慢性溃疡创面愈合的微环境变化：一项前瞻性随机对照临床研究  

The change of micro environment of wound healing of chronic ulcer： a prospective randomized controlled trail

作　　者：孔伟[1] 姜丽娟[1] 赵越 关静 崔梅花 高惠娟[3] 刘彦东[1] 蒋晓宇[1] 张洪华[1] 张艳芳[1] 韩会民[1] 

机构地区：[1]大庆市第四医院,黑龙江大庆163712 [2]大庆油田南区医院,黑龙江大庆163712 [3]大庆油田总医院,黑龙江大庆163712

出　　处：《中国中西医结合急救杂志》2016年第3期253-256,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：黑龙江省大庆市指导性科技计划项目（201539）

摘　　要：目的探讨非糖尿病慢性溃疡与糖尿病足溃疡愈合适宜的微环境状态及促创面愈合因子表皮生长因子（EGF）、血管内皮生长因子（VEGF）的表达变化，为临床治疗慢性溃疡提供理论依据。方法采用前瞻性随机对照临床试验，选择2013年1月至2015年1月大庆市第四医院住院的非糖尿病慢性溃疡组患者20例及糖尿病足溃疡组患者25例为研究对象。两组患者每日进行清创换药，局部感染控制后，给予封闭负压“开窗”技术治疗。测定两组治疗前和治疗后3d和10d创面温度、相对湿度、pH值、创面面积，于治疗前及治疗后10d用免疫组化法检测创面组织EGF、VEGF的表达情况。结果至研究结束时，糖尿病足溃疡组脱落2例，最终非糖尿病慢性溃疡组纳入患者20例、糖尿病足溃疡组纳人23例进行统计。两组治疗后3d和10d创面温度与治疗前比较变化不大，差异无统计学意义（P〉0．05）；随治疗时间延长，两组治疗后创面相对湿度、pH值均较治疗前降低，创面面积均较治疗前缩小。治疗10d糖尿病足溃疡组创面相对湿度、pH值变化较非糖尿病慢性溃疡组更显著[相对湿度：（76．84±1．93）％比（78．64±2．17）％，pH值：7．84±0．86比7．93±0．97]，创面面积缩小程度以非糖尿病慢性溃疡组较糖尿病足溃疡组更显著（cm^2：16．82±2．11比16．84±2．02）。两组治疗后10dEGF和VEGF均较治疗前不同程度增多；且糖尿病足溃疡组上述指标的表达量均较非糖尿病慢性溃疡组少[EGF（×10^3，A值）：11．81±0．87比12．87±0．54，VEGF（×10^3，A值）：13．66±0．89比15．33±0．97，均P〈0．01]。结论慢性溃疡愈合不同时期微环境会发生改变，微环境与创面愈合时间密切相关，尤以创面相对湿度、pH值对创面的愈合作用更为重要。EGF与VEGF表达增多可能与微环境改善有关。Objective To discuse on suitable micro environment for the healing of non diabetic chronic ulcer and diabetic foot ulcer, and the changes in the expression of promoting wound healing factor, such as epidermal growth factor （EGF）, vascular endothelial growth factor （VEGF）, to provide a theoretical basis for clinical treatment of chronic ulcer. Methods A prospective randomized controlled trail （RCT） was conducted. 20 cases of non diabetic chronic ulcer patients and 25 cases of diabetic foot ulcer admitted to the Fourth Hospital of Daqing City From January 2013 to January 2015 were enrolled. Two groups of patients were treated with debridement and dressing change daily, and the technique of closed negative pressure with ＂window＂ was given after local infection control; temperature, relative humidity, pH value, the wound area were measured before and after treatment of 3 days and 10 days, EGF, VEGF were detected before and after treatment of 10 days by immunohistochemical expression. Results To the end of the experiment, 2 cases of diabetic foot ulcer group fall off, 20 cases of non diabetic chronic ulcer group and 23 cases of diabetic foot ulcer group were included in the final statistics. Compared with before treatment, the changes of wound temperature in the groups after treatment of 3 days and 10 days were not significant, and there was no significant difference between the two groups （P 〉 0.05）; with prolonged treatment, the two groups of relative humidity and pH values were lower than those before treatment, the wound area were reduced after treatment. After treatment of 10 days, the changes of relative humidity and pH value in diabetic foot ulcer group was more significant than that in the non diabetic chronic ulcer group[relative humidity： （76.84 ± 1.93）% vs. （78.64 ±2.17）%, pH value： 7.84 ± 0.86 vs. 7.93 ± 0.97]. The extent of reduction of wound area in non diabetic chronic ulcer group was more significant than that of diabetic foot ulcer group （cm2：16.82 ± 2.11 vs.

关 键 词：慢性溃疡 微环境 表皮生长因子 血管内皮生长因子 

分 类 号：R711.32[医药卫生—妇产科学]