| Background:Pressure ulcer is a common health problem all over the world which brings physical and mental suffering to patients, as well as prolongs hospitalization, increases health care costs, affects the patient’s quality of life, even death in severe cases. Generally, surgical treatment is limited by the patient’s condition and complications so that it is not the first choice in pressure ulcer treatments. Nowadays Vacuum-Assisted Closure(VAC) therapy and the moist wound healing therapy are the major treatments for pressure ulcer. Moist wound healing therapy has a wide range of clinical application, but also the effect superiority of VAC therapy is admitted by more and more healthcare providers. Till now, the effective differences between the two methods is not clear, research results all over the world didn’t come to a conclusion, therefore further research is needed to confirm what is the best way for the treatment of pressure ulcer.Objective:To explore the therapeutic effects of VAC therapy and moist wound healing therapy in stage Ⅲ/Ⅳ pressure ulcers, particularly in the wound area reduction rate, healing time, time of granulation tissue cover76%-100%of the wound bed, and so forth. Meanwhile, observe the effects in wound tissue vascularization and cell proliferation activity(CD34+、PCNA). Try to compare the effect differences between the two methods so as to provide clinical evidence for the best treatment of pressure ulcers.Methods:In this research, choose patients with stage III/IV pressure ulcers in Nanjing General Hospital of Nanjing Military Command outpatient wound care center during2009January to2012December as screening population, and in these people who meet the inclusion and exclusion criteria, and voluntarily to join the study as the research objects. Prior to the intervention, all patients underwent two weeks unified basic treatment, including health education, guide family member to take pressure release measures, oral nutritional supplements, wound debridement and infection control. Two weeks later entered the experimental intervention stage. Random number table was used to divide enrolled patients randomly into the VAC treatment group(VAC group) and moist wound healing therapy group(control group).During intervention stage, VAC group implement VAC therapy with VAC "10-step" operational procedure, negative pressure value is set to-125mmHg, suction mode for intermittent suction mode (5min on2min off), document indicators during each dressing change for21days in total. Treatment of control group bases on the moist wound healing theory, use "five-step" operational procedure(1clean,2assessment,3debridement,4choose,5wrap) to treat the wound, every24to48h change the dressings meanwhile document the indicators, the observation period is21d. Observation indicators are length, width, depth of wound, and the proportion of granulation tissue cover the wound bed and tissue types, calculate wound area, volume, wound area reduction rate (wound area reduction rate=[pre-treatment area-current area]/pre-treatment area×100%), wound depth reduction rate(wound depth reduction rate=[pre-treatment depth-current depth]/pre-treatment depth×100%), wound volume reduction rate (wound volume reduction rate=[pre-treatment volume-current volume]/pre-treatment volume×100%), Pressure Ulcer Scale for Healing(PUSH scores),and wound bed tissue immunohistochemical changes (CD34+, PCNA[Proliferating Cell Nuclear Antigen], after informed consent patients in each group underwent immunohistochemical examination pre-treatment and7d,14d,21d after treatment) so as to compare the therapeutic effects of the two methods:wound reduction rate (including wound area, depth, volume reduction rate), the time of granulation tissue covering76%-100%of wound bed and the effect in pressure ulcer tissue vascularization and cell proliferation activity differences. After intervention stage(21days), continue to patient follow-ups, record the healing time, calculate the wound healing rate and compare the differences between two groups. All data were analyzed using the statistical software SPSS18.0.Results:52patients were included in this study,26in control group,26in VAC group, which5patients withdrew midway for various reasons, therefore47cases included in the statistical analysis finally,21in VAC group and26in control group.(1) comparison of effects of VAC therapy and moist wound healing therapy:total wound area, depth, volume reduction rate of21d, VAC group was33.33%,33.31%,57.79%, control group was28.73%,33.69%,54.06%, which wound area reduction rate difference was significant (P<0.05), while other differences was not statistically significant (P>0.05); during the21-day treatment, obvious differences between the two groups in weekly wound area reduction rate was found(P<0.05), but within each group, there were no significant differences(P>0.05); time of wound granulation tissue covering76%-100%of wound bed in VAC group was (24.43±13.63) d, while control group (33.19±16.75) d, upon examination there was no significant difference (P>0.05);21d after treatment, the PUSH scores of VAC group and control group were13(10,15) and14(12,16) respectively, which through the statistical comparison, the difference was not significant (P>0.05); the average healing time in VAC group was(107.19±44.34) d, and control group (98.00±38.17) d, the difference was not statistically significant(P>0.05);(2)Since wound immunohistochemical examination need informed consent, only11patients in VAC group completed the examination. Effects of VAC treatment in pressure ulcers immunohistochemical examination:results of tests in0,7,24,21days of treatment showed that differences of vascularization index CD34+expression in different time were not statistically significant(P>0.05);wound cell proliferation activity indicators PCNA expression in different time was also not significantly different (P> 0.05) between different period.Conclusion:the macro-indicators of VAC therapy and moist wound healing therapy for stage Ⅲ/Ⅳ pressure ulcers showed good therapeutic effects, means that can effectively reduce the wound area, depth, volume, and promote wound bed granulation tissue growth, accelerate wound healing; During the research, patients in two groups showed no adverse effect, implied good security; comparison of effects of two groups stated that VAC therapy accelerates wound area reduction better than moist wound healing therapy, but wound healing time were similar. However, the micro-indicators (vascularization and tissue proliferative activity expression) showed that VAC therapy for stage Ⅲ/Ⅳ pressure ulcers had no significant effect. Results of the research confirmed that VAC therapy could be used as a beneficial choice of stage Ⅲ/Ⅳ pressure ulcer treatment. However, due to the limited number of patients, further research is needed in the future with lager sample size, to clear macro-and micro-indicator effects of VAC therapy in stage Ⅲ/Ⅳ pressure ulcers. |
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