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Modified Negative Pressure Therapy in Clinical Wound Care-National Cheng Kung University Hospital Experience

改良式負壓療法在臨床傷口上的使用-成大醫院經驗

摘要


背景: 負壓抽吸療法被證實可以加速傷口癒合及刺激肉芽組織快速形成,然而健保局對於其核准仍有許多限制,且負壓抽吸療法系統自費成本很高,因此,我們在本文提出一個改良式負壓抽吸療法及本院之成果。 材料及方法: 從2007年11月到2008年8月,我們收集了49個病人(男性:27人,女性:22人,平均年齡56.8歲)接受改良式負壓抽吸療法,使用無菌海綿及病房內的負壓抽吸系統,於早上8點至晚上12點以120mmHg吸2小時休息1小時的方式間斷式抽吸,於晚上12點至早上8點以低壓(60mmHg)連續抽吸,治療前後測量傷口大小,深度,重要構造暴露大小,病人的疼痛度及滿意程度。 結果: 傷口平均大小為247.95平方公分(1.5~1875平方公分)。治療後有16個病人(63.3%)接受植皮手術,9個病人(18.3%)接受皮瓣重建,4個病人(8.2%)傷口自然癒合,3個病人(6.1%)傷口延遲性縫合,2個病人(4.1%)截肢。併發症的發生率為6.1%。傷口平均每天縮小3.43%,重要構造(肌腱韌帶骨頭等)外露平均每天縮小6.82%,傷口深度平均每天縮小5.58%,護理照護時間在改良式抽吸療法上比起傳統濕紗換藥明顯縮短(每天7.53分鐘比23.76分鐘),在花費上兩者相差不多,平均使用改良式抽吸療法的時間為10.86天,而對於較深傷口且重要構造外露的傷口平均可花13.67天讓傷口肉芽組織完全形成,不論是病人疼痛度或是滿意度都是以改良式抽吸療法比較好。 結論: 負壓療法提供一個加速傷口癒合及肉芽組織生長的替代療法,商業性負壓抽吸儀器可提供較穩定的負壓,良好的警示系統及良好的刺激肉芽組織生長結果,對於無法負擔健保保費的病人或是等待申請商業性儀器之過渡時期的病人來說,改良式負壓抽吸療法對於困難傷口是個不管在加速傷口癒合,節省照護時間,及減輕病人疼痛都優於傳統濕紗換藥的替代方法。

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並列摘要


Background: Negative pressure therapy has been shown to be an effective way to accelerate the wound healing process and stimulates the rapid formation of granulation tissue. However, the cost to rent the vaccum assisted closure (VAC) device is high and the indication for it's application is limited by National Health Insurance. Aim and Objectives: A system of ”modified negative pressure therapy (MNPT)” in clinical wound care was applied in this hospital and the experience of treatment is delineated in this article. Materials and Methods: There were 49 cases (male: 27, female: 22, mean age: 56.8 years old) received MNPT from 2007 Nov. to 2008 Aug. The sponges are disinfected. The negative pressure system included wall suction in ward with the negative pressure set about 120 mmHg with two hours on and one hour off alternately from 8AM to 12PM and lower continuous pressure (60 mmHg) from 12PM to 8AM. Several parameters were measured such as wound size, depth, vital structure exposure, wound culture, patient wound pain scale, and patient satisfaction scale before and after MNPT. Results: The wound size is 247.95cm^2 in average (1.5~1875cm^2). The final reconstruction methods after MNPT were STSG (16 patients, 63.3%), flap reconstruction (9 patients, 18.3%), healed by secondary intention healing (4 patients, 8.2%), wound closure (3 patients, 6.1%) and amputation (2 patients, 4.1%). Overall complication rate was 6.1%. Daily decrease of wound size was 3.43% per day, the shrinkage rate of vital structure exposure area was 6.82% per day and wound depth decrease rate was 5.58% per day. Overall nursing time in MNPT method is significantly shorter than that in wet dressing group (7.53mins vs. 23.76mins per day) There was no difference of daily cost in MNPT group and wet dressing group. The period of therapy was 10.86 days in average, and the duration of MNPT for deeper wounds with vital structure exposure was 13.67 days in average. The satisfaction and pain scales were better in MNPT group. Conclusion: Negative pressure therapy provides as the alternative way that accelerates the wound healing process and stimulates the rapid formation of granulation tissue. The commercial VAC device offers a constant negative pressure, good alarm system and good result of granulation. For financially unfavorable patients without coverage of National Health Insurance or those still awaiting for the approval of VAC, the MNPT was a good alternative method for obstinate wounds management compared with wet dressing method, not only in facilitating wound healing but also in saving nursing times as well as in reducing patient's suffering.

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