中华损伤与修复杂志（电子版）
中華損傷與脩複雜誌（電子版）
중화손상여수복잡지（전자판）
Chinese Journal of Injury Repair and Wound Healing
2015年
2期
160-166
,共7页
陈斓%谢卫国%叶子青%赵超莉%栾夏刚
陳斕%謝衛國%葉子青%趙超莉%欒夏剛
진란%사위국%협자청%조초리%란하강
烧伤%伤口愈合%负压伤口疗法
燒傷%傷口愈閤%負壓傷口療法
소상%상구유합%부압상구요법
Burns%Wound healing%Negative-pressure wound therapy
目的：观察封闭负压治疗对猪深Ⅱ度烧伤创面的影响。方法采用控温控压电烫仪在3只普通家猪背部对称制造深Ⅱ度热力烧伤模型，每只猪背6个创面（共18个），左右对称创面视为一对，共9对创面随机分为持续负压组、间歇负压组、常规换药组。造模24 h 后两负压组分别给予持续及间歇封闭负压治疗，压力值均为－125 mmHg（1 mmHg ＝0．133 kPa），常规换药组给予常规换药治疗。于治疗后当天、第3、6、9、14天，分别测量创面面积并计算愈合率；取创面组织进行常规苏木精-伊红（HE）染色，光学显微镜下观察病理学变化，采用免疫组织化学染色法计算细胞增殖指数（PI）及血管内皮细胞计数；记录最终创面愈合时间。数据行单因素方差分析及 LSD-t 检验。结果（1）治疗后第3天，持续负压组、间歇负压组创面愈合率分别为（18．51±4．38）％、（14．26±5．98）％，均高于常规换药组（3．86±2．35）％，差异有统计学意义（t ＝56．552、40．139，P<0．05、＝0．001），治疗后第6天，两负压组分别达（24．74±3．25）％、（20．55±3．43）％，仍高于常规换药组（13．41±4．08）％，差异有统计学意义（t ＝5．473、3．432，P<0．05、＝0．004），治疗后第9天，其愈合率分别达（49．81±3．88）％、（46．96±3．16）％，均高于常规换药组（34．29±6．69）％，差异有统计学意义（t ＝5．563、4．541，均 P<0．05）。（2）持续负压组、间歇负压组愈合时间分别为（11．67±0．52）d、（11．50±1．05） d，均短于常规换药组（13．00±0．89）d，差异有统计学意义（t ＝2．715、3．055，P ＝0．016、0．008），两负压组间比较，差异无统计学意义（t ＝0．340，P ＝0．739）。（3）治疗后第3天，常规换药组创面炎症细胞浸润较两负压组重，其高峰持续到第9天，第14天逐渐消退。（4）治疗后第3天，持续负压组和间歇负压组细胞 PI 明显升高，高于常规换药组，差异有统计学意义（t ＝10．413、9．080，均 P ★0．05），治疗后第6天分别达高峰，仍高于常规换药组，差异有统计学意义（t ＝4．549、5．557，均 P ★0．05），治疗后第9、14天，3组细胞 PI 无明显差异。（5）治疗后第3、6天，持续负压组、间歇负压组血管内皮细胞计数均高于常规换药组，差异有统计学意义（均 P ★0．05）。治疗后第9、14天，3组血管内皮细胞计数差异无统计学意义（F ＝1．639、1．711，P ＝0．218、0．205）。结论与常规换药相比，封闭负压引流治疗能加快创面坏死组织清除，促进创面炎症反应消退，加速深Ⅱ度烧伤创面愈合。
目的：觀察封閉負壓治療對豬深Ⅱ度燒傷創麵的影響。方法採用控溫控壓電燙儀在3隻普通傢豬揹部對稱製造深Ⅱ度熱力燒傷模型，每隻豬揹6箇創麵（共18箇），左右對稱創麵視為一對，共9對創麵隨機分為持續負壓組、間歇負壓組、常規換藥組。造模24 h 後兩負壓組分彆給予持續及間歇封閉負壓治療，壓力值均為－125 mmHg（1 mmHg ＝0．133 kPa），常規換藥組給予常規換藥治療。于治療後噹天、第3、6、9、14天，分彆測量創麵麵積併計算愈閤率；取創麵組織進行常規囌木精-伊紅（HE）染色，光學顯微鏡下觀察病理學變化，採用免疫組織化學染色法計算細胞增殖指數（PI）及血管內皮細胞計數；記錄最終創麵愈閤時間。數據行單因素方差分析及 LSD-t 檢驗。結果（1）治療後第3天，持續負壓組、間歇負壓組創麵愈閤率分彆為（18．51±4．38）％、（14．26±5．98）％，均高于常規換藥組（3．86±2．35）％，差異有統計學意義（t ＝56．552、40．139，P<0．05、＝0．001），治療後第6天，兩負壓組分彆達（24．74±3．25）％、（20．55±3．43）％，仍高于常規換藥組（13．41±4．08）％，差異有統計學意義（t ＝5．473、3．432，P<0．05、＝0．004），治療後第9天，其愈閤率分彆達（49．81±3．88）％、（46．96±3．16）％，均高于常規換藥組（34．29±6．69）％，差異有統計學意義（t ＝5．563、4．541，均 P<0．05）。（2）持續負壓組、間歇負壓組愈閤時間分彆為（11．67±0．52）d、（11．50±1．05） d，均短于常規換藥組（13．00±0．89）d，差異有統計學意義（t ＝2．715、3．055，P ＝0．016、0．008），兩負壓組間比較，差異無統計學意義（t ＝0．340，P ＝0．739）。（3）治療後第3天，常規換藥組創麵炎癥細胞浸潤較兩負壓組重，其高峰持續到第9天，第14天逐漸消退。（4）治療後第3天，持續負壓組和間歇負壓組細胞 PI 明顯升高，高于常規換藥組，差異有統計學意義（t ＝10．413、9．080，均 P ★0．05），治療後第6天分彆達高峰，仍高于常規換藥組，差異有統計學意義（t ＝4．549、5．557，均 P ★0．05），治療後第9、14天，3組細胞 PI 無明顯差異。（5）治療後第3、6天，持續負壓組、間歇負壓組血管內皮細胞計數均高于常規換藥組，差異有統計學意義（均 P ★0．05）。治療後第9、14天，3組血管內皮細胞計數差異無統計學意義（F ＝1．639、1．711，P ＝0．218、0．205）。結論與常規換藥相比，封閉負壓引流治療能加快創麵壞死組織清除，促進創麵炎癥反應消退，加速深Ⅱ度燒傷創麵愈閤。
