负压创面治疗对兔创面氧分压变化和血管化的影响  

The influence of oxygen partial pressure change and vascularization of rabbit wound through negative pressure wound therapy

作　　者：杨帆[1] 胡耑[1] 白祥军[1] 张锟[1] 李仁杰[1] 薛晨晨[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030

出　　处：《中华外科杂志》2012年第7期650-654,共5页Chinese Journal of Surgery

摘　　要：目的观察负压封闭引流（VSD）技术对兔创面模型局部氧分压（PtO2）变化和新生毛细血管（NBC）形成的影响。方法建立12只兔创面模型，实施VSD手术（负压组），于7d内各时间点用组织氧分压测量仪监测创面PtO：变化；以实时荧光PCR法检测创面低氧诱导因子1a（HIF-1d）mRNA的表达；以ELISA法检测创面血管内皮生长因子（VEGF）的含量；通过光镜观察血管内皮细胞（VEC）和NBC并计数。设立常规换药实验兔（常规组）进行对照。结果建模后负压组PtO2较常规组显著降低（t=-99．780～-5．305，P〈0．01）。自30min起负压组的HIF-10tmRNA表达（30min，1、6、12h分别为3．11±0．07、3．68±0．26、4．16±0．13和3．91±0．26）和VEGF含量（pg／L）（30min，1、6、12h分别为103．3±2．4、134．2±9．0、167．8±3．8和232．1±9．5）较常规组显著升高（t=13．038—80．208，P〈0．01）。1d后两组HIF-1αmRNA表达和VEGF含量均开始下调，但负压组仍持续高于常规组（P〈0．05），同时负压组的创面VEC（2．47±0．45—4．70±0．38）和NBC计数（1．33±0．49—4．33±0．68）较常规组升高（t=-0．670—16．500，P〈0．05）。结论VSD技术可通过降低创面PrO2、上调HIF-10tmRNA的表达，促进VEGF的合成，增加VEC的分化和NBC的形成，有利于创面愈合。Objective To investigate the effect of vacuum sealing drainage （VSD） on variation of oxygen partial pressure （ PtO2 ） and vascularization. Methods The 12 cases of rabbit＇s wound models were undergoing the VSD （ vacuum group, n = 6） or conventional therapy （ conventional group, n = 6）. Variation of PrO2 was measured by oxygen partial pressure admeasuring apparatus, expression of hypoxia inducible factor 1α （HIF-1α） mRNA was measured by real-time fluorescent quantitative PCR, content of vascular endothelial growth factor （VEGF） was measured by ELISA after tissue homogenate in 7 days. Vascular endothelial cell （VEC） and new blood capillary （NBC） of hematoxylin-eosin slice of tissue were counted by using light microscope. Results Average value of PrO2 of vacuum group was significant lower than conventional group （t = - 99.780 to - 5. 305, P 〈 0. 01 ）. Expression of HIF-1α （30 minutes, 1, 6, 12 hours were 3.11 ±0.07, 3.68 ±0.26, 4. 16 ±0. 13 and 3.91 ±0.26 respectively） and content of VEGF （30 minutes, 1, 6, 12 hours were 103.3 ±2.4, 134. 2 ±9. 0, 167.8 ±3.8 and 232. 1 ±9. 5 respectively） of vacuum group were increased after 30 minutes and significant lower than conventional group （ t = 13.038- 80. 208, P 〈 0. 01 ） , and both of them were reduced after 24 hours （ P 〈 0.05 ）. Counting numbers of VEC （2. 47 ±0.45 to 4.70 ±0. 38） and NBC （ 1.33 ±0.49 to 4. 33 ±0. 68） of vacuum group were increased at the same time-point and significant higher than conventional group （ t = - 0. 670 to 16. 500, P 〈 0. 05 ）. Conclusions PrO2 of wound surface could be reduced significantly by VSD. Expression of HIF-1α and content of VEGF were increased by VSD for enhancing differentiated state of VEC and construction of NBC, which were better for vascularization and wound healing.

关 键 词：负压伤口疗法 新生血管化 病理性 缺氧诱导因子1 Α亚基 血管内皮生长 因子A 

分 类 号：R644[医药卫生—外科学]