两种间歇性压力对兔后肢压力性溃疡形成的影响  

EFFECT OF TWO TYPES OF INTERMITTENT PRESSURE ON FORMATION OF PRESSURE ULCER IN RABBIT HIND LIMBS

作　　者：刘江辉[1] 王维平[1] 王科科[1] 陈锡林[1] 李强[1] 戴强生[1] 王永谦[1] 姬忠良[1] 

机构地区：[1]中山大学附属第一医院急诊科,广州510080

出　　处：《中国修复重建外科杂志》2009年第8期959-963,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过两种间歇性压力作用于兔后肢形成压力性溃疡的比较,探讨波浪床产生的渐变间歇性压力预防压力性溃疡的机制。方法成年日本大耳白兔12只,于两侧后肢3cm2大小股薄肌部位随机给予渐变间歇性压力(50～160mmHg,1mmHg=0.133kPa)和持续性压力(100mmHg)作为实验组和对照组。施压2h,去除压力30min为1个周期,重复4个周期。在施压前及各周期去除压力间歇中的每隔10min(0、10、20、30min),使用双向多普勒血流探测仪和激光多普勒血流灌注成像系统探测两组后肢血流速度和创面血流灌注。施压完成后大体观察创面情况,于受压部位取材,HE染色观察;比色法测定受压肌肉组织匀浆中NO、丙二醛(malondialdehyde,MDA)和超氧化物歧化酶(superoxidedismutase,SOD)含量。结果施压前两组血流速度差异无统计学意义(P>0.05);每个周期0min时两组血流速度均显著下降,但两组间差异无统计学意义(P>0.05);实验组于10、20、30min时血流速度均较对照组高(P<0.05)。施压前两组创面血流灌注差异无统计学意义(P>0.05),每个周期0min时两组创面血流灌注均显著下降,但两组间差异无统计学意义(P>0.05);第1个周期10min时,两组差异无统计学意义(P>0.05),20、30min时实验组高于对照组(P<0.05);之后3个周期实验组创面血流灌注较对照组恢复快(P<0.05)。大体观察可见实验组创面渗出较对照组少,镜下见无明显溃疡形成,皮肤附属器完整,炎性细胞浸润少;对照组皮肤存在明显溃疡,皮肤附属器缺失,较多炎性细胞浸润。两组NO、MDA及SOD含量比较,差异均有统计学意义(P<0.05)。结论渐变间歇性压力可以维持组织血流灌注,减轻缺血再灌注损伤,减少细胞凋亡,预防压力性溃疡的形成。Objective To compare the effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind limbs and to investigate the mechanism of gradually changed intermittent pressure produced by waves bed in the prevention of pressure ulcer. Methods Gracilis （3 cm^2） in both hind limbs of 12 adult Japanese white rabbits were randomly loaded with gradually changed intermittent pressure （50-160 mm Hg, 1 mm Hg=0.133 kPa） and sustained pressure （100 mmHg） serving as the experimental group and the control group, respectively. The experiment was terminated after 4 cycles, and a single cycle included 2 hours of compression and 30 minutes of compression-release. Blood velocity of hind limbs and blood perfusion of wound were detected by bidirectional doppler blood flow detector and laser doppler perfusion imaging detection system before compression and at every 10 minutes in compression-release period of each cycle （0, 10, 20 and 30 minutes）. After the termination, gross observation of the wound was conducted, pathomorphological changes of tissues from compressed area were observed by HE staining, and contents of NO, malondialdehyde （MDA）, and superoxide dismutase （SOD） in muscle tissue were measured using colorimetry method. Results No significant difference was evident between two groups in terms of blood flow velocity before compression （P 〉 0.05）; the blood flow velocity of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups （P 〉 0.05）; the blood flow velocity of the experimental group was higher than that of the control group at 10, 20 and 30 minutes （P 〈 0.05）. No significant difference was noted between two groups in terms of wound blood perfusion before compression （P 〉 0.05）; the wound blood perfusion of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted betw

关 键 词：压力性溃疡 间歇性压力 持续性压力 缺血再灌注 兔 

分 类 号：R632.1[医药卫生—外科学] R364.16[医药卫生—临床医学]