烧伤后24小时内削痂对深Ⅱ度创面局部炎症反应的影响  

Influence of tangential excision within 24 postburn hours on the local wound inflammatory response in patients with deep partial thickness burn

作　　者：陆树良[1] 廖镇江[1] 向军[1] 王志勇[1] 杨丽英[1] 金曙雯[1] 史济湘[1] 

机构地区：[1]第二医科大学瑞金医院烧伤科,上海200025

出　　处：《中华烧伤杂志》2005年第1期24-26,共3页Chinese Journal of Burns

基　　金：国家重点基础研究发展规划资助项目(G1999054205);上海市教委"曙光计划"(98SG41);上海市卫生系统"百人计划"(97BR002)

摘　　要：目的探讨烧伤后24h内行削痂手术对深Ⅱ度创面局部炎症反应以及组织损害的影响。方法选择12例烧伤患者,伤后24h内对深Ⅱ度创面行削痂手术,将患者同一创面分为3个标本采集区,即手术前、手术后和未手术区。手术前标本取自削痂术前创面,手术后和未手术区创面标本于伤后5—7d获取。采用组织培养和比色法测定创面组织释放白细胞介素(IL)8、髓过氧化物酶(MPO)和丙二醛(MDA)的水平,通过HE和Masson染色对创面组织坏死程度进行形态学观察。结果削痂手术后,患者创面组织局部释放IL8、MPO、MDA的水平分别为(6.83±1.85)μg/L、(4.07±0.87)U/g、(8.94±5.66)μmol/g,与未手术创面比较明显降低(P<0.01)。形态学观察显示,手术前创面有凝固性坏死灶;未手术创面炎症反应明显,坏死组织范围扩大;削痂手术后创面局部的炎症反应得到改善,未见坏死组织范围扩大。结论伤后24h内行削痂手术,可以改善深Ⅱ度烧伤创面局部的炎症反应,防止创面进行性加深,有利于创面及早愈合。Objective To investigate the influence of early tangential excision within 24 postburn hours on local wound inflammatory response and tissue injury in patients with deep partial thickness burn. Methods Twelve patients with deep partial thickness burn were enrolled in the study. Tangential excision was performed within 24 postburn hours. The same wound of a patient was divided into three areas for harvesting tissue samples, i.e. pre-operation, post-operation and non-operation areas. For each patient, the biopsies from the pre-operation area were harvested before tangential excision, while those from post-operation and non-operation areas were harvested during 5 to 7 postburn days (PBDs). The contents of IL-8, MPO and MDA in wound tissue were determined by tissue culture and chemical colorimetry, respectively. HE and Mason's staining were employed to assess the degree of necrosis of the wound tissue. Results The IL-8, MPO and MDA contents in the local wound tissue after tangential excision were 6.83±1.85 μg/L, 4.07±0.87 U/g, and 8.94±5.66 μmol/g, respectively, which were significantly lower than those from non-operation area (P<0.01). The inflammatory response in the non-operative wound area was distinct with expansion of necrotic tissue area. In contrast, the local inflammatory response of the wound after tangential excision was ameliorated without the enlargement of necrotic tissue area. Conclusion Tangential excision within 24 postburn hours could be beneficial in ameliorating local inflammatory response, and in preventing progressive deepening of the burn wounds, thus it could accelerate wound healing in patients with deep partial thickness burn.

关 键 词：创面 削痂 手术后 局部炎症 手术前 炎症反应 烧伤 标本 形态学观察 水平 

分 类 号：R644[医药卫生—外科学] R364.5[医药卫生—临床医学]