목적：관찰봉폐부압치료대저심Ⅱ도소상창면적영향。방법채용공온공압전탕의재3지보통가저배부대칭제조심Ⅱ도열력소상모형，매지저배6개창면（공18개），좌우대칭창면시위일대，공9대창면수궤분위지속부압조、간헐부압조、상규환약조。조모24 h 후량부압조분별급여지속급간헐봉폐부압치료，압력치균위－125 mmHg（1 mmHg ＝0．133 kPa），상규환약조급여상규환약치료。우치료후당천、제3、6、9、14천，분별측량창면면적병계산유합솔；취창면조직진행상규소목정-이홍（HE）염색，광학현미경하관찰병이학변화，채용면역조직화학염색법계산세포증식지수（PI）급혈관내피세포계수；기록최종창면유합시간。수거행단인소방차분석급 LSD-t 검험。결과（1）치료후제3천，지속부압조、간헐부압조창면유합솔분별위（18．51±4．38）％、（14．26±5．98）％，균고우상규환약조（3．86±2．35）％，차이유통계학의의（t ＝56．552、40．139，P<0．05、＝0．001），치료후제6천，량부압조분별체（24．74±3．25）％、（20．55±3．43）％，잉고우상규환약조（13．41±4．08）％，차이유통계학의의（t ＝5．473、3．432，P<0．05、＝0．004），치료후제9천，기유합솔분별체（49．81±3．88）％、（46．96±3．16）％，균고우상규환약조（34．29±6．69）％，차이유통계학의의（t ＝5．563、4．541，균 P<0．05）。（2）지속부압조、간헐부압조유합시간분별위（11．67±0．52）d、（11．50±1．05） d，균단우상규환약조（13．00±0．89）d，차이유통계학의의（t ＝2．715、3．055，P ＝0．016、0．008），량부압조간비교，차이무통계학의의（t ＝0．340，P ＝0．739）。（3）치료후제3천，상규환약조창면염증세포침윤교량부압조중，기고봉지속도제9천，제14천축점소퇴。（4）치료후제3천，지속부압조화간헐부압조세포 PI 명현승고，고우상규환약조，차이유통계학의의（t ＝10．413、9．080，균 P ★0．05），치료후제6천분별체고봉，잉고우상규환약조，차이유통계학의의（t ＝4．549、5．557，균 P ★0．05），치료후제9、14천，3조세포 PI 무명현차이。（5）치료후제3、6천，지속부압조、간헐부압조혈관내피세포계수균고우상규환약조，차이유통계학의의（균 P ★0．05）。치료후제9、14천，3조혈관내피세포계수차이무통계학의의（F ＝1．639、1．711，P ＝0．218、0．205）。결론여상규환약상비，봉폐부압인류치료능가쾌창면배사조직청제，촉진창면염증반응소퇴，가속심Ⅱ도소상창면유합。
Objective To investigate the effect of Vacuum-assisted closure(VAC)technology on deep partial-thickness burn wound of pigs.Methods A total of 1 8 deep partial-thickness burn wounds were established by the temperature and pressure controlled perm instrument on 3 ordinary pigs back symmetrically,6 per pig.The wounds were randomly divided into 3 groups:which were treated by vacuum-assisted closure therapy with continuous model,discontinuous model or treated by conventional dressing therapy corresponding.The wounds were placed without any treatment in 24 hours,after that,the two VAC therapy groups were given corresponding modes of vacuum-assisted closure treatment with the pressure of-1 25mmHg,while conventional dressing therapy group received iodophor vaseline gauze dressing treatment. The dates of wound area,wound healing rate were collected and analyzed at right away、3、6、9、1 4 days post treatment.Specimens from wounds were harvested for histopathology observation,including cell proliferation index and