VSD促进猪腹部爆炸伤创面愈合的实验研究

发布时间：2018-09-05 12:46

【摘要】：目的：建立爆炸伤导致的全层腹壁缺损动物模型，探讨在猪腹部爆炸伤合并内脏外露时，使用封闭负压引流控制腹腔、创面感染的作用以及对腹部爆炸创面愈合是否有促进作用，寻求腹部爆炸伤伤口最合适的二期手术闭合创面时机。方法：12只清洁健康的小型白家猪，每只猪都采用自制腹腔内脏防护装置及1g超细太安炸药，在猪左侧腹部距中线处造成1个约4×5cm的爆炸伤创面，共计12个相同位置的爆炸伤创面，伤后观察动物大体情况。所有实验动物随机分为实验组（VSD组）和对照组（盐水纱布组）：实验组（VSD组）为在6小时清创后并置入压力为-125mmHg VSD装置；对照组（盐水纱布组）为在6小时清创后并使用盐水纱布覆盖爆炸创面，常规换药治疗。分别采集治疗前第6小时和治疗后第1、3、5、7天的创面肌肉组织进行细菌检测，分析两组的细菌量；再采集两组伤后第1、3、5、7天的腹部引流液进行Elisa试剂盒检测炎性因子肿瘤坏死因子-a（Tumor necrosis factor-a，TNF-a），白介素-1（Interleukin-1，IL-1）、白介素-6（Interleukin-6，IL-6）的表达量；最后采集两组治疗后第7天皮肤、肌肉软组织标本，用实时定量PCR分析目的基因，即血管内皮细胞生长因子（vascularendothelial cell growth factor，VEGF）、碱性成纤维细胞生长因子（basic fibroblastgrowth factor，bFGF）、表皮生长因子（epidermal growth factor，EGF）及金属基质蛋白酶-9（Matrix metalloproteinase-9）相对表达量。结果：所有实验动物在致伤后均形成伤情一致的全层腹壁缺损合并内脏外露腹部爆炸伤动物模型，治疗前实验动物的细菌量均为107。VSD组和对照组在治疗后第1、3、5、7天创面的细菌数（CUF/g）分别为（637.45±108.27、121.95±30.02、32.83±8.52、1.04±0.39）和（19306.01±1042.43、11503.03±777.82、6280.01±130.11、2397.01±52.32），两组比较有统计学差异（P＜0.01）。猪腹部引流液中TNF-α，IL-1，IL-6浓度在伤后治疗第1天两组没有显著性差异（P㧐0.05）。腹部爆炸伤创面的引流液中TNF-α、IL-1、IL-6的表达量在第3、5、7天VSD组分别为(154.26±3.16ng/L、135.00±3.40ng/L、135.92±2.97ng/L)明显低于同时间对照组(215.±6.02ng/L,189.83±1.70ng/L,200.68±3.19ng/L)，三个时间点两组比较均有统计学上的显著性差异（P＜0.001）。VSD组在第7天皮肤软组织中VEGFEGF BFGF的表达量均高于对照组（P＜0.01），但MMP-9的表达无明显差异，两组比较无统计学差异（P＞0.05）。结论：实验中所建立的腹部爆炸伤合并内脏器官暴露动物模型创伤及污染较重，但致伤后生命体征较平稳，实验动物可以较长时间固定和存活，，初步证实该模型的可靠性和重复性。据实验而知，VSD早期应用于腹部爆炸创面可以有效控制创面的细菌量，减少腹腔引流液中炎性因子TNF-a,IL-1,IL-6的表达量，有利于致伤早期控制创面和腹腔感染并且减少猪腹部爆炸伤创面“间生态组织”继发坏死的可能。其次，VSD不仅使创面肿胀消退，同时促进创面生长因子表达、肉芽组织形成、缩短创面愈合时间。因此，在腹部爆炸伤创面使用VSD7天左右，以上这些因素都为二期通过手术闭合腹部爆炸伤创面提供良好的创基准备及最佳关闭腹部创面的时机。
[Abstract]:Objective: to establish an animal model of full-thickness abdominal wall defect caused by blast injury. * to explore the role of closed negative pressure drainage (BVD) in controlling the infection of abdominal cavity and wound and whether it can promote the healing of abdominal explosive wounds during the abdominal explosive injury and visceral exposure in pigs. To find out the most suitable two stage surgical closure time for abdominal explosive wound.
Methods: 12 clean and healthy miniature white pigs, each pig * * made self-made abdominal visceral protection device and 1g ultrafine Tai an explosive, and made about 1 * 4 5cm explosion wounds on the left midline of the pig. Altogether 12 explosive wounds at the same location were observed. After injury, the general situation of the animals was observed. All the experimental animals were randomly divided into experimental group (V SD group and control group (saline gauze group): experimental group (VSD group) for 6 hours after debridement and placement of pressure - 125 mmHg VSD device; control group (saline gauze group) for 6 hours after debridement and the use of saline gauze covering explosive wounds, conventional dressing change treatment. The abdominal drainage fluids of the two groups were collected at the 1st, 3rd, 5th and 7th day after injury to detect the expression of inflammatory factors such as Tumor necrosis factor-A (TNF-a), interleukin-1 (IL-1), and interleukin-6 (IL-6). The target genes, namely, vascular endothelial cell growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) and matrix metalloproteinase-9 (Matrix), were analyzed by real-time quantitative PCR in 7 days of skin and muscle soft tissue samples. Metalloproteinase-9) relative expression.
Results: All the experimental animals developed full-thickness abdominal wall defect with visceral exposure after injury. The bacterial count of the experimental animals before treatment was 107.VSD group and the control group at the first, third, fifth and seventh day after treatment (CUF/g) were (637.45 [108.27], 121.95 [30.02], 32.83 [8.52] and 1.04 [0.39] respectively. And (19306.01 + 1042.4311503.03 + 777.826280.01 + 130.112397.01 + 52.32), there was a significant difference between the two groups (P < 0.01). The concentrations of TNF- *, IL-1 and IL-6 in the abdominal drainage fluid of the pigs were not significantly different from those in the two groups (P? 0.05) after first days of treatment. The expression of VEGF EGF-BFGF in skin and soft tissue of VSD group on the 7th day was significantly higher than that of the control group (215. + 6.02 ng/L, 189.83 + 1.70 ng/L, 200.68 + 3.19 ng/L) at the same time (P < 0.001). .01), but there was no significant difference in MMP-9 expression between the two groups (P > 0.05).
CONCLUSION: The animal model of abdominal explosive injury combined with visceral organ exposure was severely injured and contaminated, but the vital signs were stable and the animal could be fixed and survived for a long time. The reliability and reproducibility of the model were preliminarily confirmed. The amount of bacteria in the wound and the expression of TNF-a, IL-1 and IL-6 in the peritoneal drainage fluid were beneficial to control the wound and abdominal cavity infection * and reduce the possibility of secondary necrosis of the "ecological tissue" in the early stage of wound injury. Secondly, VSD not only reduced the swelling of the wound, but also promoted the expression of the growth factor and granulation tissue. Therefore, the use of VSD on abdominal blast wounds for about 7 days provides good wound preparation and the best time to close the abdominal blast wounds.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R-332;R622

【参考文献】