负压封闭引流联合含氧液冲洗修复糖尿病患者慢性创面的效果观察  

Effects of vacuum sealing drainage combined with irrigation of oxygen loaded fluid on chronic wounds in diabetic patients

作　　者：张美光[1] 李志清[1] 王甲汉[1] 吴起[1] 温皇鼎 

机构地区：[1]南方医科大学南方医院烧伤科,广州510515

出　　处：《中华烧伤杂志》2014年第2期116-123,共8页Chinese Journal of Burns

摘　　要：目的评估VSD联合含氧液冲洗治疗糖尿病患者慢性创面的效果。方法2010年9月-2013年6月，将南方医科大学南方医院收治的符合纳入标准的26例糖尿病下肢慢性溃疡患者，按随机数字表法分为单纯VSD组8例、VSD＋冲洗对照组9例、VSD＋含氧液冲洗组9例。入院后行大体观察、取刨面分泌物行细菌培养后清创，术中留取创面肉芽组织用ELISA法检测乳酸脱氢酶（LDH）和琥珀酸脱氢酶（SDH）活性。术后单纯VSD组仅行VSD治疗（负压为-30--25kPa，下同），VSD＋冲洗对照组行VSD联合生理盐水冲洗治疗，VSD＋含氧液冲洗组行VSD联合含氧液（纯氧流量为1 L／min）冲洗治疗。治疗过程中记录引流管堵塞率。治疗7d后，抽取组织渗出液采用血气分析仪检测组织液氧分压；撤除VSD装置，同前行细菌培养计算细菌清除率；计算肉芽组织覆盖率后蹦取创丽中心肉芽组织，HE染色行组织病理学观察，透射电镜观察肉芽组织线粒体密度与形态，同前检测LDH和SDH活性，CD3l染色计数微血管密度（MVD）。之后行Ⅱ期手术，记录Ⅱ期手术方式及移植皮片或皮瓣成活率。对数据进行单因素方差分析、LSD-t检验、秩和检验或行Fisher确切概率法分析。结果（1）大体观察显示，清创前3组患者创面均有坏死组织存在，无肉芽组织。治疗7d，3组患肯创面均出现新生肉芽组织。HE染色显示VSD＋含氧液冲洗组创面肉芽组织内有较多新生毛细血管，Fb密集分布；VSD＋冲洗对照组肉芽组织新生毛细皿管较VSD＋含氧液冲洗组少，Fb分布较稀疏；单纯VSD组肉芽组织新生毛细血管和Fb稀疏。（2）3组间引流管堵塞率、肉芽组织覆盖率、细菌清除率总体比较均有明显差异（F值为10．98～770．24，P值均小于0．01）。VSD＋冲洗对照组和VSD＋含氧液冲洗组引流管堵塞率分别为（2．0±0．4）％和（1．9±0．6）％，均明显低�Objective To evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on chronic wounds in diabetic patients. Methods Twenty-six diabetic patients hospitalized in Nanfang Hospital of Southern Medical University from September 2010 to June 2013, with chronic ulcers on lower extremities conforming to the inclusive criteria, were divided into group VSD （ n = 8） , VSD ＋ irriga- tion control group （ VSD ＋ IC, n = 9） , VSD ＋ oxygen loaded fluid irrigation group （ VSD ＋ OLI, n = 9） ac- cording to the random number table. After gross observation was conducted and wound secretion was sent for bacterial culturing right after admission, debridement was performed. During the debridement, granulation tissue of wound center was harvested for determination of the activity of lactate dehydrogenase （LDH） and succinate dehydrogenase （SDH） with ELISA. After debridement, the patients in group VSD were treated with VSD （negative pressure from -30 to -25 kPa, the same below） ; the patients in group VSD ＋ IC were treated with VSD combining irrigation of normal saline; the patients in group VSD ＋ OLI were treated with VSD combining normal saline loaded with oxygen （flow of 1 L/min ） irrigation. Drainage tube blockage was recorded and its incidence rate was recorded during the treatment. On post treatment day （PTD） 7, tissue exudates were collected and analyzed with blood gas analyzer for determining the partial pressure of oxygen of the exudate. After the VSD was terminated, bacterial culture was conducted as before, and the bacterial clearance rate was calculated. After the calculation of granulation tissue coverage rate, the granulation tissue in the center of the wound was harvested for histopathologieal observation with HE staining; morphological characteristics and density of mitochondria were observed with transmission electron microscopy; the activity of LDH and SDH was estimated as before; microvascular density （MVD） was counted after CD31 antibody im

关 键 词：负压伤口疗法 糖尿病 氧 冲洗治疗 创面床 

分 类 号：R587.2[医药卫生—内分泌]