the number of vascular endothelial cells.The dates were analyzed by one way ANOVA and multiple group comparison with LSD-t test.Results (1 )On the third day after treatment,the healing rate of VAC therapy group with continuous model and discontinuous model were (1 8.51 ±4.38)%,(1 4.26 ± 5.98)%,which were higher than the conventional dressing therapy group(3.86 ±2.35)%(t =56.552、40.1 39,P ★ 0.05, =0.001 ).On 3 d,the healing rate of both VAC therapy group were (24.74 ± 3.25)%,20.55 ±3.43)%,which were still higher than the conventional dressing therapy group(1 3.41 ± 4.08)%(t =5.473,3.432,P ★ 0.05,=0.004).On 9 d,those were (49.81 ±3.88)%,(46.96 ± 3.1 6)%,which were higher than the conventional dressing therapy group(34.29 ±6.69)%(t =5.563, 4.541 ,P ★ 0.05).(2)The healing time of VAC therapy group of continuous model was (1 1 .67 ±0.52) d,while that discontinuous model was (1 1 .50 ±1 .05)d,both were statistically difference compared to the conventional dressing therapy group (1 3.00 ±0.89)d(t =2.71 5,3.055,P =0.01 6,0.008).There was no statistically difference between the both VAC therapy groups (t =0.340,P =0.739).(3)On the third day after treatment,the infiltration of inflammatory cells in wounds of the conventional dressing therapy group were higher than that in both VAC therapy groups,which was peaked on 9 d and faded on 1 4 d.(4)On the third day after treatment,the cells PI of the both VAC therapy groups were increased,which were higher than conventional dressing therapy group (t =1 0.41 3,9.080,P<0.05).The cells PI of the both VAC therapy groups were peaked on 6 d,which were still higher than conventional dressing therapy group (t =4.549,5.557,P<0.05).No statistically significant difference was founded between the 3 groups on the ninth and fourteenth day after treatment(F =0.488,0.630,P =0.621 ,0.542).(5)On the third and sixth day after treatment,the numbers of vascular endothelial cells of the both VAC therapy groups were higher than conventional dressing therapy group (P<0.05).No statistically significant difference was founded between the 3 groups on the treatment of 9 d and 1 4 d (F =1 .639,1 .71 1 ,P =0.21 8,0.205 ). Conclusions Compared with conventional dressing change,vacuum-assisted closure therapy can speed up the removal of necrotic tissue,accelerate wound inflammation subsided,promote the healing process of deep partial-thickness burn wounds.
