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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 37 -42. doi: 10.3877/cma.j.issn.1674-0785.2023.01.006

临床研究

低温等离子射频清创联合负压封闭引流对腹壁术后切口感染的临床效果
臧宇1, 姚胜1,†(), 戎世捧1, 田智超1   
  1. 1. 100853　北京，解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2022-01-20 出版日期:2023-01-15
  • 通信作者: 姚胜

Clinical effect of low temperature plasma ablation debridement combined with vacuum sealing drainage in treatment of postoperative abdominal wall incision infection

Yu Zang1, Sheng Yao1,†(), Shipeng Rong1, Zhichao Tian1   

  1. 1. Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2022-01-20 Published:2023-01-15
  • Corresponding author: Sheng Yao
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引用本文：

臧宇, 姚胜, 戎世捧, 田智超. 低温等离子射频清创联合负压封闭引流对腹壁术后切口感染的临床效果[J]. 中华临床医师杂志(电子版), 2023, 17(01): 37-42.

Yu Zang, Sheng Yao, Shipeng Rong, Zhichao Tian. Clinical effect of low temperature plasma ablation debridement combined with vacuum sealing drainage in treatment of postoperative abdominal wall incision infection[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(01): 37-42.

目的

探究低温等离子射频（LTPA）清创联合负压封闭引流（VSD）对腹壁术后切口感染的临床效果。

方法

采用回顾性队列研究，回顾性分析2011年1月至2021年9月解放军总医院第一医学中心收治的99例腹壁术后切口感染患者的临床资料。其中男61例，女38例，年龄（39.1±2.3）岁。按照治疗方法将其分为LTPA联合VSD组和单纯VSD组，分别为47例与52例，分析两组患者术前及术后细菌培养结果、创面愈合率、疼痛评分及不良反应发生率情况。

结果

LTPA联合VSD组术前、第1次、第2次与第3次更换VSD时细菌培养阳性率分别为100%（47/47）、2.1%（1/47）、0%（0/47）与0%（0/47），单纯VSD组相应时间点则分别为100%（52/52）、65.4%（34/52）、21.2%（11/52）与0%（0/52），LTPA联合VSD组第1次与第2次更换VSD时细菌培养阳性率均显著低于单纯VSD组（均P＜0.05）。LTPA+VSD组第1、2及3次治疗后创面愈合率分别为58.2%±11.0%、71.6%±10.1%、91.7%±11.8%，单纯VSD组则分别为43.5%±12.4%、62.3%±11.5%、75.2%±10.3%，LTPA+VSD组各时间点均显著高于单纯VSD组（均P＜0.05）。LTPA+VSD组患者创面完全愈合时间为（28.5±6.4）d，明显短于单纯VSD组的（55.3±6.5）d（P＜0.001）。LTPA+VSD组与单纯VSD组第1次治疗前VAS评分分别为（5.5±1.6）分与（5.4±1.5）分（P＞0.05）。第1次治疗10 d后，LTPA+VSD组VAS评分为（1.1±0.5）分，显著低于单纯VSD组的（3.5±0.9）分（P＜0.001）。VLTPA+VSD组术后不良反应发生率为4.3%，显著低于单纯VSD组的19.2%（P＜0.05）。

结论

LTPA联合VSD治疗腹壁术后切口感染具有可有效降低创面细菌培养阳性率、加速创面愈合、减轻术后疼痛及避免术后不良反应发生的优点。

关键词: 腹壁, 切口感染, 低温等离子射频, 负压封闭引流
Objective

To explore the clinical effect of low temperature plasma ablation (LTPA) debridement combined with vacuum sealing drainage (VSD) in the treatment of postoperative abdominal wall incision infection.

Methods

A retrospective cohort study was carried out to analyze the clinical data of 99 patients diagnosed with postoperative abdominal wall incision infection who were admitted to the First Medical Center of the General Hospital of the People's Liberation Army from January 2011 to September 2021, including 61 males and 38 females with a mean aged of (39.1±2.3) years. According to the treatment method, the patients were divided into either an LTPA combined with VSD group (47 cases) or a VSD alone group (52 cases). Preoperative and postoperative bacterial culture results, wound healing rate, pain score, and adverse reaction rate of the two groups were analyzed.

Results

The positive rate of bacterial culture in the combination group was 100% (47/47), 2.1% (1/47), 0% (0/47), and 0% (0/47), respectively, before operation and at the first, second, and third VSD replacement, and it was 100% (52/52), 65.4% (34/52), 21.2% (11/52), and 0% (0/52) in the VSD alone group, respectively; the positive rate in the LTPA+VSD group at the first and second replacement of VSD was both significantly lower than that in the VSD group at the corresponding time points (P＜0.05 for both). The wound healing rate of the LTPA+VSD group after the first, second, and third treatment was 58.2%±11.0%, 71.6%±10.1%, and 91.7%±11.8%, respectively, and it was 43.5%±12.4%, 62.3%±11.5%, and 75.2%±10.3% in the VSD alone group, respectively; the wound healing rate in the LTPA+VSD group at each time point was all significantly higher than that in the VSD group (P＜0.05 for all). The time of complete wound healing in the LTPA+VSD group was (28.5±6.4) days, which was significantly shorter than that in the VSD group [(55.3±6.5) days; P＜0.001]. The VAS score of the two groups before the first treatment was 5.5±1.6 and 5.4±1.5, respectively (P＞0.05). The VAS score at 10 days after the first treatment in the LTPA+VSD group was 1.1±0.5, which was significantly lower than that in the VSD group [(3.5±0.9), P＜0.001]. The incidence of postoperative adverse reactions in the VLTPA+VSD group was 4.3%, which was significantly lower than that in the VSD group (19.2%, P＜0.05).

Conclusion

LTPA+VSD in the treatment of postoperative abdominal wall incision infection has the advantages of effectively reducing the positive rate of wound bacterial culture, accelerating wound healing, reducing postoperative pain, and avoiding postoperative adverse reactions.

Key words: Abdominal wall, Incision infection, Low temperature plasma ablation, Vacuum sealing drainage
表1 2组腹壁术后切口感染患者一般资料比较（
xˉ
±s）
组别 例数（男/女） 年龄（岁） 体质指数（kg/m2） 手术性质（急诊/择期，例） 病程（月） 容积（ml）
单纯VSD组 52（32/20） 39.3±2.3 29.7±2.2 41/11 24.2±4.7 18.5±2.3
VSD+LTPA组 47（29/18） 38.8±2.4 28.8±2.7 33/14 25.6±5.4 19.1±2.1
统计量 χ2=0.000 t=1.058 t=1.825 χ2=0.9748 t=1.379 t=1.351
P值 0.987 0.293 0.071 0.324 0.171 0.180
表2 2组腹壁切口感染患者治疗前后创面分泌物细菌培养阳性率比较［例（%）］
组别 例数 治疗前 首次治疗后 二次治疗后
单纯VSD组 52 52（100） 34（65.4） 11（21.2）
VSD+LTPA组 47 47（100） 1（2.1） 0（0）
χ2值 - 43.222 11.185
P值 - ＜0.001 ＜0.05
表3 2组腹壁切口感染患者治疗前后创面愈合率比较（%，
xˉ
±s）
组别 例数 第1次治疗后 第2次治疗后 第3次治疗后
单纯VSD组 52 43.5±12.4 62.3±11.5 75.2±10.3
VSD+LTPA组 47 58.2±11.0 71.6±10.1 91.7±11.8
χ2值 6.212 4.255 7.428
P值 ＜0.001 ＜0.001 ＜0.001
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