封闭负压引流促进猪腹部爆炸伤创面愈合的实验研究  

Vacuum sealing drainage promotes experimental pig explosive abdomen wound healing

作　　者：师俊莉[1] 席文锦[2] 易成刚[1] 王志军[3] 郭树钟 韩岩[4] 

机构地区：[1]第四军医大学西京医院全军整形外科研究所 [2]第四军医大学基础部免疫学教研室,陕西西安710032 [3]大连大学附属新华医院,辽宁大连116021 [4]解放军总医院整形修复科,北京100853

出　　处：《细胞与分子免疫学杂志》2014年第3期312-315,共4页Chinese Journal of Cellular and Molecular Immunology

基　　金：全军医药卫生科研基金(108G116)

摘　　要：目的探讨在猪腹部爆炸伤合并内脏外露时,使用封闭负压引流(VSD)控制腹腔、创面感染的作用以及对腹部爆炸创面愈合是否有促进作用。方法爆炸伤导致的全层腹壁缺损的动物随机分为实验组(VSD组)和对照组(盐水纱布组),实验组在6 h清创后置入压力为-125 mmHg VSD装置;对照组在6 h清创后使用盐水纱布覆盖爆炸创面,常规换药治疗。分别采集治疗前6 h和治疗后1、3、5、7 d的创面肌肉组织进行细菌检测,分析2组的细菌量;ELISA检测伤后1、3、5、7 d的腹部引流液肿瘤坏死因子-α(TNF-α),白细胞介素-1(IL-1)、IL-6的表达水平;采集2组治疗后第7天的皮肤、肌肉组织标本,用实时定量PCR分析血管内皮细胞生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)及基质金属蛋白酶-9(MMP-9)相对表达量。结果 VSD组在治疗后1、3、5、7 d创面的细菌数(CFU/g)明显少于对照组,两组比较有统计学差异(P<0.01)。猪腹部引流液中TNF-α,IL-1,IL-6的表达量在伤后治疗第1天两组没有显著性差异,在第3、5、7天VSD组明显低于同时间对照组,三个时间点两组比较均有显著性差异(P<0.01)。VSD组在第7天皮肤软组织中VEGF、EGF、bFGF的表达量均高于对照组(P<0.01),但MMP-9的表达无明显差异(P>0.05)。结论 VSD可以有效控制创面的细菌量,减少腹腔引流液中TNF-α、IL-1、IL-6的表达量,促进创面生长因子表达。Objective To explore the roles of vacuum sealing drainage （VSD） in controlling infection and promoting healing on the experimental pigs with blast injury in the abdomen and exposed internal organs. Methods All animals with full-thickness abdominal wall defect were randomly divided into experimental group （VSD group） and control group （saline gauze group）. Debridement was performed 6 hours after wounding. VSD devices （ - 125 mmHg） were imbedded on animals in the experimental group, while in the control group gauzes with saline solution were used to cover the wound and conventional, treatment of dressing change was done. Specimens of muscle tissue in the wound were collected respectively from the two groups to make bacteria quantification 6 hours before the treatment and on the 1st, 3rd, 5th, and ？th day of treatment. Specimens of abdominal drainage fluid were collected respectively on the 1st, 3rd, 5th, and 7th day of treatment to detect inflammatory cytokines （TNF-a, IL-1, IL-6） using ELISA kit. Specimens of the skin and muscle tissues were collected respectively from the two groups on the 7th day to detect target genes （VEGF, bFGF, EGF, and MMP-9） using qRT-PCR. Results The bacteria counts （CFU/g） in the VSD group on the 1st, 3rd, 5th, and 7th day of treatment were significantly less than those in the control group at the corresponding time points, and the differences between the two groups were statistically significant （ P 〈 0. 01 ）. There were no distinct differences between the two groups in the expressions of TNF-α, IL-1 and IL-6 in the abdominal drainage fluid of pig on the 1st day of treatment. The expressions of TNF-α, IL-1 and IL-6 on the 3rd, 5th, and 7th day of treatment in the VSD group were significantly lower than those in the control group at the corresponding time points （P〈0. 01）. The expressions of VEGF, EGF and bFGF in the skin and soft tissues in the VSD group on the 7th day was higher than those in the control group （ P 〈 0. 01 ）, while the e

关 键 词：封闭负压引流 细胞因子 创面愈合 

分 类 号：R392.11[医药卫生—免疫学] R826.5[医药卫生—基础医学]