不同处理方法对兔深度烧伤切痂创面的影响  

Effects on wound bed of deep burn following eschar excision with different wound management in rabbits

作　　者：薛迪建 林俊瀚 陈炯[1] 黄文祥[1] 苏国良[1] 

机构地区：[1]温州医科大学附属第三医院烧伤及皮肤修复外科,浙江省瑞安市325200

出　　处：《中华医学杂志》2016年第30期2427-2432,共6页National Medical Journal of China

基　　金：基金项目：浙江省医学重点建设学科计划（2010-311-07-006）;温州市院士专家工作站专项（2012-72）

摘　　要：目的比较不同处理方法对兔深度烧伤切痂创面的影响。方法 将18只日本大耳白兔造成Ⅲ度烧伤后第3天切痂，按随机数表法分为传统敷料组、生物敷料组和负压治疗组各6只，于切痂后第7天处死。在切痂即日及切痂后第7天分别观察和测定创面大体情况、创面组织菌量计数、创周组织干湿比、创面组织肿瘤坏死因子（TNF）－α、白细胞介素（IL）－1β、IL－6含量、组织成纤维细胞计数及新生血管内皮细胞计数，并进行统计学分析。结果 切痂后第7天负压治疗组创面基底最佳；传统敷料组、生物敷料组和负压治疗组切痂后第7天创面组织菌量分别为（9.4±1.5）×10^4、（8.1±2.7）×10^4、（3.9±0.7）×10^4 cfu/g，负压治疗组均显著低于传统敷料组和生物敷料组（均P〈0.05），且三组均显著低于切痂即日的（576.9±169.5）×10^4、（589.9±99.6）×10^4、（583.0±160.4）×10^4 cfu/g（均P〈0.05）；三组各时相点组间及组内创周组织干湿比差异均无统计学意义（均P〉0.05）；生物敷料组切痂后第7天的IL－6显著高于传统敷料组[（94±10）比（76±8）ng/L，P〈0.05]；切痂后第7天三组成纤维细胞计数分别为（60±9）、（55±12）、（77±17）个/视野，负压治疗组均显著高于传统敷料组和生物敷料组（均P〈0.05），且三组均显著高于切痂即日的（39±6）、（39±11）、（38±6）个（均P〈0.05）；切痂后第7天三组微血管密度计数分别为（42±6）、（53±4）、（82±10）个/视野，负压治疗组均显著高于传统敷料、生物敷料组，生物敷料组显著高于传统敷料组（均P〈0.05），且生物敷料组、负压治疗组均显著高于切痂即日的（36±5）、（36±5）个/视野（均P〈0.05）。结论 在抑制创面细菌增殖、促进胶原纤维沉积及组织血管化方面负压治疗技术具有显著优势，但不同方法对局部组织水肿、炎症反�ObjectiveTo compare the effects on wound bed of deep burn following eschar excision with different wound management in rabbits.MethodsEighteen full-thickness burns models of Japanese white rabbits were established. They were randomly divided into 3 groups of traditional dressing, biological dressing and negative pressure wound therapy （NPWT） （n=6 each）, according to the random number table. Eschar excision was performed three days later. The wound bed was observed and wound tissue was harvested for counting the quantity of bacteria, tissue dry wet ratio, measuring the level of tumor necrosis factor alpha （TNF-α）, interleukin （IL）-1β and IL-6, the amount of collagen fibers and the microvessel density instantly and again seven days later. Statistical analyses were performed.ResultsThe NPWT group was better than other groups by observing the wound bed. The quantity of bacteria of traditional dressing group, biological dressing group and NPWT group at the time point of seven days after escharectomy turned out to be （9.4±1.5）×10^4, （8.1±2.7）×10^4, （3.9±0.7）×10^4 cfu/g, the NPWT group was significantly lower than traditional dressing group and biological dressing group （both P〈0.05）, and all lower than that at the time point of the day when escharectomy was performed （576.9±169.5）×10^4, （589.9±99.6）×10^4, （583.0±160.4）×10^4 cfu/g （ all P〈0.05）. There were no statistically significant differences among three groups at two time points in tissue dry wet ratio （all P〉0.05）. The IL-6 of biological dressing group was higher than that of traditional dressing group at the time point of seven days after the eschar excision was performed[（94±10） vs （76±8） ng/L, P〈0.05]. The amount of collagen fibers of three group at the time point of seven days after escharectomy turned out to be （60±9）, （55±12）, （77±17）. The NPWT group was significantly higher than traditional dressing group and biological dressing group （P〈0.05）, and all h

关 键 词：烧伤 生物敷料 负压伤口疗法 兔 

分 类 号：R644[医药卫生—外科学]