[不同伤口处理方式对兔深Ⅱ度烧伤焦痂切除术后创面床的影响]
[Effects on wound bed of deep burn following eschar excision with different wound management in rabbits].
作者信息
Xue D J, Lin J H, Chen J, Huang W X, Su G L
机构信息
Burns and Skin Repair Surgery, Third Affiliated Hospital, Whenzhou Medical University, Ruian 325200, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2016 Aug 9;96(30):2427-32. doi: 10.3760/cma.j.issn.0376-2491.2016.30.013.
OBJECTIVE
To compare the effects on wound bed of deep burn following eschar excision with different wound management in rabbits.
METHODS
Eighteen full-thickness burns models of Japanese white rabbits were established. They were randomly divided into 3 groups of traditional dressing, biological dressing and negative pressure wound therapy (NPWT) (n=6 each), according to the random number table. Eschar excision was performed three days later. The wound bed was observed and wound tissue was harvested for counting the quantity of bacteria, tissue dry wet ratio, measuring the level of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-6, the amount of collagen fibers and the microvessel density instantly and again seven days later. Statistical analyses were performed.
RESULTS
The NPWT group was better than other groups by observing the wound bed. The quantity of bacteria of traditional dressing group, biological dressing group and NPWT group at the time point of seven days after escharectomy turned out to be (9.4±1.5)×10(4,) (8.1±2.7)×10(4,) (3.9±0.7)×10(4) cfu/g, the NPWT group was significantly lower than traditional dressing group and biological dressing group (both P<0.05), and all lower than that at the time point of the day when escharectomy was performed (576.9±169.5)×10(4,) (589.9±99.6)×10(4,) (583.0±160.4)×10(4) cfu/g ( all P<0.05). There were no statistically significant differences among three groups at two time points in tissue dry wet ratio (all P>0.05). The IL-6 of biological dressing group was higher than that of traditional dressing group at the time point of seven days after the eschar excision was performed[(94±10) vs (76±8) ng/L, P<0.05]. The amount of collagen fibers of three group at the time point of seven days after escharectomy turned out to be (60±9), (55±12), (77±17). The NPWT group was significantly higher than traditional dressing group and biological dressing group (P<0.05), and all higher than that at the time point of the day when escharectomy was performed[(39±6), (39±11), (38±6)](all P<0.05). The microvessel density of three groups at the time point of seven days after escharectomy turned out to be (42±6), (53±4), (82±10). The NPWT group was higher than that of the other two groups, and biological dressing group was higher than that of traditional dressing group (all P<0.05). The biological dressing group and NPWT group were both higher than that of the day when the eschar excision was performed (36±5) and (36±5) (P<0.05).
CONCLUSIONS
NPWT is the optimal selection for wound to inhibit the growth of bacteria, promote the accumulation of collagen and tissue vascularization. But these managements have similar effects on reducing tissue edema and inflammatory reaction.
目的
比较不同创面处理方法对兔深度烧伤创面床的影响。
方法
建立18只日本大耳白兔全层烧伤模型,按随机数字表法将其随机分为传统敷料组、生物敷料组和负压伤口治疗(NPWT)组,每组6只。3 d后行焦痂切除,观察创面床情况,取创面组织计数细菌数量、测量组织干湿比、检测肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-1β及IL-6水平、测定胶原纤维含量及微血管密度,于术后即刻及7 d后再次检测并进行统计学分析。
结果
观察创面床情况,NPWT组优于其他两组。切痂术后7 d,传统敷料组、生物敷料组和NPWT组创面细菌数量分别为(9.4±1.5)×10⁴、(8.1±2.7)×10⁴、(3.9±0.7)×10⁴ cfu/g,NPWT组显著低于传统敷料组和生物敷料组(均P<0.05),且均低于切痂当日的(576.9±169.5)×10⁴、(589.9±99.6)×10⁴、(583.0±160.4)×10⁴ cfu/g(均P<0.05)。两组组织干湿比在两个时间点差异均无统计学意义(均P>0.05)。切痂术后7 d,生物敷料组IL-6水平高于传统敷料组[(94±10)比(76±8)ng/L,P<0.05]。切痂术后7 d,三组胶原纤维含量分别为(60±9)、(55±12)、(77±17),NPWT组显著高于传统敷料组和生物敷料组(P<0.05),且均高于切痂当日的(39±6)、(39±11)、(38±6)(均P<0.05)。切痂术后7 d,三组微血管密度分别为(42±6)、(53±4)、(82±10),NPWT组高于其他两组,生物敷料组高于传统敷料组(均P<0.05),生物敷料组和NPWT组均高于切痂当日的(36±5)(P<0.05)。
结论
NPWT是抑制创面细菌生长、促进胶原蓄积和组织血管化的最佳选择,但这些处理方法在减轻组织水肿和炎症反应方面效果相似。