中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
9期
940-944
,共5页
杨帆%胡耑%白祥军%李仁杰%张锟%薛晨晨%李波
楊帆%鬍耑%白祥軍%李仁傑%張錕%薛晨晨%李波
양범%호단%백상군%리인걸%장곤%설신신%리파
负压封闭引流%创面%氧分压%厌氧菌%愈合%感染
負壓封閉引流%創麵%氧分壓%厭氧菌%愈閤%感染
부압봉폐인류%창면%양분압%염양균%유합%감염
Vacuum sealing drainage%Wound%Oxygen partial pressure%Anaerobic bacteria%Healing%Infection
目的 观察负压封闭引流(VSD)术后不同负压值对兔创面局部氧分压和愈合的影响。方法 建立兔创面模型12只并随机分组,其中实施VSD手术6只(负压组),以不同负压值(-75 mmHg、- 125 mmHg、- 225 mmHg和-350 mmHg)(1 mmHg=0.133 kPa)持续吸引7d,分别于各时间点用组织氧分压测量仪监测创面局部组织氧分压( Pt02)变化;用游标卡尺测量并计算VSD敷料和创面大小的变化;用细菌培养检测创面有无厌氧菌生长;用光镜观察HE染色后创面的组织形态学改变和愈合情况,并同时设立建模前实验兔(正常组)、VSD假手术实验兔(假手术组)和建模后常规换药实验兔(常规组)各6只进行对照。结果 负压组PtO2为(1.68±0.03) kPa且7d内逐步降低,常规组Pt02为(2.82±0.37) kPa,正常组Pt02为(5.79±0.50)kPa,负压组PtO2较常规组和正常组显著性降低,差异具有统计学意义(P＜0.01),且随着负压值的增高,同一时间点的Pt02进一步降低;术后5s时即降为初始Pt02的80.94％。VSD敷料经负压吸引后面积显著性缩小,差异具有统计学意义(P＜0.01),术后5 min即缩小为原敷料面积的65.36％。经物理负压治疗,负压组创面面积较常规组显著性缩小,差异具有统计学意义(P＜0.01),术后7d时缩小为初始面积的62.82％。其中- 350 mmHg组的创面变化率显著性高于其他组,差异具有统计学意义(P＜0.01)。术后负压组创面未见厌氧菌生长。结论 VSD技术可显著降低创面PtO2,且未见厌氧菌生长。- 350 mmHg压力下可显著缩小VSD敷料,协助收敛创面,促进创面的愈合。
目的 觀察負壓封閉引流(VSD)術後不同負壓值對兔創麵跼部氧分壓和愈閤的影響。方法 建立兔創麵模型12隻併隨機分組,其中實施VSD手術6隻(負壓組),以不同負壓值(-75 mmHg、- 125 mmHg、- 225 mmHg和-350 mmHg)(1 mmHg=0.133 kPa)持續吸引7d,分彆于各時間點用組織氧分壓測量儀鑑測創麵跼部組織氧分壓( Pt02)變化;用遊標卡呎測量併計算VSD敷料和創麵大小的變化;用細菌培養檢測創麵有無厭氧菌生長;用光鏡觀察HE染色後創麵的組織形態學改變和愈閤情況,併同時設立建模前實驗兔(正常組)、VSD假手術實驗兔(假手術組)和建模後常規換藥實驗兔(常規組)各6隻進行對照。結果 負壓組PtO2為(1.68±0.03) kPa且7d內逐步降低,常規組Pt02為(2.82±0.37) kPa,正常組Pt02為(5.79±0.50)kPa,負壓組PtO2較常規組和正常組顯著性降低,差異具有統計學意義(P＜0.01),且隨著負壓值的增高,同一時間點的Pt02進一步降低;術後5s時即降為初始Pt02的80.94％。VSD敷料經負壓吸引後麵積顯著性縮小,差異具有統計學意義(P＜0.01),術後5 min即縮小為原敷料麵積的65.36％。經物理負壓治療,負壓組創麵麵積較常規組顯著性縮小,差異具有統計學意義(P＜0.01),術後7d時縮小為初始麵積的62.82％。其中- 350 mmHg組的創麵變化率顯著性高于其他組,差異具有統計學意義(P＜0.01)。術後負壓組創麵未見厭氧菌生長。結論 VSD技術可顯著降低創麵PtO2,且未見厭氧菌生長。- 350 mmHg壓力下可顯著縮小VSD敷料,協助收斂創麵,促進創麵的愈閤。
목적 관찰부압봉폐인류(VSD)술후불동부압치대토창면국부양분압화유합적영향。방법 건립토창면모형12지병수궤분조,기중실시VSD수술6지(부압조),이불동부압치(-75 mmHg、- 125 mmHg、- 225 mmHg화-350 mmHg)(1 mmHg=0.133 kPa)지속흡인7d,분별우각시간점용조직양분압측량의감측창면국부조직양분압( Pt02)변화;용유표잡척측량병계산VSD부료화창면대소적변화;용세균배양검측창면유무염양균생장;용광경관찰HE염색후창면적조직형태학개변화유합정황,병동시설립건모전실험토(정상조)、VSD가수술실험토(가수술조)화건모후상규환약실험토(상규조)각6지진행대조。결과 부압조PtO2위(1.68±0.03) kPa차7d내축보강저,상규조Pt02위(2.82±0.37) kPa,정상조Pt02위(5.79±0.50)kPa,부압조PtO2교상규조화정상조현저성강저,차이구유통계학의의(P＜0.01),차수착부압치적증고,동일시간점적Pt02진일보강저;술후5s시즉강위초시Pt02적80.94％。VSD부료경부압흡인후면적현저성축소,차이구유통계학의의(P＜0.01),술후5 min즉축소위원부료면적적65.36％。경물리부압치료,부압조창면면적교상규조현저성축소,차이구유통계학의의(P＜0.01),술후7d시축소위초시면적적62.82％。기중- 350 mmHg조적창면변화솔현저성고우기타조,차이구유통계학의의(P＜0.01)。술후부압조창면미견염양균생장。결론 VSD기술가현저강저창면PtO2,차미견염양균생장。- 350 mmHg압력하가현저축소VSD부료,협조수렴창면,촉진창면적유합。
