The Clinical Research About Negative Pressure Therapy Combined With Moist Wound Therapy For Cancer Patients Difficult-to-heal Wounds

Objective To observe therapeutic effects of Negative Pressure Wound Therapy contrast moist wound therapy in cancer patients refractory wounds,to explore whether the negative pressure Wound therapy combined with moist wound therapy is better than that of single treatment group and to provide new ideas for the treatment of cancer patients refractory wounds.Methods A convenient sampling of cancer patients who went to see doctor in the wound outpatient of a teaching tertiary general hospital in henan province and had refractory wounds in each department and who met the inclusion criteria and were willing to participate in this study were enrolled from August 2014 to March2016.Then these patients were randomly divided into the moist wound therapy group, the negative pressure wound therapy group and the combined group.In order to maintain comparability of baseline and control of bias, all patients underwent two weeks of wound bed preparation(preparation period).During the intervention stage,the moist wound therapy group received standard therapy(alginate+hydrocolloid dressing),the negative pressure wound therapy group were filled with gauze dressingand the combined group were used the negative pressure treatment of filler for alginate dressing. Treatment period 28 days,the main index has the wound area reduction rate,time of granulation tissue cover 76%~100% of the wound bed,pain,PUSH score and wound healing rate.The SPSS 21.0 was used to analyze the data.Descriptive statistical analysis, ANOVA and Kruskal-Wallis rank sum test and so on.Results The study included 78 patients, 26 in each of the three groups and 4 cases were lost in the process of intervention.The attrition rate was 5.13%. A total of 74 cases completed the intervention, 26 in the moist therapy group, 23 in the negative pressure therapy, 25 in the combined group.(1)comparison of effects of each group in 28 d wound reduction rate(%)Comparison: about wound area reduction rate,MWT group, NPWT group and the combination group were 34.04%, 64.02% and 71.30%, differences were statistically significant( P(28)011.0).By pairwise comparison,in addition to the combined group and NPWT group had no significant difference( P(29)05.0), other differences between the two groups had statistical significance( P(27)05.0).About the depth of the wound,MWT group, NPWT group and the combination group were(37.57 ±26.12)%,(40.89 ± 33.50)% and(60.07 ± 27.34)%, the difference was significant( P(28)015.0).By pairwise comparison, the combined group contrast MWT group,NPWT group difference was statistically significant( P(27)05.0),but MWT group and NPWT group with no significant difference( P(29)05.0); In the volume reduction rate,MWT group, NPWT group and the combination group were 61.03%,69.78% and87.00%,the difference was statistically significant( P(28)005.0).By pairwise comparison, the combined group and MWT group had significant difference( P(27)05.0),while the other two groups was not statistically significant( P(29)05.0).(2)The comparison of time of wound granulation tissue covering 76%~100% of wound bed:Time of MWT group, NPWT group and the combined group were(28.46± 9.58)d,(20.96 ± 9.43)d and(17.12 ± 5.86)d,the differences were statistically significant( P(27)05.0).By pairwise comparison,the combined group,NPWT group and MWT group the difference was statistically significant( P(27)05.0),the combinedgroup and NPWT group the difference was not statistically significant( P(28)362.0).(3)The comparison of the PUSH scores after 28 d treatment, :the PUSH scores of each group was 14, 13 and 12, the statistical analysis showed no significant difference in each group( P(28)079.0).(4)The comparison of the pain score at different times in each group :MWT group, NPWT group and the combined group were compared at different time.The results showed that the overall difference of three groups was statistically significant from the 14 th day( P(27)05.0).By pairwise comparison,MWT group, NPWT group were statistically significant compared to group( P(27)05.0)after 14 day;The combined group and MWT group had no statistical significance on the 14 d,but was statistically significant after 14d;The difference of the combined group and NPWT group was statistically significant on 14 d and 28d( P(27)05.0), but was not statistically significant on 21d( P(29)05.0).(5)The comparison of healing rate after follow-up 30 d :the total effective rate of MWT group, NPWT group and the combined group were 92%,95.65% and95.65%,the difference was not statistically significant( P(29)05.0).Conclusion(1)In the treatment of cancer patients refractory wounds,the negative Pressure Wound Therapy has an advantage in reducing the wound area,relieving pain and promoting granulation tissue formation.(2) the negative pressure Wound therapy combined with moist wound therapy has more obvious advantage in the depth of the wound reduction rate and relieving pain.