碱烧伤创面切痂与植皮时机选择的实验研究  

Experimental Researches of Time Selection of Excision of Eschar and Skin Grafting after Alkali Burn

作　　者：吴兰草[1] 赵耀华[1] 张业龙[1] 查新建[1] 曹平[1] 牛希华[1] 刘凤云[2] 张穗[2] 杨光英[2] 

机构地区：[1]郑州市第一人民医院烧伤科,郑州市450004 [2]郑州市第五人民医院病理科,郑州市450003

出　　处：《医药论坛杂志》2005年第24期30-32,35,F0004,共5页Journal of Medical Forum

摘　　要：目的探讨碱烧伤创面切痂植皮最佳时机,提高植皮成活率.方法将纯种Wistar健康大白鼠90只脱毛后随机分两组(A、B).A组切痂立即植皮;B组切痂延迟48h植皮.A、B两组动物各45只,伤后分9个时间段(1、2、4、8、12、24、48、72、96h)切痂,每个时间段5只.两组动物手术同时测pH(切痂后、植皮前)并行病理切片组织学观察损伤程度及炎性细胞浸润.结果A组切痂后pH(10.5±0.5),处理后创面pH(7.6±0.2),8h前切痂组织块病理观察除全层皮肤坏死外,横纹肌浊肿但无炎性细胞浸润,植皮成活率98.66%,12～48h切痂后组织块病理观察不但全层皮肤坏死,而且有明显的炎性反应,肌组织间有大量PMNs浸润,皮肤成活率明显降低,仅79.65%,统计学分析有显著性差异(P＜0.001).B组切痂后pH同A组,48h后pH虽有下降但不明显,pH(9.5±0.5),处理创面后pH同A组,植皮成活率98.47%.两组植皮成活率差异无显著性意义,P＞0.05,但两组之间存在着交互效应,P＜0.001,即不同处理方法对植皮存活率的影响随时间的变化而变化.结论大鼠皮肤碱烧伤创面根据不同时间切痂早期病理组织学观察,8h前切痂适合立即植皮;8h后切痂适合延迟植皮.Objective To explorie the time of excision of eschar and skin grafting after alkali burn, improving the surviving rate of skin grafting. Methods 90 healthy Wistar rats were divided into 2 groups （A ,B） averagely, each group 45 rats. A group＇s rats were treated by excision of eschar and instantly skin grafting, and B group＇s rats were treated by excision of eschar and skin grafting after 48 hours. The grafting time was separated into 9 segments （ 1 、2、4、8、12、24 、48、72、96h）, and every time segments was presented 5 rats. The wound surfaces of 2 groups animals were tested pH value and were made pathology slicings to observe the damage degree and the information of inflammation cells soakaging at the time of the operation. Results The wound surface of A group animals pH value was （ 10.5 ± 0.5） after excision of eschar, and the pH value of the wound surface was （7.6 ± 0.2） after treating. The pathology observation of the tissue of excision of eschar before 8 hours showed that except the full skin necrosis, the striated muscle was feculcnt and tumid, but there were not inflammation cell soakaging. The surviving rate of skin grafting was 98.66% ; the pathology observation of the tissue of excision of eschar during 12 -48 hours indicated that nut only the full skin had necrosis, but also had obvious inflammation. There were amount of PMNs soakaging in the muscle tissue, and the surviving rate （79. 65%） of the skin decreased distinctively, the difference had statistical face was equal to A group after treating. The surviving rate of skin grafting was 98.47%. The difference of surviving rate of the 2 groups had no significance （ F = 0.002, P 〉 0.05 ）, but the surviving rate of the 2 groups had crossing effect（ P 〈0.001 ）. That is, the effect of different treatments to the surviving rate had the change along with the change of the time. Conclusion The different time of the early patholo - histological observation of the wound surface of rat skin alkali burn, the wound su

关 键 词：碱烧伤 组织学 切痂植皮 时机选择 

分 类 号：R644[医药卫生—外科学]