两种皮肤保护方法在负压治疗慢性伤口中的应用研究

doi:10.3761/j.issn.0254-1769.2019.01.006

摘要/Abstract

摘要：

目的探索两种皮肤保护方法对预防负压伤口治疗相关的潮湿相关性皮肤损伤的效果。方法纳入具有负压伤口治疗适应证的慢性伤口患者132例,随机分为两组,每组各66例。试验组采用防漏膏封堵伤口周围皮肤保护法,对照组采用多聚合物无痛皮肤保护膜涂抹法,两组均干预14 d后,使用标准的湿性治疗随访至愈合或3个月。评价指标：负压治疗期间伤口周围皮肤潮湿相关性皮肤损伤发生率为主要结局指标,负压治疗过程中的漏气报警和皮肤浸渍频次、伤口面积、深度缩小率及随访3个月末的伤口治愈率与愈合时间为次要结局指标。结果共脱落6例,试验组在负压治疗期间潮湿相关性皮肤损伤发生率、漏气报警和皮肤浸渍频次均少于对照组（均P<0.05）。试验组负压治疗14 d的伤口面积缩小率大于对照组（P<0.05）,深度缩小率两组接近（P>0.05）。随访期末试验组治愈率高于对照组（P<0.05）,两组愈合时间接近（P>0.05）。结论两种皮肤保护法对预防潮湿相关性皮肤损伤均有一定效果,防漏膏保护法效果更优,在确保负压治疗顺利进行,改善伤口治疗效果,促进伤口愈合中发挥重要作用,适用于不同类型、不同部位的慢性伤口患者。

关键词: 负压伤口疗法, 慢性伤口, 潮湿相关性皮肤损伤, 伤口愈合, 伤口护理

Abstract:

Objective To explore the effect of two skin protecting methods in negative pressure wound therapy （NPWT） for chronic wounds in order to prevent NPWT-related moisture-associated skin damage（MASD）. Methods A total of 132 patients with chronic wounds were enrolled and randomly divided into two groups,66 cases in each group. During NPWT,the intervention group used a leak-proof paste for protecting peri-wound skin,and the control group was applied with a multi-polymer free pain skin protective dressing for protecting peri-wound skin. Both groups were treated for 14 days and then followed up with standard moisture therapy until healed or 3 months. Primary outcome：incidence of MASD around wound during NPWT;secondary outcomes：frequency of leakage alarm,skin impregnation frequency,the reduction rate of wound area,depth during NPWT,and rate of wound healing,and healing time during the follow-up. Results A total of 6 cases were dropped. In the full analysis set,the MASD incidence,the frequency of leakage alarm and skin impregnation in the intervention group were less than those in the control group（P<0.05）. The difference in the reduction rate of wound area between the two groups was significant（P<0.05）. The difference in the depth reduction rate between the two groups was no significance（P>0.05）. At the end of the follow-up period,the rate of wound healing in the intervention group was higher than that in the control group（P<0.05）,and healing time of both groups was close（P>0.05）. Conclusion The research proved that two protecting skin methods had some effects on protect peri-wound skin and preventing NPWT-related MASD.The leak-proof paste method was better and it played an important role in ensuring NPWT,improving wound treatment outcomes and promoting wound healing and it is suitable for patients with different types and locations of chronic wounds.

Key words: Negative-Pressure Wound Therapy, Chronic Wounds, Moisture-Associated Skin Damage, Wound Healing, Wound Nursing

蒋琪霞, 王建东, 董珊, 彭青, 黄秀玲. 两种皮肤保护方法在负压治疗慢性伤口中的应用研究[J]. 中华护理杂志, 2020, 55(1): 39-44.

JIANG Qixia, WANG Jiandong, DONG Shan, PENG Qing, HUANG Xiuling. Comparative study of two methods of protecting skin for patients with chronic wounds treated by negative pressure wound therapy[J]. Chinese Journal of Nursing, 2020, 55(1): 39-44.

