负压封闭引流技术对提高儿童急性损伤创面愈合机制的研究  

Mechanism of vacuum sealing drainage for improving wound healing and immune response in children

作　　者：江琦庆[1] 熊斌[1] 林智峰[1] Jiang Qiqing;Xiong Bin;Lin Zhifeng(Department of Pediatric Orthopedics,Jiangxi Provincial Children＇s Hospital,Nanchang 330006,China)

机构地区：[1]江西省儿童医院骨科,南昌330006

出　　处：《中华小儿外科杂志》2018年第9期693-697,共5页Chinese Journal of Pediatric Surgery

基　　金：江西省卫计委科技计划项目（20141146）

摘　　要：目的 探讨负压封闭引流（VSD）技术对儿童急性创面新生肉芽组织内血管内皮生长因子（VEGF）表达及对巨噬细胞迁移的影响.方法 选取2013年3月至2015年3月因外伤所致四肢皮肤软组织撕脱及软组织缺损患儿40例,创面约为体表面积1％～3％,受伤后6～8 h内入院并急诊行清创治疗,在Ⅰ期行彻底清创治疗后按照随机数字表法均分为2组,每组各20例,研究组采用VSD处理,对照组采用传统的换药治疗.分别于治疗后第7天和第14天取创缘新生肉芽组织用免疫组织化学染色法（S-P法）,高倍镜下观察VEGF表达及巨噬细胞数量的变化.结果 研究组在VSD治疗后VEGF在肉芽组织内血管内皮细胞表达明显较对照组多,VEGF标记指数在7 d、14 d时均高于对照组,差异有统计学意义（P〈0.01）;研究组及对照组的VEGF标记指数2个时间点相比较,14 d时VEGF标记指数均高于7 d,差异均有统计学意义（P〈0.01）.VSD治疗后研究组巨噬细胞数在7 d时均高于对照组,差异有统计学意义（P〈0.01）;VSD治疗后14 d时研究组巨噬细胞数与对照组比较差异无统计学意义（P〉0.05）.研究组2个时间点相比较,14 d与7 d巨噬细胞数差异无统计学意义（P〉0.05）;对照组2个时间点相比较,14 d时巨噬细胞数高于7 d,差异均有统计学意义（P〈0.01）.结论 VSD 治疗与常规换药相比,能够更好地提高 VEGF 的表达,加速创面愈合.VSD能增强创面巨噬细胞的迁移及活化,诱导组织细胞增生,使创面肉芽组织更好、更快的生长.相对于传统的常规换药,VSD 技术能够对儿童大面积皮肤软组织损伤创面起到更加积极的疗效.Objective To explore the mechanism of vacuum sealing drainage （VSD）on vascular endothelial growth factor （VEGF）expression and macrophage migration.Methods Forty children with skin soft tissue avulsion of extremities and soft tissue defect resulting from injuries were selected from March 2013 to March 2015. Wound area for total body surface area was about 1 ％-3％. Hospitalized within 6-8 hours,they received emergency debridement.After thorough debridement in stage I,they were divided into 2 groups （n =20 each）.The experimental group received VSD while control group routine dressing.New granulation tissues were harvested on Days 7 and 14 respectively and stained with S-P immunohistochemical method. Expression of VEGF and the number of macrophages were observed.Results After VSD,VEGF expression in vascular endothelial cells of granulation tissue in experimental group significantly increased as compared to control group.On Days 7 and 14,VEGF labeling parameters were higher than those of control group and there was a significant difference （P 〈0.01 ）;on Day 14,VEGF labeling parameters were higher than those on Day 7 in both experimental and control groups and significant differences existed in each group （P 〈0.01）.Numbers of macrophages obviously increased on Day 7 in experimental group after VSD and markedly higher than those on Day 7 in control group.And the differences were statistically significant （P 〈0.01 ）;however,there was no statistical differences on Day 14 （P 〉 0.05 ）;The number of macrophages on Days 7 and 14 in experimental groups showed no statistical differences （P 〉0.05 ）. The number of macrophages on Day 14 was higher than that on Day 7 in control groups and significant difference existed in this group （P 〈0.01 ）.Conclusions Compared to conventional treatment,VSD can enhance the expression of VEGF and shorten the time of wound healing.It may enhance the migration and activation of macrophages of wound, induce tissue cell proliferation and enable gran

关 键 词：引流术 负压伤口疗法 血管内皮生长因子 巨噬细胞 

分 类 号：R726.5[医药卫生—儿科]