自体富血小板血浆联合Meek微型皮片修复严重烧伤患者四肢创面的效果及其机制的前瞻性研究  

A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients

作　　者：郑健生[1] 刘胜利[1] 彭晓菁 刘小飞 禹乐[2] 梁声强 Zheng Jiansheng;Liu Shengli;Peng Xiaojing;Liu Xiaofei;Yu Le;Liang Shengqiang(Department of Burns and Plastic Surgery,the 909th Hospital of the Joint Logistic Support Force of PLA(Affiliated Southeast Hospital of Xiamen University),Zhangzhou 363000,China;Department of Pathology,the 909th Hospital of the Joint Logistic Support Force of PLA(Affiliated Southeast Hospital of Xiamen University),Zhangzhou 363000,China;Department of Blood Transfusion,the 909th Hospital of the Joint Logistic Support Force of PLA(Affiliated Southeast Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]解放军联勤保障部队第909医院(厦门大学附属东南医院)烧伤整形科,漳州363000 [2]解放军联勤保障部队第909医院(厦门大学附属东南医院)病理科,漳州363000 [3]解放军联勤保障部队第909医院(厦门大学附属东南医院)输血科,漳州363000

出　　处：《中华烧伤杂志》2021年第8期731-737,共7页Chinese Journal of Burns

基　　金：南京军区医学科技创新课题(11MA079);福建省自然科学基金(2019J01143)。

摘　　要：目的观察自体富血小板血浆(PRP)联合Meek微型皮片修复严重烧伤患者四肢创面的效果,并探讨其机制。方法采用前瞻性对照研究方法。解放军联勤保障部队第909医院烧伤整形科2016年9月—2020年1月收治16例符合入选标准的大面积深度烧伤患者(男9例、女7例,年龄18~69岁)。8例患者两侧患肢损伤程度相近,按随机数字表法将患肢分为Meek植皮+PRP组和单纯Meek植皮组;将另8例患者损伤较重一侧患肢纳入Meek植皮+PRP组,另一侧患肢纳入单纯Meek植皮组。2组患肢创面进行相应治疗。术后10 d,观察Meek微型皮片成活和融合情况,并计算皮片成活率和融合率,苏木精-伊红染色观察Meek微型皮片基底组织形态,免疫组织化学染色观察Meek微型皮片基底组织微血管增生情况并计数。对数据进行配对样本t检验。结果术后10 d,Meek植皮+PRP组患肢创面较干燥,绝大部分Meek微型皮片与基底贴合牢固;单纯Meek植皮组患肢创面可见少量分泌物,小部分Meek微型皮片脱落或与基底贴合不牢固。术后10 d,Meek植皮+PRP组患肢创面皮片成活率、融合率分别为(94±3)%、(86±4)%,明显高于单纯Meek植皮组的(89±4)%、(79±4)%(t=3.633、4.229,P<0.01)。术后10 d,Meek植皮+PRP组患肢创面Meek微型皮片基底表皮与真皮连接紧密,有较多炎症细胞浸润,微血管增生活跃;单纯Meek植皮组患肢创面Meek微型皮片基底表皮与真皮连接欠紧密,真皮层下胶原纤维变性明显,炎症细胞浸润较少,微血管增生情况欠佳。术后10 d,Meek植皮+PRP组患肢创面Meek微型皮片基底组织微血管呈簇状密集分布,单纯Meek植皮组患肢创面皮片基底组织微血管呈散在、稀疏、点状分布;Meek植皮+PRP组患肢创面Meek微型皮片基底每400倍视野下的微血管数为(36±6)条,明显多于单纯Meek植皮组的(29±7)条(t=2.671,P<0.05)。结论自体PRP可能通过促进皮片基底微血管新生,提高严重烧伤患者四肢�Objective To observe the effect of autologous platelet-rich plasma(PRP)combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients,and to explore the mechanism.Methods The prospective controlled research method was used.From September 2016 to January 2020,16 patients aged 18-69 years,with extensive deep burns,including 9 males and 7 females,who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA.The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table;in the other 8 patients,the limbs with severer injury were included in Meek skin grafting+PRP group,and the limbs on the other side were included in Meek skin grafting alone group.The wounds of affected limbs in the two groups were treated correspondingly.On post surgery day(PSD)10,the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated;the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining,respectively,with the microvessels being counted.Data were statistically analyzed with paired sample t test.Results On PSD 10,the wounds of affected limbs in Meek skin grafting+PRP group were dry,and most of the transplanted skin grafts were closely adhered to the basal tissue;while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group,and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue.On PSD 10,the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were(94±3)%and(86±4)%,which were significantly higher than(89±4)%and(79±4)%of Meek skin grafting alone group,respectively(t=3.633,4.22

关 键 词：烧伤 富血小板血浆 Meek微型皮片 

分 类 号：R641[医药卫生—外科学] R318[医药卫生—临床医学]