Objective To investigate the effect of vacuum sealing drainage (VSD) with different negative pressures on variation of oxygen partial pressure (PtO2 ) and wound healing in the rabbits.Methods Twelve rabbit wound models were made and randomly (random number) divided into two groups, namely vacuum group ( n =6 ) in which rabbits were treated with VSD by different negative pressures ( - 75 mmHg, - 125 mmHg, - 225 mmHg and - 350 mmHg) for 7 days, and routine treatment group ( n =6). At each interval of measurement, variation of PtO2 was measured by oxygen partial pressure admeasuring device, and area of VSD dressing and surface of wound were measured by vernier caliper, and growth of anaerobic bacteria was detected by bacterial culture, and morphological change and the course of wound healing were observed under by light microscope after HE tissue staining. Meanwhile anther two groups (n =6, in each) were set for comparing, including normal group, sham operation group. Results Average PtO2 value of vacuum group was in the range of ( 1.87 +0. 19) kPa to ( 1.54 ±0. 21 ) kPa which was decreased gradually in 7 days under different negative pressures. Average PtO2 value of routine treatment group and normal group were ( 2. 82 ± 0. 37 ) kPa and ( 5.79 + 0. 50 ) kPa, respectively which weresignificant higher than that in vacuum group ( P ＜ 0. 01 ). PtO2 was fell to 80. 94％ of its original value after VSD for 5 seconds, and continued the downward trend with the increasing of negative pressure at the same interval of measuring. Area of VSD dressing significantly decreased to 65. 36％ of its original area after VDS for5 minutes (P＜0.01). Surface of wound was minimized to 62. 82％ of its original area after VSD for 7 days ( P ＜ 0. 01 ), and variations of those in - 350 mmHg group were significant greater than those in other groups ( P ＜ 0. 01 ). There was no evidence of anaerobic bacteria growth in vacuum group during this experiment. Conclusions PtO2 could be down-regulated by VSD significantly without growth of anaerobic bacteria, and minimization of VSD dressing at - 350 mmHg was significantly helpful to reduce the area of wound for promoting the healing.
