富血小板血浆治疗四肢皮肤缺损的临床应用研究

发布时间：2018-12-09 07:54

【摘要】：目的:研究富血小板血浆(platelet-rich plasma,PRP)在治疗四肢皮肤缺损中的治疗特点,得出最适宜老年病人且合并心肺疾病无法进行手术治疗四肢皮肤缺损的治疗方式。方法:将四肢皮肤缺损的病例按照皮肤缺损面积的大小进行分组,实验组分别设定为面积8cm2组(A组)、12cm2组(B组),每组15例,其中车祸伤导致皮肤缺损16例,高处坠落伤致皮肤缺损14例,对照组选取皮肤缺损面积8cm2组(C组)、12cm2组(D组),每组15例,其中车祸伤导致皮肤缺损18例,高处坠落伤致皮肤缺损12例,所有病例纳入标准需排除:1)血液系统疾病2)糖尿病3)全身感染4)伤口感染。四组患者一般情况(根据入选及排除标准)比较无统计学意义(P0.05)。实验组通过抽取肘部外周静脉血制备PRP,具体方法为于患者肘部取外周静脉血50ml,经3500转/分离心10min,去除底层红细胞,将其剩余20ml再次以3700转/分离心10min,离心浓缩为10ml,制备成PRP,将制备好的PRP放于缺损的皮肤处,表面放置可吸收止血纱,7天后去除残存止血纱及血痂壳,14天后逐渐去除血痂壳,观察创面愈合情况。对照组采用常规伤口清洗、消毒,用重组人表皮生长因子凝胶覆盖皮肤缺损处,在第7天和第14天时观察皮肤缺损面积变化情况。在治疗过程中记录两组患者皮肤缺损面积变化情况,另在治疗前、治疗时第7天、14天静脉采血,分析血常规白细胞总数、血沉数据,并同时送伤口分泌物送检,记录回示结果。结果:(1)A组、B组在第7天观察创面,见各组皮肤缺损处结痂,创面无渗出,由边缘向中心去除部分痂壳,痂下表皮红润,其中A组面积缩小约1/2,B组面积缩小约1/3。C、D组在第7天时伤口进行换药,见创面边缘少许表皮生长,肉芽组织红润,C组面积缩小约1/5,D组面积缩小约1/6,A、B组在第7天时经过PRP治疗后面积较C、D组经过重组人表皮生长因子治疗后面积缩小明显,各组之间差异明显(P0.05)。(2)A组、B组、C组、D组病例在第14天观察创面,A组去除剩余痂壳,创面愈合良好,大部份表皮生长红润,伤口愈合情况较好,B组见创面明显缩小,约3.0-3.6cm2皮肤缺损未愈合,表皮周围肉芽组织红润,C组创面缩小约2.0cm2,创面未愈合,创面少许渗液,D组创面缩小约2.4cm2,创面未愈合,表皮周围肉芽组织红润,创面少许渗液。A、B、C、D组在第14天时经过治疗后皮肤缺损面积变化明显,各组之间差异明显(P0.05)。(3)A、B、C、D四组患者一般资料(年龄、性别、皮肤缺损部位)比较无统计学差异(P0.05)。结论(1)PRP治疗8cm2、12cm2四肢皮肤缺损面积时较重组人表皮生长因子凝胶治疗8cm2、12cm2四肢皮肤缺损面积时具有较好的优势。(2)PRP在治疗皮肤缺损合并高龄、呼吸系统疾病的患者时,能够促进创面早期愈合,缩短住院时间,减少卧床并发症,减轻经济负担。
[Abstract]:Objective: to study the characteristics of platelet-rich plasma (platelet-rich plasma,PRP) in the treatment of skin defects in extremities, and to find out the most suitable treatment for skin defects of extremities in elderly patients and complicated with cardiopulmonary diseases. Methods: according to the size of skin defect, the patients were divided into two groups: 8cm2 group (group A) and 12cm2 group (group B). There were 15 cases in each group. There were 14 cases of skin defect caused by falling injury from high places. In control group, 15 cases were skin defect caused by 8cm2 group (group C) and 15 cases by 12cm2 group (group D), including 18 cases of skin defect caused by accident injury and 12 cases of skin defect caused by falling injury. All cases should be excluded from the criteria: 1) hematological diseases 2) diabetes mellitus 3) systemic infection 4) wound infection. The general condition of the four groups (according to the criteria of inclusion and exclusion) was not statistically significant (P0.05). In the experimental group, the PRP, was prepared by extracting the peripheral venous blood of the elbow. The blood of the peripheral vein was taken from the elbow of the patient. The blood was collected from the peripheral vein of the patient by 3500 rpm / 10 min, the bottom red blood cells were removed, and the remaining 20ml was concentrated into 10ml at 3700 rpm / 10min again. The prepared PRP was prepared by PRP, and placed on the skin of the defect. The absorbable hemostatic yarn was placed on the surface. After 7 days, the residual hemostatic yarn and the blood crusts were removed. After 14 days, the blood crusts were gradually removed to observe the healing of the wounds. In the control group, the skin defect was covered with recombinant human epidermal growth factor gel. The area of skin defect was observed on the 7th and 14th day. In the course of treatment, the changes of skin defect area were recorded in the two groups. Venous blood was collected before treatment, on the 7th day and on the 14th day after treatment. The total number of white blood cells (WBC), erythrocyte sedimentation rate (ESR) data were analyzed, and the wound secretion was sent for examination at the same time. Record the results of the review. Results: (1) in group A and group B, the wound was observed on the 7th day. There was no exudation in the skin defect in each group, and part of the crust was removed from the edge to the center, and the skin was ruddy under the callus, in which the area of group A was reduced by about 1 / 2. The area of group B was reduced by about 1 / 3. The area of group D was changed on the 7th day, and a little epidermis was found on the edge of the wound, the granulation tissue was ruddy, and the area of group C was reduced by about 1 / 5%, and the area of group D was reduced by about 1 / 6 A. On the 7th day, the area of group B after PRP treatment was significantly smaller than that of group C D treated with recombinant human epidermal growth factor (P0.05). (2). The wounds of group D were observed on the 14th day. The wounds in group A healed well, most of the epidermis grew ruddy, and the wound healed well. In group B, the wound was obviously reduced, and the skin defect of 3.0-3.6cm2 was not healed. The granulation tissue around the epidermis was ruddy. In group C, the wound was reduced about 2.0 cm ~ 2, the wound was not healed, the wound surface was slightly exudate, the wound in group D was reduced about 2.4 cm ~ 2, the wound was not healed, the granulation tissue around the epidermis was ruddy, the wound surface was a little effusion. On the 14th day after treatment, the area of skin defect in group D changed significantly (P0.05). (3). The general data (age, sex) of four groups of patients (age, sex) were significantly different from those in group D (P0.05). There was no statistical difference in the skin defect (P0.05). Conclusion (1) PRP is superior to recombinant human epidermal growth factor gel in the treatment of skin defect in extremities of 8 cm ~ 2 ~ (12) cm ~ 2. (2) PRP is an effective method in treating skin defects in elderly patients with respiratory diseases. It can promote the early healing of wound, shorten the hospitalization time, reduce the complications of bed rest and reduce the economic burden.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R658

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