应用自体富血小板血浆治疗慢性难愈性创面的实验研究  

Autologous platelet-rich plasma for treatment of chronic refractory wounds

作　　者：李明[1] 章军辉[1] 李淑敏[2] 狄正林[1] 何志勇[1] 贾伟涛[3] 袁霆[3] 张长青[3] 

机构地区：[1]宁波市第六医院关节外科,315040 [2]宁波市第六医院内分泌科,315040 [3]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华关节外科杂志（电子版）》2016年第6期34-39,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：宁波市卫生局科研基金(2013A34)

摘　　要：目的探索富血小板血浆(PRP)治疗慢性难愈性创面的安全性和疗效,通过体外实验评价其抗感染作用。方法 2010年9月至2014年12月,宁波市第六医院内分泌科和上海市第六人民医院骨科采用局部喷洒PRP的方法治疗21例慢性难愈性创面患者。通过观察创面愈合情况、测量创面体积、计算创面覆盖率和比较细菌培养结果评价其安全性和疗效。选取创面感染最常见的金黄色葡萄球菌作为实验菌株,分别在PRP凝胶及PRP培养基中孵育,分别于多个时间点取样行菌落计数,采用SPSS 17.0统计学软件,血小板、白细胞和细菌计数的组间比较采用单因素方差分析,两两比较采用t检验分析各组间的统计学差异。结果本研究未发生创面感染加重、菌血症、局部异常组织增生等不良反应。治疗后第1、2、4周随访时创面覆盖率分别为(55.1±22.6)%、(72.0±16.2)%,(84.3±14.0)%,不同用药后时间点与创面覆盖率的差异有统计学意义(P<0.05),说明在治疗的4周内,创面处于持续修复状态。3个月随访时,创面体积为(1.5±1.8)ml,创面平均覆盖率为(85.6±12.5)%,治愈率为57.1%,治疗的有效率和患者主观满意率均为95.23%。体外抑菌结果显示PRP凝胶抗菌作用明显,细菌数量于孵育4 h时降至最低。结论 PRP不但能有效安全的促进慢性难愈性创面的愈合,并有潜在的抗感染作用。Objective To determine the safety and effectiveness of treating chronic refractory wounds with platelet-rich plasma （PRP） and to evaluate its antibacterial effect in vitro. Methods From September 2010 to December 2014, 21 patients of chronic refractory wounds were treated with 2 - 7 ml PRP. The patients included eight males and 13 females, aged from 48 to 78 years （58.5 -± 12）. The bacterial culture results, wound healing size and rates were analyzed for treatment efficacy evaluation. The wound deterioration, aggravated infection, bacteremia, wound recurrence and other adverse reactions were recorded to evaluate the safety of this treatment. The patients were clinically prospectively evaluated before the treatment and at one, two, four and 12-week follow-up. As the most common seen strains, staphylococcus aureus was selected to be incubated in PRP and PRP gel. Staphylococcus aureus were sampled and compared at multiple time points. Results No complication such as wound deterioration, aggravated infection, bacteremia, wound recurrence, or other major adverse events occurred. Only two weeks after PRP iniection, chronic wounds contracted significantly in 21 natients with purulence and necrosis tissue cleaned up, circulation of soft tissue improved and exposed bone or muscle tissue covered by neogenetic granulation. The wound sizes in one, two and four weeks of the follow-up, were （5.5 ± 3.9） ml, （3.5 ± 2. 9） ml and （2.0 ± 2. 1 ） ml, respectively. The chronic wounds proportion decreased to （55.1 ± 22.6）%, （72.0 ± 16.2）%, （84.3 ± 14.0）% after the PRP therapy when compared with the preoperative data, which showed significant difference （P 〈 0. 05）. Three months after the PRP injection, the average coverage rate was （85.6 ± 12. 5）%, when compared with （84. 3 ± 14. 0）% at the 4^th week after the therapy, which showed no significant difference （ P 〉 0. 05 ）. The cure rate and subjective satisfaction rate were 57.1% and 95.23%, respectively. In vitro experiment s

关 键 词：富血小板血浆 创伤和损伤 伤口愈合 葡萄球菌 金黄色 

分 类 号：R641[医药卫生—外科学]