纳米银对肛周坏死性筋膜炎术后创面愈合的临床疗效及机制研究  

The clinical effect and mechanism of nano-silver in the postoperative wound healing of perianal necrotizing fasciitis

作　　者：孙壮[1] 杨宇慎 李静慧[1] 白景舒[1] Sun Zhuang;Yang Yushen;Li Jinghui;Bai Jingshu(Department of Coloproctological Surgery,Dalian University Affiliated Xinhua Hospital,Dalian 116021,China)

机构地区：[1]大连大学附属新华医院肛肠外科,辽宁116021

出　　处：《国际医药卫生导报》2021年第10期1459-1463,共5页International Medicine and Health Guidance News

基　　金：大连市医学科学研究计划项目(1911124)。

摘　　要：目的探讨纳米银对肛周坏死性筋膜炎术后创面愈合的临床疗效及其作用机制。方法选取2018年1月至2020年2月本院收治的60例肛周坏死性筋膜炎患者,根据随机数字表法分为两组,各30例。研究组男21例,女9例,平均年龄49.5岁;对照组男22例,女8例,平均年龄49.0岁。两组均急诊彻底清创引流及加强营养、支持治疗,研究组术后创面采用纳米银纱布敷料换药法治疗,对照组术后创面采用传统四黄纱布敷料换药法治疗。在此基础上,再细分为单一肛周组和其他合并组。比较分析各分组间患者的术后创面愈合相关指标及术后3 d、7 d、14 d血清肿瘤坏死因子β1(tumor necrosis factor-β1,TNF-β1)、白细胞介素-6(interleukin-6,IL-6)、Ⅰ/Ⅲ型胶原蛋白及血管内皮生长因子(vascular endothelial growth factor,VEGF)水平变化。结果研究组术后创面愈合时间、住院时间分别为(29.13±5.61)d、(15.27±2.96)d,均优于对照组的(37.63±8.85)d、(22.57±4.44)d,差异均有统计学意义(均P<0.05);研究组临床治愈率为93.3%(28/30),明显高于对照组的63.3%(19/30),差异有统计学意义(P<0.05);3 d、7 d、14 d,研究组术后血清TNF-β1、IL-6水平均显著低于对照组,Ⅰ/Ⅲ型胶原蛋白、VEGF水平均显著高于对照组,差异均有统计学意义(均P<0.05);两组肛周坏死性筋膜炎患者并发症发生率比较,差异无统计学意义(P>0.05)。细分的单一肛周组患者中,研究组14例和对照组12例,研究组术后创面愈合时间、住院时间分别为(24.50±3.23)d、(13.14±1.75)d,均优于对照组的(31.08±3.26)d、(19.75±2.34)d,差异均有统计学意义(均P<0.05)。细分的其他合并组患者中,研究组16例和对照组18例;研究组术后创面愈合时间、住院时间分别为(33.19±3.78)d、(17.13±2.53)d,均优于对照组(42.00±8.74)d、(24.44±4.55)d,差异均有统计学意义(均P<0.05);研究组临床治愈率为87.5%(14/16),明显优于对照组44.4%(8/18),差异有统计�Objective To investigate the clinical effect and mechanism of nano-silver in the postoperative wound healing of perianal necrotizing fasciitis.Methods Sixty patients with perianal necrotizing fasciitis admitted to our hospital were selected from January 2018 to February 2020.The patients were randomly divided into a control group(n=30)and a study group(n=30).There were 21 males and 9 females in the study group,with the average age of 49.5 years old;there were 22 males and 8 females in the control group,with the average age of 49.0 years old.Emergency thorough debridement,drainage,reinforce of nutritional therapy,and supportive treatment were performed in both groups.In addition,the study groups and the control groups underwent dressing change respectively using nano-silver dressing and traditional dressing.On the basis,both groups were subdivided into single perianal groups and other combined groups.Then the related indicators of postoperative wound healing and the changes of serum tumor necrosis factor-β1(TNF-β1),interleukin-6(IL-6),collagenⅠ/Ⅲ,and vascular endothelial growth factor(VEGF)levels 3 d,7 d,14 d after treatment were compared and analyzed.Results The healing time of wound and hospital stay in the study group were(29.13±5.61)d and(15.27±2.96)d,which were significantly shorter than those in the control group[(37.63±8.85)d and(22.57±4.44)d](both P<0.05).The clinical cure rate in the study group was significantly higher than that in the control group[93.3%(28/30)vs.63.3%(19/30)](P<0.05).The serum TNF-β1 and IL-6 levels in the study group were significantly lower than those in the control group,and serum collagenⅠ/Ⅲand VEGF levels in the study group were significantly higher than those in the control group at 3 d,7 d,14 d after treatment(all P<0.05).There was no statistically significant difference in the rate of complications between the two groups(P>0.05).Among the patients in the single perianal group,there were 14 cases in the study group and 12 cases in the control group;the healing tim

关 键 词：纳米银 肛周坏死性筋膜炎 术后创面愈合 临床疗效 

分 类 号：R686.3[医药卫生—骨科学]