中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2011年
6期
456-460
,共5页
雷晋%李虎山%郝振明%段鹏%郝文杰
雷晉%李虎山%郝振明%段鵬%郝文傑
뢰진%리호산%학진명%단붕%학문걸
清创术%负压伤口疗法%内皮细胞,组织移植%复杂创面%难愈性创面%增殖期细胞
清創術%負壓傷口療法%內皮細胞,組織移植%複雜創麵%難愈性創麵%增殖期細胞
청창술%부압상구요법%내피세포,조직이식%복잡창면%난유성창면%증식기세포
Debridement%Negative-pressure wound therapy%Endothelial cells%Tissue transplantation%Complicated wounds%Refractory wounds%Proliferation period cells
目的 观察清创术-负压治疗-组织移植模式对复杂、难愈性创面的临床疗效. 方法 选择2008年5月-2010年6月笔者单位收治的20例患者(共计20处复杂、难愈性创面),清创后按照交替法随机分为治疗组(负压治疗,- 19～-8 kPa)与对照组(凡士林纱布+生理盐水纱布+干纱布覆盖),每组10例.治疗4、7、14d切取4 mm×3 mm×2 mm创面肉芽组织进行HE染色,观察肉芽组织生长情况,包括毛细血管、炎性细胞数量及胺原纤维的排列；采用兔抗人凝血因子Ⅷ相关抗原多克隆抗体、鼠抗人Ki-67单克隆抗体进行免疫组织化学染色,计数血管内皮细胞和增殖期细胞.对数据进行t检验.在此基础上采用清创术-负压治疗(同前)-适时植皮(皮瓣)修复模式,治疗笔者单位同一时期收治的59例患者共计62处复杂、难愈性创面,观察疗效. 结果 (1)与对照组比较,治疗组治疗7d时毛细血管数量明显增多、炎性细胞少；治疗14 d,治疗组腔原排列较对照组规则.治疗组治疗4、7、14 d时血管内皮细胞计数分别为每400倍视野(108.7±11.2)、(138.0±14.7)、(68.7±6.9)个,明显高于对照组[(31.0±3.6)、(34.6±4.5)、(55.1±6.5)个,t值为4.62～30.28,P值均等于0.01].治疗组治疗4、7 d增殖期细胞计数分别为每400倍视野(88.9±5.9)、(128.1±13.0)个,明显高于对照组[(16.6±3.3)、(11.01±8.9)个,t值分别为19.89、3.33.P值均小于0.05],治疗组治疗14 d增殖期细胞计数为每400倍视野(26.7±5.1)个,明显低于对照组[(59.7±4.5)个,t=12 43,P =0.01].(2)经过上述模式治疗,62处复杂、难愈性创面坏死组织被彻底清除,肉芽组织生长快,皮片或皮瓣成活率高,创面修复教果好.结论 负压治疗能加速清创后组织血管内皮细胞生成,刺激细胞增殖.清创术-负压治疗-适时植皮(皮瓣)修复的模式能有效提高复杂、难愈性创面的愈合率.
目的 觀察清創術-負壓治療-組織移植模式對複雜、難愈性創麵的臨床療效. 方法 選擇2008年5月-2010年6月筆者單位收治的20例患者(共計20處複雜、難愈性創麵),清創後按照交替法隨機分為治療組(負壓治療,- 19～-8 kPa)與對照組(凡士林紗佈+生理鹽水紗佈+榦紗佈覆蓋),每組10例.治療4、7、14d切取4 mm×3 mm×2 mm創麵肉芽組織進行HE染色,觀察肉芽組織生長情況,包括毛細血管、炎性細胞數量及胺原纖維的排列；採用兔抗人凝血因子Ⅷ相關抗原多剋隆抗體、鼠抗人Ki-67單剋隆抗體進行免疫組織化學染色,計數血管內皮細胞和增殖期細胞.對數據進行t檢驗.在此基礎上採用清創術-負壓治療(同前)-適時植皮(皮瓣)脩複模式,治療筆者單位同一時期收治的59例患者共計62處複雜、難愈性創麵,觀察療效. 結果 (1)與對照組比較,治療組治療7d時毛細血管數量明顯增多、炎性細胞少；治療14 d,治療組腔原排列較對照組規則.治療組治療4、7、14 d時血管內皮細胞計數分彆為每400倍視野(108.7±11.2)、(138.0±14.7)、(68.7±6.9)箇,明顯高于對照組[(31.0±3.6)、(34.6±4.5)、(55.1±6.5)箇,t值為4.62～30.28,P值均等于0.01].治療組治療4、7 d增殖期細胞計數分彆為每400倍視野(88.9±5.9)、(128.1±13.0)箇,明顯高于對照組[(16.6±3.3)、(11.01±8.9)箇,t值分彆為19.89、3.33.P值均小于0.05],治療組治療14 d增殖期細胞計數為每400倍視野(26.7±5.1)箇,明顯低于對照組[(59.7±4.5)箇,t=12 43,P =0.01].(2)經過上述模式治療,62處複雜、難愈性創麵壞死組織被徹底清除,肉芽組織生長快,皮片或皮瓣成活率高,創麵脩複教果好.結論 負壓治療能加速清創後組織血管內皮細胞生成,刺激細胞增殖.清創術-負壓治療-適時植皮(皮瓣)脩複的模式能有效提高複雜、難愈性創麵的愈閤率.
