VAC聯合郵票植皮修復兒童難愈性創面療效探討

張朦 章磊 杜琳

[摘要]目的：觀察負壓封閉引流技術（Vacuum-assisted closure，VAC）聯合郵票植皮修復早期不當處理形成的難愈性創面的療效。方法：選取筆者醫院2016年2月-2020年2月因早期不當處理致創面加深患兒60例為研究對象，依據非隨機臨床同期對照研究及患兒家屬自愿原則分為觀察組（n=32）、對照組（n=28），觀察組予以VAC+郵票植皮技術治療，對照組采用傳統打包結合郵票植皮技術治療，比較兩組植皮優良率、治療結果（手術時間、術后換藥次數、住院時間、創面愈合時間）、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）]、血管內皮生長因子（VEGF）水平及患兒家屬滿意度。結果：觀察組植皮優良率高于對照組，差異有統計學意義（P<0.05）。觀察組的手術時間、住院時間、創面愈合時間及術后換藥次數均較對照組少，差異有統計學意義（P<0.05）。觀察組治療后7d、14d植皮成活率高于對照組，差異有統計學意義（P<0.05）。觀察組治療后血清IL-1、IL-6、TNF-α水平明顯低于對照組，而VEGF水平較對照組高，差異有統計學意義（P<0.05）。觀察組患兒家屬治療后滿意度高于對照組，差異有統計學意義（P<0.05）。結論：早期不當處理致創面加深后運用VAC聯合郵票植皮療效較好，可明顯提高植皮成活率，減少手術時間和術后換藥次數，并下調炎癥因子水平，有利于創面愈合。

[關鍵詞]難愈性創面;負壓封閉引流技術;郵票植皮;療效;炎癥因子;血管內皮生長因子

[中圖分類號]R622? ? [文獻標志碼]A? ? [文章編號]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聯合郵票植皮修復兒童難愈性創面療效探討[J].中國美容醫學，2020，29（12）：82-86.