富血小板血浆联合微粒皮移植在高原地区老年慢性小创面中的临床研究  

Clinical study of platelet-rich plasma combined with micro-skin grafting in elderly patients with chronic small wounds in plateau area

作　　者：祁焕康 包俊杰[1] 张婧 田琰[1] 卓么加[1] 祁万乐[1] Qi Huankang;Bao Junjie;Zhang Jing;Tian Yan;Zhuo Mejia;Qi Wanle(Department of Burns and Plastic Surgery,Qinghai Provincial People′s Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院烧伤整形科,西宁810000

出　　处：《中华损伤与修复杂志（电子版）》2023年第1期32-38,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：青海省卫生健康委员会指导性课题(2019-wjzdx-28)。

摘　　要：目的探究在高原地区老年慢性小创面治疗中使用富血小板血浆(PRP)联合微粒皮移植的治疗效果。方法选取2018年2月至2022年2月青海省人民医院烧伤整形科收治的老年慢性小创面患者60例。根据患者入院时间不同将患者分为观察组和对照组,观察组采用PRP联合微粒皮移植,对照组采用PRP联合刃厚邮状皮移植。采集患者的外周静脉血,采用二次离心法制备PRP;2组患者均于局部浸润麻醉下应用电动取皮机自大腿前内侧根据创面需要取合适大小刃厚皮片,皮片厚度约0.2 mm,观察组供受区比例为1∶4~1∶8,将所取皮片剪碎后切割成直径<1 mm 2的微粒皮备用;对照组供受区比例为1∶1~1∶2,将所取皮片制备为大小约1 cm×1 cm的刃厚邮状皮备用。创面清创、止血后,观察组将制备好的微粒皮均匀涂抹在创面后以PRP填充创面,用聚氨酯泡沫敷料或凡士林纱布覆盖创面避免PRP流失及失活,清洁敷料覆盖并固定;对照组将制备好的PRP填充于创面,再将制备好的刃厚邮状皮片移植于PRP之上,用凡士林或聚氨酯泡沫敷料覆盖清洁敷料加压包扎。2组术后均常规行抗感染等治疗,术后第6、11、16、21、26天创面换药,直至创面完全愈合。术后第21天,统计2组患者的治疗有效率;统计2组患者的创面愈合时间;创面愈合后6个月,以温哥华瘢痕评估量表(VSS)对2组患者的瘢痕情况进行评估。数据比较采用Mann-Whitney U检验和χ^(2)检验。结果术后第21天,观察组治疗有效27例,无效3例,治疗有效率为90.00%;对照组治疗有效20例,无效10例,治疗有效率为66.67%,2组比较差异有统计学意义(χ^(2)=6.278,P=0.043)。观察组创面愈合时间为为26.0(24.0,27.0)d,短于对照组[43.0(39.8,47.3)d],2组比较差异有统计学意义(Z=-6.531,P<0.05)。创面愈合后6个月,观察组VSS评分中色素沉着、瘢痕厚度、血管分布和柔韧性评分分别为0(0,0)、0(0,0)、0(0,0)、1(0,1)分,均Objective To explore the effect of platelet-rich plasma(PRP)combined with micro-skin transplantation in the treatment of chronic small wounds in the elderly in plateau area.Methods From February 2018 to February 2022,sixty elderly patients with chronic minor wounds were selected from Department of Burns and Plastic Surgery,Qinghai Provincial People′s Hospital.Patients were divided into observation group and control group according to the time of admission.The observation group was treated with PRP combined with micro-skin graft,while the control group was treated with PRP combined with blade-thick mail-like skin graft.The peripheral venous blood of patients was collected and PRP was prepared by secondary centrifugation.Under local infiltration anesthesia,all patients in the two groups used an electric skin-taking machine to take a skin piece with a suitable size and a blade thickness of about 0.2 mm from the front inner thigh according to the needs of the wound.The ratio of donor and recipient areas in the observation group was 1∶4 to 1∶8,and the taken skin piece was cut into small pieces with a diameter of<1 mm for later use.In the control group,the ratio of donor and recipient areas was 1∶1 to 1∶2,and the skin graft was made into mail-like skin with blade thickness of about 1 cm×1 cm for later use.After wound debridement and hemostasis,the observation group evenly smeared the prepared micro-particle skin on the wound,then filled the wound with PRP,covered the wound with polyurethane foam dressing or vaseline gauze to avoid the loss and inactivation of PRP,and covered and fixed with clean dressing;in the control group,the prepared PRP was filled in the wound surface,and then the prepared blade-thick mail-like skin graft was transplanted on the PRP,and the cleaning dressing was covered with vaseline or polyurethane foam dressing for pressure dressing.Both groups were routinely treated with anti-infection therapy after operation,and the wound was changed on the 6th,11th,16th,21st and 26th day after oper

关 键 词：富血小板血浆 皮肤移植 高原地区 慢性创面 微粒皮 

分 类 号：R47[医药卫生—护理学]