| [Objective]The purpose of this study is to explore the effects of negative pressure wound therapy combined with topical oxygen therapy and negative pressure wound therapy on clinical and laboratory indicators of chronic wounds,including granulation tissue coverage rate,wound volume reduction rate,pressure ulcer scale for healing scores,temperature,pH,wound healing rate and healing time,bacterial culture results,and histopathological examination results,to provide evidence for choosing chronic wound treatment.[Methods]A total of 64 patients who met the inclusion and exclusion criteria at the outpatient wound care center from January 2019 to December 2019 were randomly divided into experimental group(negative pressure wound therapy combined with topical oxygen therapy)and control group(negative pressure wound therapy)each with 32 cases.For 2 weeks of continuous intervention,researchers and international wound therapists observed and recorded wound granulation tissue coverage rate,PUSH scores,temperature and pH before and 7,14 days after the intervention,and wound volume reduction rates at 7 and 14 days after the intervention;Bacteria culture,hematoxylin-eosin staining,and immunohistochemical staining were performed on the wound secretions and wound tissues before and 14 days after the intervention,and the results of bacterial culture,histology,and the expression of Ki67 and CD34 molecular markers in wound tissue were observed.After the intervention,the patients were given standard wet treatment and followed up to 3 months after the intervention to observe the wound healing rate and healing time.During treatment and follow-up,patients were observed for adverse reactions such as wound bleeding,dehiscence and infection.[Results]This study included 64 patients with chronic wounds,5 were lost,and 59 patients completed the study.(1)Baseline dataThere was no significant difference in gender,age,height,weight,BMI,admission method,nutritional status,and comorbidities in the demographic data of the two groups of patients(P>0.05);There were also no significant differences in wound type,duration,wound volume,PUSH score,granulation tissue coverage rate,wound temperature,pH,exudate volume,tissue type,and bacterial culture results between the two groups of patients(P>0.05).Therefore,the baseline data of the two groups of patients were comparable.(2)Clinical indicators? Granulation tissue coverage rate:The full analysis set shows that the granulation tissue coverage rate of the experimental group and the control group after 14 days of intervention was(61.91 ± 13.50)%and(46.63±13.03)%,the difference was statistically significant(P<0.001);in per-protocol set,the difference in granulation tissue coverage rate between the two groups was also statistically significant(P<0.001).? Wound volume reduction rate:At 7 and 14 days of intervention,the wound volume reduction rate of the experimental group was higher than that of the control group,but the difference was not statistically significant(P>0.05).?PUSH scores:There was an interaction effect between intervention and intervention time.When the intervention factors were fixed,the difference between the experimental group and the control group at 7 days and 14 days was statistically significant compared with the PUSH score before the intervention(P<0.001).When the time factor was fixed,there was no significant difference in the PUSH score between the experimental group and the control group at 7 days and 14 days of intervention(P>0.05).?Temperature:There was an interaction effect between intervention and intervention time.When the interventions factor were fixed,the difference between the experimental group and the control group at 7d and 14d was statistically significant compared with the wound temperature before the intervention(P<0.001).When the time factor was fixed,the difference in wound temperature between the experimental group and the control group was also statistically significant(P<0.05),and at the 7d and 14d,the difference in wound temperature were statistically significant(P<0.05).?pH:There was an interactive effect between the intervention and the intervention time.When the intervention factors were fixed,the differences between the experimental group and the control group at 7 and 14 days were statistically significant compared with the pre-intervention pH(P<0.001).When the time factor was fixed,,the difference between the pH of the experimental group and the control group was not statistically significant at 7d(P>0.05),and the difference was statistically significant at 14d(P<0.05).? Wound healing rate and healing time:Follow-up to 3 months after intervention,28 cases in the experimental group healed,the healing rate was 93.33%,and 24 cases in the control group healed,the healing rate was 82.75%,the difference was not statistically significant(P=0.209).The mean healing time of the experimental group was(54.18±17.99)days,and that of the control group was(63.38±14.21)days.The difference was statistically significant(P=0.049).(3)Laboratory indicators? Bacterial culture results:After 14 days of intervention,the positive rates of bacterial cultures in the experimental group and the control group were 26.67%and 41.38%,respectively,with no significant difference(P=0.223).Analysis of the bacterial culture results before and after the intervention of the two groups showed that there was no significant difference in the control group(P=0.115),and the difference in the experimental group was statistically significant(P<0.001).Staphylococcus aureus,Pseudomonas aeruginosa,and E.coli were the most common in chronic wound bacterial culture.? Histopathological examination results:Hematoxylin-eosin staining results showed a large number of inflammatory cell infiltration,inflammatory granulation tissue and necrotic tissue formation,with inflammatory exudation and bleeding;immunohistochemical staining results showed that both interventions were able to increase the Ki67 positive rate of chronic wounds and promote the formation of new blood vessels.The difference was statistically significant(P<0.05).(4)Safety indicatorsThere were no adverse reactions such as wound bleeding,dehiscence,infection and oxygen toxicity in the experimental group and the control group.[Conclusions]Comparing the clinical indicators of negative pressure wound therapy combined with topical oxygen therapy and negative pressure wound treatment,it is concluded that both interventions can reduce PUSH scores and improve wound healing rate during follow-up.However,negative pressure wound therapy combined with topical oxygen therapy has certain advantages in significantly increasing the coverage of granulation tissue,increasing the temperature of the wound,lowering the pH value,and shortening the wound healing time.Comparing the laboratory indicators of the two interventions,it was concluded that negative pressure wound therapy combined with topical oxygen therapy can reduce the positive rate of bacterial culture,improve tissue proliferation activity,and increase vascularization.Observation of adverse reactions during the intervention revealed that both interventions have high safety. |
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