负压封闭引流联合含氧液冲洗对下肢慢性静脉性溃疡患者创面的影响  

Effects of vacuum sealine drainage combined with irrigation of oxygen loaded fluid on wounds of pa-tients with chronic venous leg ulcers

作　　者：温皇鼎 李志清[1] 张美光[1] 王甲汉[1] 王桂芳[1] 吴起[1] 童森[1] 

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》2015年第2期86-92,共7页Chinese Journal of Burns

摘　　要：目的评估VSD联合含氧液冲洗对下肢慢性静脉性溃疡（CVLU）患者创而肉芽组织生长及巨噬细胞活化的影响。方法2010年12月一2014年7月，将笔者单位收治的34例CVLU患者，按随机数字表法分为单纯VSD组（简称A组）11例、VSD＋生理盐水组（简称B组）11例、VSD＋含氧液组（简称C组）12例。入院后清创，术中留取创面中心肉芽组织标本，术后A组仅行VSD治疗（负压值为－30～－25kPa，下同），B组采用VSD联合生理盐水冲洗，C组采用VSD联合含氧生理盐水（含氧液）冲洗（氧流量1L／min）。冶疗7d，去除VSD装置。清创前及治疗7d行创面大体观察、治疗7d，计算创面肉芽组织覆盖率，并取创面中心肉芽组织标本以HE染色、Masson染色后行组织病理学观察。清创后VSD治疗前（以下简称治疗前）及治疗7d，用经皮氧分压测定仪检测创周皮肤局部氧分压。治疗7d，取创面肉芽组织用免疫组织化学染色法检测血管内皮生长因子（VEGF）表达。治疗前及治疗7d，取创面肉芽组织行免疫荧光染色观察CD68与诱导型一氧化氮合酶双阳性（I型巨噬细胞）、CD68与精氨酸酶1双阳性（Ⅱ型巨噬细胞）细胞许计数。对数据行Fisher确切概率法检验、单因素方差分析、协方差分析、配对t检验、LSD检验。结果（1）大体观察示，清创前3组患者创面均存在坏死组织，肉芽组织较少。治疗7d，3组患者创而均出现新生肉芽组织，且C组创而新生肉芽组织最多。（2）治疗7d，C组患者创面肉芽组织覆盖率高于A、B组（P〈0．05或P〈0．01）、（3）治疗7d，HE染色示C组患者创面新生毛细血管和Fb较A、B组更丰富；Masson染色示C组患并创面新生胶原较A、B组更丰富，且分布均匀。（4）治疗7d，C组患者创删皮肤局部氧分压为（40．7±4．1）nunHg（1mmHg=0．133kPa），高于A组的（35．0±3．1）mmHg和B组的（35．4±2．7）mmHg（PObjective To evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on the growth of granulation tissue and macrophage polarization in chronic venous leg ulcers. Methods Thiry-four patients with chronic venous leg ulcers hospitalized in our department from December 2010 to July 2014 were divided into VSD group （ A, n = 11 ） , VSD ＋ irrigation group （ B, n = 11 ） , and VSD ＋ oxygen loaded fluid irrigation group （ C, n = 12） according to the random number table. After admis-sion, debridement was performed, and granulation tissue in the center of the wound was harvested during the operation. After debridement, the patients in group A were treated with VSD only （negative pressure from -30 to -25 kPa, the same below） ; the patients in group B were treated with VSD combining irrigation of normal saline; the patients in group C were treated with VSD combining normal saline loaded with oxygen ir- rigation （flow of 1 L/min）. On post treatment day （PTD） 7, the VSD devices were removed. Gross obser- vation was conducted before debridement and on PTD 7. On PTD 7, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining and Masson staining, following calculation of granulation tissue coverage rate. After debridement but before the negative pressure therapy （ hereinafter referred to as before treatment） and on PTD 7, partial pressure of oxygen of the skin around the wound was measured by transcutaneous tissue oxygen tension survey meter. On PTD 7, expression of vascu- lar endothelial growth factor （VEGF） was determined with immunohistochemistry. Before treatment and on PTD 7, cells with double positive expressions of induced nitric oxide synthase plus CD68 （type I macro- phage） and arginase 1 plus CD68 （type Ⅱ macrophage） were observed with immunofluorescence staining and quantified. Data were processed with Fisher＇s exact test, one-way analysis of variance, covariance anal- ysis, paired t

关 键 词：负压伤口疗法 静脉曲张溃疡 氧 巨噬细胞活化 冲洗治疗 

分 类 号：R658.3[医药卫生—外科学]