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目的对于保肢患者创面应用负压封闭引流技术(vacuum sealing drainage,VSD),探讨术后引流量的相关规律。方法 2011年1月至2015年1月,63例四肢外伤合并主干动脉损伤患者(上肢亚组38例,下肢亚组25例)接受血管修复后残留创面无法一期关闭,应用VSD对创面临时覆盖。另有38例骨筋膜室综合征(无并发主干动脉损伤,上肢亚组16例,下肢亚组22例)患者,切开减张创面应用VSD临时覆盖。估算创面大小并记录VSD引流量。对比2组病例应用VSD术后7天内单位面积VSD引流量并加以对比。结果对于主干动脉损伤组,术后1~7天单位面积平均引流量(单位:ml/cm~2)分别:上肢亚组:1.50,1.48,1.35,1.09,0.97,0.86,0.94;下肢亚组:1.25,0.83,0.65,0.74,0.59,0.47,0.42;而骨筋膜室综合征组,术后1~7天单位面积平均引流量(单位:ml/cm2)分别是:上肢亚组:1.21,0.92,0.60,0.47,0.42,0.33,0.26;下肢亚组:0.55,0.58,0.40,0.37,0.25,0.24,0.26。应用独立样本t检验,血管损伤组术后单位面积平均引流量在上肢亚组及下肢亚组均多于骨筋膜室综合征组相应亚组,但仅在上肢亚组术后2~7天的数据差异有统计学意义(P<0.05)。而在同组内相应亚组对比,上肢亚组单位面积平均引流量多于下肢亚组,但仅在血管损伤组术后第2~7天数值差异有统计学意义(P<0.05)。结论对于保肢患者创面应用VSD后创面引流量大,须密切监测。
Objective To apply vacuum sealing drainage (VSD) to wounds of patients with limb salvage and to explore the related rules of postoperative drainage. Methods From January 2011 to January 2015, 63 patients with limbs trauma with arterial injury (38 cases in the upper extremity and 25 cases in the lower extremity) were unable to close the residual wounds after vascular repair. The wounds were temporarily covered with VSD . In addition, there were 38 patients with osteofascial compartment syndrome (without primary arterial injury, 16 in the upper limbs and 22 in the lower extremities). The incised wounds were treated with VSD temporary coverage. Estimate the wound size and record the VSD drainage. Comparing the two groups of patients VSD drainage within 7 days after the unit area VSD drainage and compared. Results The average drainage volume per unit area (unit: ml / cm ~ 2) at 1 ~ 7 days after operation in the group of main arterial injury were: upper limbs subgroups: 1.50,1.48,1.35,1.09,0.97,0.86,0.94; : 1.25,0.83,0.65,0.74,0.59,0.47,0.42; and osteoflagellar syndrome group, the average drainage volume per unit area from 1 to 7 days after surgery (unit: ml / cm2) are: upper limb subgroup: 1.21 , 0.92,0.60,0.47,0.42,0.33,0.26; lower limbs subgroups: 0.55,0.58,0.40,0.37,0.25,0.24,0.26. The independent sample t-test showed that the average drainage volume per unit area of the vascular injury group was more than that of the subfascial compartment group in the upper extremity subgroup and the lower limb subgroup but only in the upper limb subgroup 2 to 7 days after operation The difference was statistically significant (P <0.05). In comparison with the corresponding subgroups in the same group, the average drainage volume per unit area in the upper limbs subgroup was more than that in the lower limb subgroups. However, there was significant difference between the two groups (P <0.05). Conclusions For patients with limb salvage wounds VSD wound drainage, should be closely monitored.