and analyze the collected clinical cases,we formulate a relatively ideal flow chart of pressure injury treatment and clinical information record table. |
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