目的:比较Barker等人描述的使用真空辅助闭合(NPC)的腹壁闭合的有效性。在第一次手术中使用双聚乙烯袋的机构协议,在随后的手术中,将其更改为放在肠管上的聚乙烯袋和连接到腹部筋膜(MMFC)的普林网眼。
方法:随机对照试验。该研究包括由于外伤或医学原因而患有开放性腹部(OA)的患者。研究的变量包括人口统计,手术指征,干预措施的数量,住院时间(HLOS),ICU住院时间,腹部伤口护理费用,并发症发生率,确定筋膜闭合的方法和时间。
结果:从2011年6月至2013年4月,75名患者被纳入研究。在48小时内死亡的患者被排除在外;因此,共评估53例患者。NPC在75%的患者中实现了筋膜闭合,MMFC在71.9%的患者中实现了闭合。继发于医学原因的OA患者的闭合率(80%的NPC与71.4%由MMFC)或创伤性原因(70%由NPC与MMFC的73.7%)在两个治疗组中相似。就OA的病因而言,两组之间没有差异,并发症,住院时间,或在重症监护室的住院时间。
结论:MMFC是一种与NPC相媲美的方法,用于临时治疗OA,导致相似的闭合和并发症发生率。
OBJECTIVE: To compare the effectiveness of abdominal wall closure using the vacuum-assisted closure (NPC) as described by Barker et al. with an institutional protocol using a double polyvinyl bag in the first surgery, which is changed in subsequent surgeries to a polyvinyl bag placed over the bowel loops and a prolene mesh attached to the abdominal fascia (MMFC).
METHODS: Randomized controlled
trial. Patients with open abdomen (OA) due to a traumatic or a medical cause were included in the
study. Variables studied included demographics, indication for surgery, number of interventions, hospital length of stay (HLOS), ICU length of stay, abdominal wound care costs, complication rates, and method and time to definitive fascial closure.
RESULTS: From June 2011 to April 2013, 75 patients were enrolled in the
study. Patients who died within 48 h were excluded; therefore, 53 patients in total were assessed. NPC achieved fascial closure in 75% of patients, and MMFC achieved closure in 71.9% of patients. The closure rates in patients with OA secondary to medical causes (80% by NPC vs. 71.4% by MMFC) or traumatic causes (70% by NPC vs. 73.7% by MMFC) were similar in both treatment groups. There were no differences between the groups with respect to cause of OA, complications, length of hospital stay, or the length of stay in the intensive care unit.
CONCLUSIONS: MMFC is a method comparable to NPC for the temporary management of OA that results in similar closure and complication rates.