负压封闭引流联合肝素灌洗治疗兔烫伤并海水浸泡创面  

Effects of vacuum drainage combined with heparin irrigation for treatment of scald burns with seawater immersion in rabbits

作　　者：张文浩[1] 吴起[1] 马军[1] 王甲汉[1] 

机构地区：[1]南方医科大学南方医院烧伤科,广东广州510515

出　　处：《南方医科大学学报》2015年第10期1481-1486,共6页Journal of Southern Medical University

摘　　要：目的观察负压封闭引流联合肝素溶液灌洗对兔背部烫伤合并海水浸泡创面愈合影响。方法选用新西兰大白兔20只,在脊柱两侧建立4个1%TBSA深Ⅱ度烫伤创面模型,分别给予常规换药(A组)、海水浸泡后常规换药(B组)、海水浸泡后封闭负压吸引治疗(C组)、海水浸泡后封闭负压吸引联合肝素灌洗(D组)。在烫伤后第1,3,5,7天观察创面渗出及坏死情况,并取材进行HE及免疫组化染色。光镜观察创面病理改变及血管内皮生长因子(VEGF)和cd31表达,计算组织血管密度。电子显微镜下观察创面毛细血管和内皮细胞形态学变化。利用干湿重法计算组织含水量。第3、5、7、14天利用毫米方格纸计算创面愈合率。结果相对于非浸泡组(A组),海水浸泡后(B组)的创面干枯、加深,水肿程度高。C组及D组组创面与B组相比,坏死组织脱落快,基底血运好,且创面早期坏死程度较B组低。烫伤后各组创面组织含水量均升高,至第3天达到峰值,在各时间点B组创面含水量均最高。C,D组含水量低于B组,差异有统计学意义。光镜及电镜观察示:烫伤后各组创面均有炎症细胞浸润及不同程度的血管基底膜损伤,B组创面血管内皮细胞损伤重,皱缩明显,血管内可见皱缩红细胞聚集、血管栓塞最为明显,D组毛细血管基底膜损伤较轻,内皮细胞膜较完整。各组创面伤后于第3天开始出现散在新生血管,D组出现最早,且高峰值最高,B组微血管生成较晚且密度低。结论负压封闭引流治疗联合肝素溶液湿敷治疗,可有效地减轻海水浸泡后烫伤创面的组织水肿程度,改善组织微循环,加快坏死组织的清除,促进新生血管的生长,是治疗海水浸泡后烧烫伤创面的有效手段。Objective To investigate the effect of closed vacuum drainage combined with heparin irrigation in the treatment of scald burns with seawater immersion in rabbits. Methods Twenty New Zealand rabbits were subjected to deep partialthickness scald burns in 4 regions on the bilateral skin of the spine. The wounds were managed with common dressing（group A）, common dressing after seawater immersion（group B）, closed vacuum drainage after seawater immersion（group C）, or closed vacuum drainage combined with heparin irrigation after seawater immersion（group D）. Wound effusion and tissue necrosis were observed at 1, 3, 5 and 7 days after the burns. Tissue samples were collected from the wounds for HE staining and immunohistochemistry for VEGF and CD31, and the changes of capillary endothelial cells in the wound were observed using electron microscopy. The water content in the wound tissues was determined, and the wound healing rate was calculated after the injury. Results Sea water immersion of the wound results in earlier onset of edema and more extensive tissue necrosis in the scalded rabbits. The mean necrotic area in groups C and D was smaller than that in group B early after the burns, and vacuum drainage promoted necrotic tissue elimination and accelerated wound healing. Early after the burns,water content in the tissues increased with time in all the groups and reached the highest level at 3 days, and was significantly lower in groups C and D than in group B. Pathologically, vascular endothelial cell damage at the wound site was worsened after seawater immersion. In group D, the basement membrane damage was milder and the endothelial cell membrane remained intact at the wound site, where new blood vessels occurred at 3 days after the burns, a time earlier than that in the other 3 groups with also the highest vascular density. Conclusion Closed vacuum drainage combined with heparin irrigation can relieve edema at the scald wound with seawater immersion, improve microcirculation, accelerate the removal o

关 键 词：烧伤 海水 负压封闭引流 肝素 内皮细胞 

分 类 号：R644[医药卫生—外科学]