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参考文献 27

[1]	Baranoski S, Ayello EA . Wound care essentials:practice principles[M]. 3rd. Ambler: Lippincott Williams﹠Wilkins, 2012: 83-100.
[2]	Tricco AC, Cogo E, Isaranuwatchai W , et al. A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types[J]. BMC Med, 2015,13:90.
[3]	Tricco AC, Antony J, Vafaei A, , et al. Seeking effective interventions to treat complex wounds:an overview of systematic reviews[J]. BMC Med, 2015,13:89-122.
[4]	蒋琪霞, 李晓华, 彭青 , 等. 负压伤口治疗技术用于53例慢性伤口的效果评价[J]. 中华护理杂志, 2012,47(4):293-296.
[5]	Liu X, Zhang H, Cen SQ , et al. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures:a systematic review and meta-analysis[J]. Int J Surg, 2018,53:72-79.
[6]	蒋琪霞 . 负压封闭伤口治疗理论与实践[M]. 北京: 人民卫生出版社, 2018:44-47, 91-102, 119-122.
[7]	Guffanti A . Negative pressure wound therapy in the treatment of diabetic foot ulcers:asystematic review of the literature[J]. J Wound Ostomy Continence Nurs, 2014,41(3):233-237.
[8]	Dumville JC, Land L, Evans D , et al. Negative pressure wound therapy for treating leg ulcers[J]. Cochrane Database Syst Rev, 2015(7):CD011354.
[9]	Dumville JC, Webster J, Evans D , et al. Negative pressure wound therapy for treating pressure ulcers[J]. Cochrane Database Syst Rev, 2015(5):CD011334.
[10]	Chiang N, Rodda OA, Sleigh J , et al. Effects of topical negative pressure therapy on tissue oxygenation and wound healing in vascular foot wounds[J]. J Vasc Surg, 2017,66(2):564-571.
[11]	Ali E, Raghuvanshi M . Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy:a systematic review[J]. J Wound Care, 2017,26(12):712-719.
[12]	Sartelli M, Guirao X, Hardcastle TC , et al. 2018 WSES/SIS-E consensus conference:recommendations for the management of skin and soft-tissue infections[J]. World J Emerg Surg, 2018,13:58-82.
[13]	Valls-Matarín J, Del Cotillo-Fuente M, Ribal-Prior R , et al. Incidence of moisture-associated skin damage in an intensive care unit[J]. Enferm Intensiva, 2017,28(1):13-20.
[14]	蒋琪霞 . 伤口护理实践原则[M]. 3版. 北京: 人民卫生出版社, 2017: 120, 142-168.
[15]	Swanson T, Keast D . Clinical innovation:2016 wound infection consensusdocument[J]. Wounds Int, 2017,8(2):19-21.
[16]	Readding L . Practical guidance for nurses caring for stoma patients with long-term conditions[J]. Br J Community Nurs, 2016,21(2):90-98.
[17]	徐娟, 蒋琪霞, 刘颖 , 等. 给氧负压封闭伤口治疗在骨科慢性伤口中的应用效果研究[J]. 中华护理杂志, 2016,51(6):650-654.
[18]	蒋琪霞, 徐娟, 李晓华 , 等. 负压封闭结合局部氧疗改善创伤性慢性伤口愈合的效果研究[J]. 医学研究生学报, 2016,29(7):731-736.
[19]	Pather P, Hines S, Kynoch K , et al. Effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis:a systematic review[J]. JBI Database System Rev Implement Rep, 2017,15(5):1473-1496.
[20]	宋娟, 蒋琪霞, 王雪妹 . 不同护理措施预防重症患者失禁相关性皮炎的对比研究[J]. 中华护理杂志, 2016,51(1):62-65.
[21]	杨婷, 蒋琪霞, 唐蓉蓉 , 等. 不同皮肤保护剂护理失禁患者的效果分析[J]. 医学研究生学报, 2019,32(1):87-90.
[22]	蒋琪霞, 朱礼霞, 张媛 , 等. 负压伤口治疗联合湿性疗法用于交通挤压伤的研究[J]. 医学研究生学报, 2014,27(9):955-958.
[23]	蒋琪霞 . 压疮护理学[M]. 北京: 人民卫生出版社,2015: 93-103, 71-88, 233-269.
[24]	Doughty D, Junkin J, Kurz P , et al. Incontinence-associated dermatitis:consensus statements,evidence-based guidelines for prevention and treatment,and current challenges[J]. J Wound Ostomy Continence Nurs, 2012,39(3):303-315.
[25]	Kon Y, Ichikawa-Shigeta Y, Iuchi T , et al. Effects of a skin barrier cream on management of incontinence-associated dermatitis in older women:acluster randomized controlled trial[J]. J Wound Ostomy Continence Nurs, 2017,44(5):481-486.
[26]	Liu S, He CZ, Cai YT , et al. Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers:systematic review and meta-analysis[J]. Ther Clin Risk Manag, 2017,13:533-544.
[27]	Armstrong DG, Marston WA , ReyzelmanAM,et al. Comparison of negative pressure wound therapy with an ultraportable mechanically powered device vs. traditional electrically powered device for the treatment of chronic lower extremity ulcers:a multicenter randomized-controlled trial[J]. Wound Repair Regen, 2011,19(2):173-180.