Use of Vacuum-Assisted Wound Closure to Manage Problem Wounds in Patients Suffering from Poorly Healing Pressure Ulcers

使用負壓傷口癒合機治療困難褥瘡傷口的臨床經驗

黃文賢(Wen-Shyan Huang) ； 謝尚卿(Shang-Chin Hsieh) ； 蔡子斌(Tzyy-Bin Tsay) ； 謝俊昇(Chun-Sheng Hsieh)

《南臺灣醫學雜誌》 3卷3期 (2007/12) Pp. 132-138

https://doi.org/10.6726/MJST.200712_3(3).0003

摘要

為了找出較有效率的困難褥瘡傷口治療方式，收集本院困難褥瘡傷口住院病患，包括外科及內科會診病患，共28人，40個傷口。將病患分成第一組（接受負壓傷口癒合機治療）和第二組（接受傳統溼紗換藥治療）兩組，第一組：住院後先行清創手術，清除死組織及感染組織後，接受負壓傷口癒合機（-120mmHg，間歇性每二小時吸一小時）治療，每隔4～5天，更換敷料；第二組：同樣清創手術治療後，接受濕紗換藥，每四至八小時更換一次。並觀查，記錄，傷口分泌物的：1.顏色、2.味道、3.量、4.傷口周圍紅腫範圍、5.傷口大小。經治療後，傷口大小癒合面積百分比：負壓傷口癒合機為47％，溼紗換藥為40％；傷口引流量減少的百分比：負壓傷口癒合機為44％，溼紗換藥為33％；傷口進步指標百分比：負壓傷口癒合機為45％，溼紗換藥為41％；換藥的衛材成本：負壓傷口癒合機每天為1500元，溼紗換藥為每天為400元；而醫護人員換藥的時間：負壓傷口癒合機，每天平均2.4分鐘，溼紗換藥為每天平均16分鐘。結論：負壓傷口癒合機，可藉由負壓抽吸的原理，有效率的吸除發炎或感染的組織滲液或膿水，並促進抽吸部位的局部血液循環，而促進傷口的癒合。對於慢性病患、不適合接受麻醉或大手術的病人，負壓傷口癒合機治療，提供一種非手術的治療方式。雖然成本稍高一點，但可使醫護人員較有效率的處置困難褥瘡傷口。在醫管精進的時代，以VAC治療此困難褥瘡傷口；是個較有效率的傷口治療方式。

關鍵字

褥瘡

並列摘要

Objective: This study compared the effectiveness of vacuum-assisted wound closure (VAC) with traditional wet-dressing techniques in the wound care. The data was obtained from the admitted-patient medical records over a three year period for patients suffering chronic medical disease associated with pressure ulcers. Methods: The first group of patients underwent the VAC technique for wound care every four to five days. The second group of patients received traditional wet-dressing for wound care every four to eight hours. The outcome parameters evaluated included wound size, drainage-fluid color, presence of perimarginal edema, presence of wound odor, and drainage volume. Results: The wound-size reduction level (percentage) was 47% for VACversus 40% for saline dressing. The drainage-volume reduction level was 44% for VAC versus 33% for saline dressing. The wound-score reduction level was 45% for VAC versus 41% for saline dressing. The cost of dressing materials was around 1,500 Taiwanese dollars per day for the VAC procedure versus 400 Taiwanese dollars for saline dressing. The daily nursing time for wound management was 2.4 minutes per day for VAC versus 16 minutes for saline dressing. Conclusions: The VAC technique appears to be more effective than saline dressing for the management of difficult wound dressing for patients considered inappropriate for a surgical procedure.

並列關鍵字

pressure ulcer