Uporaba terapije z negativnim tlakom pri pacientih po operacijah implantacije endoprotez spodnjih okončin : diplomsko delo

Kozinc, Leja (author), Pajnič, Manca (mentor), Ravljen, Mirjam (reviewer)

Uvod: Operacija implantacije totalne endoproteze spodnjih okončin predstavlja enega najpogostejših in najuspešnejših kirurških posegov. Z naraščanjem števila teh operacij narašča tudi število zapletov, vključno z okužbami in zapleti kirurških ran. Zapleti pri celjenju ran so vzročni dejavnik obprotezne okužbe, zdravljenje ran z negativnim tlakom pa lahko predstavlja metodo zdravljenja za zmanjšanje teh zapletov. Zdravljenje ran z negativnim tlakom je oblika dopolnilnega zdravljenja, ki v zadnjem času pridobiva vse več pozornosti na področju ortopedije. Namen: Namen diplomskega dela je predstaviti terapijo z negativnim tlakom v povezavi s totalnimi endoprotezami spodnjih okončin, predstaviti zaplete v povezavi s kirurško rano in primerjati učinkovitost terapije z negativnim tlakom z učinkovitostjo drugih oblog. Metode dela: Uporabili smo deskriptivno metoda dela. Naredili smo pregled domače in tuje literature, iskane med februarjem 2022 in aprilom 2023. Z oddaljenim dostopom Univerze v Ljubljani smo dostopali do baz podatkov MedLine in ScienceDirect, uporabljena sta bila tudi spletna brskalnika PubMed in Google učenjak ter 1 članek (Gillespie et al., 2015) iz referenčnih seznamov uporabljene strokovne literature. Rezultati: V pooperativnem obdobju lahko pride do zapletov pri celjenju ran. V pregledanih študijah so bili zabeleženi naslednji zapleti: okužba rane (povrhnja in globoka), okužba totalne endoproteze, podaljšano trajanje izločanja izcedka iz rane, hematom, serom, dehiscenca, mehurji na povrhnjici kože, modrice, krvavitev, hiperemija, nekroza in celulitis. Nekatere študije so potrdile, da terapija z negativnim tlakom vpliva na pojav nastanka mehurjev na povrhnjici kože, vendar kljub temu omogoča učinkovitejše celjenje kirurških ran. Zabeleženih je manj skupnih zapletov in okužb ran. Razprava in zaključek: V diplomskem delu smo ugotovili, da je skupna incidenca zapletov pri uporabi terapije z negativnim tlakom v primerjavi z uporabo drugih oblog manjša, kar vodi v krajšanje hospitalizacij in znižanje stroškov. Ker zamenjava sklepa in rehabilitacija predstavljata veliko finančno obremenitev za zdravstvo, se daje velik poudarek na preprečevanje pooperativnih zapletov. Uporaba terapije z negativnim tlakom pri zaprtih kirurških ranah je zato smiselna predvsem pri pacientih z vsaj enim dejavnikom tveganja za zaplete rane, predvsem pri pacientih s povišanim indeksom telesne mase.

• Language: Slovenian
• Keywords: diplomska dela, zdravstvena nega, terapija z negativnim tlakom, artroplastika kolena, artroplastika kolka, zaplet kirurške rane, okužba kirurške rane
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [L. Kozinc]
• Year: 2023
• Number of pages: 35 str.
• PID: 20.500.12556/RUL-149090
• UDC: 616-083
• COBISS.SI-ID: 163166211
• Publication date in RUL: 03.09.2023

Secondary language

• Language: English
• Title: Negative pressure wound therapy in patients after lower extremity joint arthroplasty : diploma work

Abstract

Introduction: Lower extremity arthroplasty is one of the most common and most efficient surgical procedures. With growing numbers of these surgical procesures, there is also a growing complication rate, including surgical site infections and surgical wound complications. Wound complications are the main reason for prosthetic joint infection. Negative pressure wound therapy is a successful tool for preventing prosthetic joint infection. Purpose: The purpose of diploma work is to present negative pressure wound therapy following lower extremity arthroplasty, to present surgical wound complications and to show the effect of negative pressure wound therapy on complication rate in comparison with other dressings. Methods: Descriptive method was used. The literature search was conducted between February 2022 and April 2023. We studied the literature in Slovene and English language. With remote access from University of Ljubljana MedLine and ScienceDirect international databases were searched, as well as Pubmed and Google Scholar search engines were used. Results: Surgical site infection (deep and superficial), prosthetic joint infection, prolonged wound secretion, haematoma, seroma, wound dehiscence, blister formation, bruising, haemorrhage, hyperemia, necrosis and cellulitis were mentioned as surgical wound complications in studied literature. Some studies showed that negative pressure wound therapy is the reason for blister formation. Negative pressure wound therapy facilitates efficient wound healing. Complication rate and the incidence of surgical site infection was lower when negative pressure wound therapy was used. Discussion and conclusion: In diploma work we showed that the complication rate is lower in groups where negative pressure wound therapy was applied in contrast to groups where standard wound dressing was used. Lower complication rates lead to shorter hospitalisation and lower costs of hospitalisation. That is why negative pressure wound therapy should be applied to patients with predisposing factors for surgical wound complications, especially in obese patients.

• Keywords: diploma theses, nursing care, negative pressure wound therapy, knee arthroplasty, hip arthroplasty, surgical wound complication, surgical site infection