多种负压创伤治疗方式的应用有助于危重患者复杂创伤的管理

摘要

负压伤口治疗(NPWT)是一种多功能的伤口管理工具，可用于帮助有并发症风险的患者伤口愈合。虽然NPWT单独提供了支持伤口愈合的好处，但它也可以与局部溶液的灌注和滞留(NPWTi-d)结合在伤口床上。NPWTi-d与标准网状开孔泡沫敷料或专用通孔敷料(ROCF-CC)配合使用，可通过溶解和清除伤口表面的感染性物质来清洁伤口。我们介绍了在危重患者复杂伤口中使用多种NPWT的经验。患者1为60岁女性，有高血压、甲状腺功能减退、静脉性腿部溃疡及行走功能障碍病史。她的症状是感染性休克和一个大的小腿溃疡覆盖纤维化的蜕皮。患者2为36岁男性，表现为腹痛、呕吐及腹泻。计算机断层扫描显示坏死性筋膜炎的迹象，这是确定在切除清创术。患者3是一名62岁女性，有直肠癌和子宫内膜癌、慢性梗阻、结肠皮肤瘘、糖尿病、高血压和房颤病史。她的表现是腹膜蜂窝织炎，表面表皮起泡和坏死。 In all cases, patients received intravenous antibiotics and debridements were performed as necessary. Patients 2 and 3 were initially treated with NPWT with standard or polyvinyl alcohol dressings. All patients were treated with NPWTi-d, instilling 0.125% hypochlorous solution or normal saline, as needed. Instillation solutions were dwelled for 10 minutes, followed by 1-3.5 hours of -125 mmHg negative pressure. In areas with thick exudate or high amounts of slough, ROCF-CC dressings were used. Dressings were changed every 2-3 days. Use of multiple NPWT modalities in the management of these complex wounds supported wound healing in these patients.