富血小板血浆治疗下肢缺血性难愈创面的临床观察  

Clinical observation of platelet-rich plasma in the treatment of ischemic non-healing wounds in the lower limbs

作　　者：刁永鹏 张榜[2] 吴志远 刘平[2] 杜萌萌[2] 兰勇 许政曦 周涛[2] 李拥军 DIAO Yongpeng;ZHANG Bang;WU Zhiyuan;LIU Ping;DU Mengmeng;LAN Yong;XU Zhengxi;ZHOU Tao;LI Yongjun(Institute of Geriatrics,Chinese Academy of Medical Sciences/National Center for Geriatrics/Department of Vascular Surgery,Beijing Hospital,Beijing 100730,China;Department of Peripheral Vascular Surgery,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]中国医学科学院老年医学研究院/国家老年医学中心/北京医院血管外科,北京100730 [2]河南中医药大学第一附属医院周围血管科,河南郑州450000

出　　处：《中国普通外科杂志》2024年第6期952-960,共9页China Journal of General Surgery

基　　金：河南省中医药科学研究专项基金资助项目(2021JDZY052)。

摘　　要：背景与目的:下肢缺血性难愈创面在经过积极腔内介入或开放手术重建肢体血运后,仍然存在住院周期长、治疗难度大、费用较高等,且创面愈合效果不佳。富血小板血浆(PRP)具有制备简单、来源丰富、相对安全无副作用等优势,可直接作用于创面并增强创面愈合进程,已广泛应用于难愈创面修复领域,但对于下肢缺血性难愈创面少有报道。本研究探讨PRP在下肢缺血性难愈合创面治疗中的临床疗效及安全性,以期为此类难愈性创面的临床治疗提供参考和借鉴。方法:在2021年1月—2022年12月北京医院血管外科、河南中医药大学第一附属医院周围血管科收治的下肢缺血性难愈创面患者中,选取患肢踝肱指数(ABI)>0.5~<0.9、创面床分期为红期(肉芽组织期)、创面面积>1~<20 cm^(2)、无死腔或引流不畅的难愈性创面;抽取患者自体静脉血50 mL,采用密度梯度离心法二次离心,制备PRP及PRP凝胶。在戒烟、降脂、抗凝、抗血小板、改善循环、降压、降糖全身治疗基础上,创面清创后局部给予PRP创基直接注射和创面外用PRP凝胶联合治疗,隔7 d换药1次。观察14 d后创面面积(依据创面面积判定疗效)、肉芽评分、渗出量评分、创面深度评分,以及炎性指标[白细胞(WBC)、C-反应蛋白(CRP)水平、红细胞沉降率(ESR)水平]、疼痛评分与不良反应发生情况。结果:经PRP治疗14 d后,患者创面面积较治疗前明显缩小[(10.16±4.07)cm^(2) vs.(5.11±3.38)cm^(2),P=0.000],其中创面面积痊愈8例(12.7%)、显效25例(39.7%)、有效24例(38.1%)、无效6例(9.5%),总有效率90.5%;创面局部深度、肉芽组织及渗出量量化评分均较治疗前明显改善(均P<0.05)。治疗后均未应用抗生素治疗,炎性指标WBC、CRP、ESR水平较前降低,患者自我疼痛评分较前减低(均P<0.05);治疗过程中均未见明显不良反应。结论:PRP创基直接注射和创面局部外用凝胶的联合方法,�Background and Aims:After undergoing active endovascular intervention or open surgery to reconstruct limb blood flow,patients with ischemic non-healing wounds in the lower limbs still face long hospital stays,high treatment difficulty,high costs,and poor wound healing outcomes.Platelet-rich plasma(PRP)is advantageous due to its simple preparation,abundant sources,relative safety,and lack of side effects.It can be directly applied to wounds to enhance the healing process and has been widely used in the field of non-healing wound repair.However,there are few reports on its use for ischemic nonhealing wounds in the lower limbs.This study was performed to explore the clinical efficacy and safety of PRP in the treatment of ischemic non-healing wounds in the lower limbs,so as to provide a reference for clinical treatment of such refractory wounds.Methods:From January 2021 to December 2022,patients with ischemic non-healing wounds in the lower limbs admitted to the Vascular Surgery Department of Beijing Hospital and the Peripheral Vascular Department of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected.Patients had an ankle-brachial index(ABI)of>0.5 to<0.9,wound bed tissue in the red phase(granulation tissue phase),wound area>1 to<20 cm²,and non-healing wounds without dead space or poor drainage.Autologous venous blood(50 mL)was drawn from patients and centrifuged using a density gradient centrifugation method to prepare PRP and PRP gel.On the basis of systemic treatments including smoking cessation,lipid-lowering,anticoagulation,antiplatelet therapy,circulation improvement,blood pressure reduction,and blood sugar control,debridement was performed,followed by direct PRP injection into the wound base and external application of PRP gel to the wound,with dressing changes every 7 d.After 14 d,wound area(clinical efficacy was determined according to wound area reduction),granulation score,exudate score,and wound depth score,as well as inflammatory markers(CRP,WBC,ESR),pain scor

关 键 词：闭塞性动脉硬化 下肢 溃疡 富血小板血浆 

分 类 号：R654.3[医药卫生—外科学]