负压创面治疗技术早期应用对软组织爆炸伤创面作用的研究  

Effect of Vacuum-Assisted Infection Control and Granulation Formation on Soft Tissue Explosive Defects

作　　者：钱玉鑫[1] 芦立轩[1] 侯强[1] 江华[1] 张文俊[1] 刘安堂[1] 

机构地区：[1]第二军医大学附属长征医院整形外科,上海市200003

出　　处：《组织工程与重建外科杂志》2011年第6期321-325,354,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：全军医药卫生科研项目基金(08G069);南京军区医学科技创新课题(10MA026)

摘　　要：目的动态观察爆炸伤创面内细菌数量及病理改变,探讨负压创面治疗技术(NPWT)早期应用,对于控制软组织爆炸伤创面感染及肉芽生长的作用。方法采用猪爆炸伤软组织缺损模型,3只家猪随机分为一侧NPWT组,对侧为纱布敷料组,每组6个创面;另选取两只家猪形成的6个创面设为暴露组。致伤后分别于6 h及第3、5、7天取各组创面中央组织行细菌定量,创面组织培养,HE染色观察肉芽生长情况。结果治疗前各组间细菌数无统计学差异。治疗后各时间点NPWT组细菌计数较纱布组、暴露组数值小。治疗后第3天NPWT组计数达到最高,第5天细菌计数降至感染临界值水平以下。NPWT治疗后创面面积缩小,深度变浅。NPWT组治疗后第3天肉芽组织新生较纱布组多,成纤维细胞、血管内皮细胞染色明显,组织细胞水肿减轻。结论 NPWT早期应用能有效抑制爆炸伤创面细菌增殖,促进肉芽生长。Objective To observe the effect of early NPWT application on infection control and granulation formation in explosive soft tissue defects by comparing the bacteria colony-forming unit and pathological changing. Methods Explosive soft tissue defects were created in pig model. Twelve defects were created on 3 pigs and divided into 2 groups randomly. NPWT group was on one side and Gauze group on opposed side. Each group had 6 wounds. Exposure group was composed of another 2 pigs with 6 wounds. At 6 hours, Day 3, Day 5 and Day 7, specimens were harvested in the center of the wound for counting of bacteria and HE staining. Microscopy was used for observation Granulation formation was observed by microscope. Results The numbers of bacteria colony on NPWT group were smaller than that of Gauze group and Exposure group at Day 3, 5 and 7. The counting of NPWT group peaked at Day 3 and declined below the critical value of infection at Day 5. After the NPWT application, the wound area shrank and became superficial. Compared with Gauze group, more granulation formation, and obvious staining with fibroblast and endothelium cell, as well as edema fading of the cells were observed in NPWT group. Conclusion Compared with the Gauze group, early application of NPWT can effectively control the bacteria multiplication and promote granulation formation on soft tissue explosive defects.

关 键 词：爆炸伤 负压创面治疗 感染 肉芽 

分 类 号：R826.5[医药卫生—临床医学]