负压创面疗法联合运用莫匹罗星溶液促进创面修复的临床研究
发布时间：2018-07-14 19:23
【摘要】：目的:通过观察负压封闭引流技术与莫匹罗星溶液应用于创面修复的治疗效果,研究两者的联合应用对改善创面情况的影响。方法:收集我整形烧伤科2013年6月至2014年12月因外伤、烧烫伤、感染等原因导致的四肢及躯干全层皮肤缺损的住院病例46例。所有病例均为面积大于5*5cm、无法自行愈合、需后期行植皮或者皮瓣的方法修复的创面。将符合条件病例随机分成三组,联合组、单纯负压组、单纯外用莫匹罗星换药组。联合组以莫匹罗星溶液经负压装置冲洗创面,单纯负压组仅单纯负压吸引治疗,莫匹罗星组行常规换药并使用莫匹罗星溶液治疗创面。在临床观察过程中记录患者创面情况变化、创面面积大小改变、创面达到手术条件的时间,创面坏死组织残留率,创面细菌清除率,II期手术植皮或皮瓣存活率,创面新鲜肉芽组织行HE镜下及免疫组织化学染色后观察以CD34标记的新生微血管密度(MVD),负压治疗过程中堵管等并发症发生情况,运用SPSS软件对部分观察指标进行分析。结果:1、负压治疗联合莫匹罗星溶液冲洗组(联合组)在治疗7天后肉芽组织的各项指标均优于单纯负压治疗组及莫匹罗星换药组。三组分别于治疗前后在HE染色后镜下观察创面肉芽组织情况,联合组较之单纯负压治疗组及莫匹罗星组可见炎性细胞侵润程度较低,新生血管及成纤维细胞增生活跃,胶原纤维等细胞外基质丰富而规则。2、通过对比三组创面坏死组织及肉芽组织覆盖面积的变化,联合组在治疗7天后坏死组织残留率低于单纯负压组及莫匹罗星组,差异有统计学意义(p0.01)。联合组于7天后对比其余二组在创面组织新生血管增生明显,以CD34标记之MVD值在治疗后高于单纯负压组及莫匹罗星组,差异有统计学意义(p0.05)。3、三组在创面达到手术条件即“创面清洁”标准[1]所用时间存在差异,联合组较之单纯负压治疗组及莫匹罗星组时间更短,差异有统计学意义(p0.05)。通过对比三组在治疗前后所做创面组织细菌培养计数,联合组创面细菌清除率[2,3,4]高于单纯负压组及莫匹罗星组,差异有统计学意义(p0.05)。4、三组创面经治疗后7天在创面首次植皮及皮瓣移植存活率上存在差异,联合组高于单纯负压组及莫匹罗星组,差异有统计学意义(p0.05)。同时联合组对比单纯负压组在治疗中发生堵管等并发症的发生率较低,差异有统计学意义(p0.05)。结论:1、负压创面疗法联合莫匹罗星溶液冲洗与单纯负压治疗及莫匹罗星溶液换药治疗相比,能缩短达到创面达到手术条件所用时间,更好地控制创面感染,并且能减少负压创面疗法并发症的发生率。2、负压创面疗法联合莫匹罗星溶液冲洗较之单纯负压治疗及莫匹罗星换药治疗,能降低坏死组织残留率,控制创面感染,更好地促进组织微血管的增生及创面肉芽组织生长,改善创面情况,提高II期创面首次植皮或皮瓣移植存活率,更加利于后期创面修复。
[Abstract]:Objective: to observe the effect of negative pressure sealing drainage and mupiroxine solution on wound healing and to study the effect of combined application of the two methods on the improvement of wound condition. Methods: from June 2013 to December 2014, 46 cases of full-thickness skin defects in limbs and trunk caused by trauma, burn and infection were collected. All cases were more than 5 ~ 5 cm in area and could not heal by themselves. Skin grafting or skin flap was needed to repair the wound. The eligible cases were randomly divided into three groups: combination group, negative pressure group and mupiroxine group. In the combined group, the wounds were flushed with the solution of mupiroxine, the wounds in the group of pure negative pressure were only treated by negative pressure suction, and the wounds in the group of mupiroxine were treated by routine change of medicine and treatment with the solution of mupiroxine. In the course of clinical observation, the changes of the wound condition, the size of the wound surface, the time when the wound reached the operative condition, the residual rate of necrotic tissue, the bacterial clearance rate of the wound and the survival rate of the skin graft or flap were recorded. The microvessel density (MVD) labeled by CD34 and the complications of occluding tube during the treatment of negative pressure were observed under HE microscope and immunohistochemical staining of fresh granulation tissue of the wound. Some of the observed indexes were analyzed by SPSS software. Results after 7 days of treatment, the granulation tissue indexes in the combined group treated with negative pressure therapy combined with mupiroxine solution irrigation were superior to those in the control group and the mupiroxine replacement group after 7 days of treatment. The granulation tissue of wound was observed before and after treatment with HE staining in the three groups. The degree of infiltration of inflammatory cells was lower and the proliferation of neovascularization and fibroblast was active in the combined group than that in the control group and mupiroxin group. Collagen fibers and other extracellular matrix were abundant and regular. By comparing the changes of wound necrosis tissue and granulation tissue coverage in the three groups, the residual rate of necrotic tissue in the combined group was lower than that in the negative pressure group and mupiroxin group after 7 days of treatment. The difference was statistically significant (p 0.01). After 7 days, the MVD labeled by CD34 in the combined group was significantly higher than that in the negative pressure group and mupiroxine group, compared with the other two groups, and the MVD of the combined group was higher than that of the single negative pressure group and the mupiroxine group. The difference was statistically significant (p0.05) .3.There was significant difference in the time between the three groups when the wound reached the standard of "wound cleaning", and the time in the combined group was shorter than that in the single negative pressure group and mupiroxine group (p0.05). By comparing the bacterial culture of wound tissue in the three groups before and after treatment, the bacterial clearance rate of wound in the combined group was higher than that in the negative pressure group and mupiroxin group. The difference was statistically significant (p0.05). There was significant difference in the survival rate of the first skin graft and flap graft 7 days after treatment in the three groups, and the difference was statistically significant in the combined group than in the negative pressure group and mupiroxin group (p0.05). At the same time, the incidence of complications such as catheter occlusion in the combined group was lower than that in the negative pressure group (p0.05). Conclusion compared with simple negative pressure therapy and mupiroxine solution replacement therapy, the treatment of negative pressure combined with flushing of mupiroxine solution can shorten the time to reach the operation condition and control the infection of the wound better than that of the simple negative pressure therapy and the change of medicine with mupiroxine solution. In addition, it can reduce the incidence of complications of negative pressure wound therapy. The negative pressure wound therapy combined with mupiroxine solution washing can reduce the residual rate of necrotic tissue and control the infection of the wound, compared with the simple negative pressure therapy and the change of medicine treatment of mupiroxine. It can promote the proliferation of tissue microvessels and the growth of granulation tissue, improve the condition of wound, increase the survival rate of the first time skin graft or flap transplantation of stage II wound, which is more favorable to the later wound repair.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R64
