| Surgery is one of the most important surgical treatments,but there is a risk of surgical site infection(SSI).Incision infection in general surgery is one of the common postoperative complications.Once it occurs,it will bring physical and economic pressure to patients,and may cause serious medical disputes and accidents in the current severe medical situation.Especially for class ? incision in gastrointestinal surgery,according to the standard definition of class ? incision on behalf of fresh open surgery,surgical incision to acute inflammation development stage and maturation,and gastrointestinal surgery will appear obvious gastrointestinal spillover pollution,intraoperative sterile technique also can appear loophole,on the basis of such circumstances,surgical incision infection is frequent phenomenon.Incision infection is usually caused by bacterial infection.Therefore,the current main method is to control this situation by strengthening environmental management,such as operating room management and aseptic operation.All these methods have improved postoperative infection to some extent,but on the whole,these operations have not fully benefited.The academic circles at home and abroad have also carried out studies on this issue and made some achievements,but no substantial clinical progress has been made due to the complicated steps that have increased the human and financial burden.In some foreign reports,it is believed that closed wound drainage is the most practical method and the most advanced technology.Followed by medical also in clinical practice in China for a new method,is to increase the subcutaneous negative pressure drainage tube,drainage tube for the side hole to be buried in the subcutaneous tissue and the abdominal muscle,between end keep in the change of external drainage of fluid can be observed,is convenient to infection do early discovery,early diagnosis,early treatment,outside this end is feasible brine rinse when necessary,to maintain pressure suction.This method has been widely used in clinical departments since it came into being,and the results show that it effectively inhibits the occurrence ofinfection,which also verifies the effectiveness of this method.This study is also aimed at this kind of methods.Objective:Choose two groups of patients,through two groups of patients using the different processing methods are divided into trial group and control group,compared two groups of patients with incision infection rate and other symptoms,verify whether subcutaneous application of negative pressure drainage tube can reduce the infection rate,improve the quality of incision healing,at the same time to have bacterial infection patients in testing,validation,clear common type of bacteria,bacterial species lay a foundation for extensive application in clinical.The independent risk factors that had been reported before and during the perioperative period to affect incision healing were recorded,such as age,duration of surgery,amount of bleeding,preoperative hemoglobin,preoperative albumin,preoperative procalcitonin,postoperative hemoglobin,postoperative albumin,and postoperative procalcitonin,etc.Methods:Retrospective analysis in January 2017 to October 2019 our department treated 140 cases of patients with abdominal incision ? class,among which 76 were male,female 64 cases.The subcutaneous negative pressure drainage tube was divided into experimental group and control group,with 70 cases in each group.There were 5 cases of diabetes and 5cases of hypertension in the test group.There were 7 cases of diabetes and 9 cases of hypertension in the control group(P>0.05),which had no statistical significance and had no effect on the test results.? class type incision surgery included gastrointestinal perforation repair,intestinal resection(including strangulation obstruction and traumatic enterorrhexis),colostomy HaiNa etc.There were 25 cases of fistula reduction,27 cases of digestive tract perforation repair,49 cases of abdominal trauma combined with intestinal rupture,and 39 cases of strangulated intestinal obstruction.In the test group,there were 14 cases of fistula reduction,15 cases of digestive tract perforation repair,22 cases of abdominal trauma combined with intestinal rupture,and 19 cases of strangulated intestinalobstruction.In the control group,there were 11 cases of fistula reduction,12 cases of digestive tract perforation repair,27 cases of abdominal trauma combined with intestinal rupture,and 20 cases of strangulated intestinal obstruction.Patients in both groups were treated with general anesthesia,followed by postoperative irrigation with normal saline.The subcutaneous tissue in the test group was not sutured,and the subcutaneous negative pressure drainage tube was prepositioned close to the fascia,occupying the entire incision length.The lower end was extracted from the outside of the incision by puncture tunnel 2cm from the outside,and the 100 mL negative pressure drainage ball was connected to the skin to suture the skin.Observation group: observe the character,color and quantity of drainage fluid,keep it in a state of negative pressure,change the dressing in parallel and observe the incision.Control group: conventional dressing change,incision observation,3-5 days later when the negative pressure ball fluid <5ml/ day,timely drainage tube extraction.Experimental procedure: observe the drainage tube every day after 1 day.Two days later,the control group received routine dressing change to check the incision status,and the group continued to observe the changes of drainage tube fluid.According to the diagnostic criteria of nosocomial infection,the positive rate of bacterial culture for infection was checked.After 3-5 days,the amount of drainage fluid was < 5ml,and the drainage tube was removed.Finally,the infection and healing of incision were observed,and preoperative patient data and postoperative indicators were recorded.Analyze the data and draw a conclusion.Results:In the study,the following data were compared for the study results: 1)the incidence of incision infection;2)adverse rate of wound healing;3)incidence of secondary suture;4)positive rate of bacterial culture;5)grade a healing rate;6)hospital stay.And according to the specific comparison of the two groups of patients,test group incision infection rate was 2.8%,the incidence of poor healing of incision was 12.8%,the control group(P < 0.05,the result was statistically significant,the experimental group was better than control group,incision secretion of infection in patients with bacterial culture,theresults show that the main type of e.coli bacteria,4 cases of e.coli merger dung enterococcus in 1 case,white merger of e.coli pneumonia klebsiella bacillus in 1 case,sewer enterobacter in 1 case,e.coli with pseudomonas aeruginosa in 1 case,no bacteria(3cases).Based on the results of bacterial culture,it can be concluded that the main bacterial types of gastrointestinal operation infection are gram-negative bacteria,which are mixed with anaerobic bacteria and have strong virulence.According to the statistical analysis of the wound healing,4 cases in the experimental group had poor wound healing,and 12 cases in the control group had poor wound healing.The comparison showed that there were more cases of poor wound healing in the control group than in the experimental group.The statistical results showed that P<0.05 was statistically significant.The results showed that the experimental group was significantly better than the control group in terms of the incidence of adverse wound healing,the rate of grade a healing and the length of hospital stay,and the statistical analysis was statistically significant.The statistics of the patients who underwent secondary suture showed that 1 patient in the experimental group underwent secondary suture,and 3 patients in the control group underwent secondary suture.The comparison of the number of cases in the experimental group was better than that in the control group,but the statistics showed that P>0.05 was meaningless.In the postoperative follow-up,the experimental group also achieved better results than the control group.Conclusion:The method of subcutaneous indwelling drainage tube with negative pressure suction can effectively reduce the postoperative infection rate of abdominal type ? incision in gastrointestinal surgery,improve the postoperative wound healing,and reduce the length of hospital stay.The method is simple and easy to use,and the consumables are cheap.1 Incision infection in gastrointestinal surgery is usually dominated by gram-negative bacteria(g-bacteria),and this bacterial infection is usually a cross-mixed infection.2 For some patients with excessively thin abdominal skin,the pre-set subcutaneousnegative pressure drainage tube should not be used.3 Preset subcutaneous negative pressure drainage tube was adopted to treat the primary complications. |
PDF Full Text Request