[不同内层敷料在负压伤口治疗中对全层烧伤兔焦痂切除伤口的影响]
[Influence of different inner dressings in negative-pressure wound therapy on escharectomy wound of full-thickness burn rabbits].
作者信息
Lin J H, Chen J, Xue D J, Huang W X, Su G L
机构信息
Burns and Skin Repair Surgery, the Third Affiliated Hospital of Whenzhou Medical University, Ruian 325200, China.
出版信息
Zhonghua Shao Shang Za Zhi. 2017 Jul 20;33(7):431-436. doi: 10.3760/cma.j.issn.1009-2587.2017.07.008.
To explore the influence of different inner dressings in negative-pressure wound therapy (NPWT) on escharectomy wound of full-thickness burn rabbits. Eighteen Japanese white rabbits were inflicted with full-thickness burn on unilateral back. They were divided into polymer dressing group (PD), biological dressing group (BD), and silver biological dressing group (SBD), according to the random number table, with 6 rabbits in each group. On 3 days post burn, the wounds were performed with escharectomy, and then wounds of rabbits in group PD were covered with polyurethane foam. Wounds of rabbits in group BD were covered with porcine acellular dermal matrix (ADM) and wounds of rabbits in group SBD were covered with silver porcine ADM. Then continuous NPWT was performed on rabbits of the three groups for 7 days. Immediately after surgery and on post surgery day (PSD) 7, general observation of wound was conducted and tissue around the wound was harvested for determination of dry to wet weight ratio. The content of bacteria was counted and the content of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6 in wound was determined by enzyme-linked immunosorbent assay. Fibroblasts in wound were counted after Masson staining and number of microvessels was counted after CD31 antibody immunohistochemical staining. Data were processed with analysis of variance for repeated measurement, LSD- test, paired samples test, and Bonferroni correction. (1) Immediately after surgery, there was no granulation tissue in basal wound of rabbits in the three groups, with rich blood supply and obvious edema. On PSD 7, much granulation tissue was found in basal wound of rabbits in the three groups, with no or mild edema and no obvious redness and swelling in wound edge. (2) There were no significant differences in dry to wet weight ratios of tissue around the wound among and within the three groups immediately after surgery and on PSD 7 (with values respectively 0.70 and 0.09, values from 0.17 to 0.52, values above 0.05). (3) Immediately after surgery, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD was respectively (603.0±146.0) ×10(4,) (573.0±63.0) ×10(4,) and (590.0±100.0)×10(4) colony-forming unit (CFU)/g, with no significant difference among them (=0.13, >0.05). On PSD 7, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD were respectively (5.4±0.8) ×10(4,) (4.6±0.9) ×10(4,) and (3.5±0.9)×10(4) CFU/g. Among them, the content of bacteria in wounds of rabbits in group SBD was lower than that in groups PD and BD, respectively (with values respectively 3.78 and 2.29, <0.05 or <0.01). The content of bacteria in wounds of rabbits in the three groups on PSD 7 was decreased compared with that immediately after surgery (with values from 10.05 to 21.81, values below 0.01). (4) There was no significant difference in content of TNF-α, IL-1β, and IL-6 in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with values from 0.10 to 1.89, values above 0.05). The content of TNF-α in wounds of rabbits in the three groups on PSD 7 was significantly higher than that immediately after surgery (with values from 2.93 to 5.01, <0.05 or <0.01). (5) There was no significant difference in amount of fibroblasts in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with values respectively 0.01 and 0.81, values above 0.05). The amount of fibroblasts in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with values from 4.78 to 11.58, values below 0.01). (6) There was no significant difference in number of microvessels in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with values respectively 2.42 and 2.49, values above 0.05). The number of microvessels in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with values from 7.17 to 11.14, values below 0.01). SBD is better at inhibiting the growth of bacteria. PD, BD, and SBD have almost the same effects on reducing tissue edema and inflammatory reaction, and on promoting the accumulation of collagen fibers and tissue vascularization.
探讨负压伤口治疗(NPWT)中不同内层敷料对兔全层烧伤焦痂切除术后创面的影响。18只日本大耳白兔单侧背部造成全层烧伤。按随机数字表法分为高分子敷料组(PD)、生物敷料组(BD)和含银生物敷料组(SBD),每组6只。烧伤后3天进行焦痂切除术,术后PD组兔创面覆盖聚氨酯泡沫,BD组兔创面覆盖猪脱细胞真皮基质(ADM),SBD组兔创面覆盖含银猪ADM。然后对三组兔持续进行NPWT 7天。术后即刻及术后第7天对创面进行大体观察,并取创面周围组织测定干重与湿重比,计数细菌含量,采用酶联免疫吸附测定法测定创面肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)及IL-6含量。Masson染色后计数创面成纤维细胞,CD31抗体免疫组织化学染色后计数微血管数量。数据采用重复测量方差分析、LSD检验、配对样本t检验及Bonferroni校正处理。(1)术后即刻,三组兔创面基底均无肉芽组织,血运丰富,水肿明显。术后第7天,三组兔创面基底出现较多肉芽组织,无水肿或轻度水肿,创面边缘无明显红肿。(2)术后即刻及术后第7天,三组创面周围组织干重与湿重比组间及组内比较差异均无统计学意义(F值分别为0.70和0.09,P值为0.17~0.52,均>0.05)。(3)术后即刻,PD组、BD组和SBD组兔创面细菌含量分别为(603.0±146.0)×10⁴、(573.0±63.0)×10⁴和(590.0±100.0)×10⁴CFU/g,组间比较差异无统计学意义(F=0.13,P>0.05)。术后第7天,PD组、BD组和SBD组兔创面细菌含量分别为(5.4±0.8)×10⁴、(4.6±0.9)×10⁴和(3.5±0.9)×10⁴CFU/g。其中,SBD组兔创面细菌含量低于PD组和BD组,差异有统计学意义(t值分别为3.78和2.29,P<0.05或P<0.01)。三组兔术后第7天创面细菌含量均低于术后即刻(t值为10.05~21.81,P<0.01)。(4)术后即刻及术后第7天,三组兔创面TNF-α、IL-1β及IL-6含量比较差异均无统计学意义(F值为0.10~1.89,P>0.05)。三组兔术后第7天创面TNF-α含量均高于术后即刻(t值为2.93~5.01,P<0.05或P<0.01)。(5)术后即刻及术后第7天,三组兔创面成纤维细胞数量比较差异均无统计学意义(F值分别为0.01和0.81,P>0.05)。三组兔术后第7天创面成纤维细胞数量均多于术后即刻(t值为4.78~11.58,P<0.01)。(6)术后即刻及术后第7天,三组兔创面微血管数量比较差异均无统计学意义(F值分别为2.42和2.49,P>0.05)。三组兔术后第7天创面微血管数量均多于术后即刻(t值为7.17~11.14,P<0.01)。含银生物敷料在抑制细菌生长方面效果更佳。高分子敷料组、生物敷料组和含银生物敷料组在减轻组织水肿、炎症反应以及促进胶原纤维积聚和组织血管化方面效果相近。