脱细胞异体真皮基质联合自体微粒皮移植术在深度烧伤创面中的临床研究  

Clinical effect of autologous micro-skin grafting on granulation wound covered with skin matrix in deep burn wound

作　　者：随永敏 王大鹏 吴首臣 张蕾 SUI Yongmin;WANG Dapeng;WU Shouchen;ZHANG Lei(Department of Dermatology,The Fourth People's Hospital of Hen Hengshui 053000,China)

机构地区：[1]衡水市第四人民医院皮肤科,河北衡水053000 [2]华北医疗健康集团峰峰总医院外科,河北邯郸056200 [3]华北医疗健康集团峰峰总医院科教科,河北邯郸056200

出　　处：《中国美容整形外科杂志》2024年第11期641-644,661,共5页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：2022年度河北省医学科学研究课题计划项目(20221558)。

摘　　要：目的 探析复合移植[脱细胞异体真皮基质(acelluar allogenic dermal matrix, ADM)+自体微粒皮移植术]治疗深度烧伤创面的临床疗效。方法 前瞻性研究选择华北医疗健康集团峰峰总医院自2021年10月至2022年12月,收治的85例深度烧伤患者,采用随机数表法分为观察组43例,对照组42例。观察组给予复合移植(ADM+自体微粒皮移植术)修复;对照组给予自体微粒皮移植术修复。比较两组皮片成活率、温哥华瘢痕量表(vancouver scar scale, VSS)评分、日常生活能力量表(activity of daily living scale, ADL)、免疫功能、炎性因子、血管相关生长因子。结果 治疗后2周观察组皮片成活率为97.62%(41/42)明显高于对照组80.95%(34/42),差异有统计学意义(χ^(2)=4.242,P<0.05)。治疗后观察组VSS、ADL评分、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-6(interleukin-6, IL-6)、白细胞介素-10(interleukin-10, IL-10)均低于对照组,而CD3^(+)、CD4^(+)/CD8^(+)、免疫球蛋白A(immunoglobulin A, Ig A)、表面生长因子(epidernal growth factor, EGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor, bFGF)、血小板衍生生长因子-AB(platelet-derived growth factor-AB, PDGF-AB)均高于对照组(P<0.05)。结论 ADM复合覆盖肉芽组织自体微粒皮移植术应用于深度烧伤创面中效果显著,可有效提高皮片成活率,改善患者免疫功能、炎性介质及相关生长因子水平,促进瘢痕快速痊愈及日常功能康复。Objective To explore the clinical effect of composite transplantation[acellular allogenic dermal matrix(ADM)+autologous micro-skin grafting]on deep burn wounds.Methods In a prospective study,85 patients with deep burn who were treated in the Fourth People's Hospital of Hengshui from October 2021 to December 2022 were randomly divided into observation group(43 patients)and control group(42 patients).The control group was treated with autologous micro-skin grafting for repair,and the observation group was treated with composite transplantation(ADM+autologous micro-skin grafting).The survival rate of skin graft,vancouver scar scale(VSS),activity of daily living scale(ADL),immune function,inflammatory factor.Results The survival rate of skin graft in the observation group was 97.62%(41/42),which was significantly higher than that in the control group 80.95%(34/42)2 weeks after operation(χ^(2)=4.242,P<0.05).Postoperative observation group VSS,ADL score,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)were lower than those in the control group,while CD3^(+),CD4^(+)/CD8^(+),immunoglobulin A(Ig A),epidernal growth factor(EGF),basic fibroblast growth factor(bFGF),platelet-derived growth factor-AB(PDGF-AB)were higher than those in the control group(P<0.05).Conclusion ADM combined with granulation autogenous micro-skin grafting has a significant effect in the treatment of deep burn wounds.It can effectively improve the survival rate of skin graft,improve the immune function,inflammatory mediators and vascular related growth factor levels of patients,and promote the rapid recovery of scar and daily function recovery.

关 键 词：深度烧伤 自体微粒皮移植术 脱细胞异体真皮基质 皮片成活率 免疫功能 炎性因子 

分 类 号：R644[医药卫生—外科学]