本文编号：2122697
[Abstract]:Objective: to observe the effect of negative pressure sealing drainage and mupiroxine solution on wound healing and to study the effect of combined application of the two methods on the improvement of wound condition. Methods: from June 2013 to December 2014, 46 cases of full-thickness skin defects in limbs and trunk caused by trauma, burn and infection were collected. All cases were more than 5 ~ 5 cm in area and could not heal by themselves. Skin grafting or skin flap was needed to repair the wound. The eligible cases were randomly divided into three groups: combination group, negative pressure group and mupiroxine group. In the combined group, the wounds were flushed with the solution of mupiroxine, the wounds in the group of pure negative pressure were only treated by negative pressure suction, and the wounds in the group of mupiroxine were treated by routine change of medicine and treatment with the solution of mupiroxine. In the course of clinical observation, the changes of the wound condition, the size of the wound surface, the time when the wound reached the operative condition, the residual rate of necrotic tissue, the bacterial clearance rate of the wound and the survival rate of the skin graft or flap were recorded. The microvessel density (MVD) labeled by CD34 and the complications of occluding tube during the treatment of negative pressure were observed under HE microscope and immunohistochemical staining of fresh granulation tissue of the wound. Some of the observed indexes were analyzed by SPSS software. Results after 7 days of treatment, the granulation tissue indexes in the combined group treated with negative pressure therapy combined with mupiroxine solution irrigation were superior to those in the control group and the mupiroxine replacement group after 7 days of treatment. The granulation tissue of wound was observed before and after treatment with HE staining in the three groups. The degree of infiltration of inflammatory cells was lower and the proliferation of neovascularization and fibroblast was active in the combined group than that in the control group and mupiroxin group. Collagen fibers and other extracellular matrix were abundant and regular. By comparing the changes of wound necrosis tissue and granulation tissue coverage in the three groups, the residual rate of necrotic tissue in the combined group was lower than that in the negative pressure group and mupiroxin group after 7 days of treatment. The difference was statistically significant (p 0.01). After 7 days, the MVD labeled by CD34 in the combined group was significantly higher than that in the negative pressure group and mupiroxine group, compared with the other two groups, and the MVD of the combined group was higher than that of the single negative pressure group and the mupiroxine group. The difference was statistically significant (p0.05) .3.There was significant difference in the time between the three groups when the wound reached the standard of "wound cleaning", and the time in the combined group was shorter than that in the single negative pressure group and mupiroxine group (p0.05). By comparing the bacterial culture of wound tissue in the three groups before and after treatment, the bacterial clearance rate of wound in the combined group was higher than that in the negative pressure group and mupiroxin group. The difference was statistically significant (p0.05). There was significant difference in the survival rate of the first skin graft and flap graft 7 days after treatment in the three groups, and the difference was statistically significant in the combined group than in the negative pressure group and mupiroxin group (p0.05). At the same time, the incidence of complications such as catheter occlusion in the combined group was lower than that in the negative pressure group (p0.05). Conclusion compared with simple negative pressure therapy and mupiroxine solution replacement therapy, the treatment of negative pressure combined with flushing of mupiroxine solution can shorten the time to reach the operation condition and control the infection of the wound better than that of the simple negative pressure therapy and the change of medicine with mupiroxine solution. In addition, it can reduce the incidence of complications of negative pressure wound therapy. The negative pressure wound therapy combined with mupiroxine solution washing can reduce the residual rate of necrotic tissue and control the infection of the wound, compared with the simple negative pressure therapy and the change of medicine treatment of mupiroxine. It can promote the proliferation of tissue microvessels and the growth of granulation tissue, improve the condition of wound, increase the survival rate of the first time skin graft or flap transplantation of stage II wound, which is more favorable to the later wound repair.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R64
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