목적 관찰청창술-부압치료-조직이식모식대복잡、난유성창면적림상료효. 방법 선택2008년5월-2010년6월필자단위수치적20례환자(공계20처복잡、난유성창면),청창후안조교체법수궤분위치료조(부압치료,- 19～-8 kPa)여대조조(범사림사포+생리염수사포+간사포복개),매조10례.치료4、7、14d절취4 mm×3 mm×2 mm창면육아조직진행HE염색,관찰육아조직생장정황,포괄모세혈관、염성세포수량급알원섬유적배렬；채용토항인응혈인자Ⅷ상관항원다극륭항체、서항인Ki-67단극륭항체진행면역조직화학염색,계수혈관내피세포화증식기세포.대수거진행t검험.재차기출상채용청창술-부압치료(동전)-괄시식피(피판)수복모식,치료필자단위동일시기수치적59례환자공계62처복잡、난유성창면,관찰료효. 결과 (1)여대조조비교,치료조치료7d시모세혈관수량명현증다、염성세포소；치료14 d,치료조강원배렬교대조조규칙.치료조치료4、7、14 d시혈관내피세포계수분별위매400배시야(108.7±11.2)、(138.0±14.7)、(68.7±6.9)개,명현고우대조조[(31.0±3.6)、(34.6±4.5)、(55.1±6.5)개,t치위4.62～30.28,P치균등우0.01].치료조치료4、7 d증식기세포계수분별위매400배시야(88.9±5.9)、(128.1±13.0)개,명현고우대조조[(16.6±3.3)、(11.01±8.9)개,t치분별위19.89、3.33.P치균소우0.05],치료조치료14 d증식기세포계수위매400배시야(26.7±5.1)개,명현저우대조조[(59.7±4.5)개,t=12 43,P =0.01].(2)경과상술모식치료,62처복잡、난유성창면배사조직피철저청제,육아조직생장쾌,피편혹피판성활솔고,창면수복교과호.결론 부압치료능가속청창후조직혈관내피세포생성,자격세포증식.청창술-부압치료-괄시식피(피판)수복적모식능유효제고복잡、난유성창면적유합솔.
Objective To ohserve therapeutic effect of negative-pressure treatment combined with tissue transplantation on complicated and refractory wounds after debridement.Methods After debridement,20 patients with 20 complicated and refractory wounds hospitalized in our burn wards from May 2008 to June 2010 were randomly divided into treatment group (T,treated with negative-presaure from - 19 kPa to -8 kPa,n =10) and control group (C,covered with petrolatum gauze overlaid with saline gauze and dry gauze,n - 10) according to alternating method.On post treatment day (PTD) 4,7,and 14,granulation tissues of wound surface in size of 4 mm × 3 mm × 2 mm were harvested for histopathological observation ( including capillary growth,inflammatory cells,and collagen arrngement ) with HE staining,and the numbers of vascular endothelial cells ( VEC,with addition of rabbit anti-human coagulation factor Ⅷ related antigen polyclonal antibody ) and proliferation period cells (with addition of mouse anti-human Ki-67 monoclonal antibody) were counted by immunohistochemical staining.Data were proessed with t test.Another 59 patients harboring 62 complieated and refractory wounds admitted to our burn ward at the same period were treated with the same mode of debridement,negative-pressure therapy,followed by timely skin or skin flap grafting.Results (1) Granulation tissue in T group grew more rapidly than that in C group.More capillaries and less inflammatory cells were observed in T group on PTD 7 as compared with those in C group.Collagen in T group on PTD 14 was more regular in arrangement than that in C group.The number of VEC per 400 times visual field in T group on PTD 4,7,and 14 was respectively higher than that in C group ( 108.7 ± 11.2 vs.31.0±3.6,138.0±14.7 vs.34.6±4.5,68.7±6.9 vs.55.1 ±6.5,with t values from 4.62 to 30.28,P values all equal to 0.01 ).The number of proliferation period cell per 400 times visual field in T group on PTD4 and7 was respectively higher than that in C group (88.9 ±5.9 vs.16.6 ±3.3,128.1 ±13.0 vs.110.1 ± 8.9,with t value respectively 19.89,3.33,P values all below 0.05 ).The number of proliferation period cell per 400 times visual field in T group on PTD 14 was obviously lower than that in C group (26.7±5.1 vs.59.7 ±4.5,t =-12.43,P =0.01).(2) After being treated with above therapeutic mode,necrotic tissues were removed completely and granulation tissue grew rapidly in 62 complicated and refratory wounds with high survival rate of skin grafts or skin flaps with good repair effect. Conclusions Negative-pressure therapy can accelerate VEC formation and stimulate cell proliferation after debridenent.Debridement,negative-pressure therapy,and timely skins/skin flaps grafting can effectively increase healing rate of complicated and refractory wounds.
