封闭负压引流技术及其联合灌洗对肢体枪伤治疗效果的研究

发布时间：2019-02-10 19:12

【摘要】：目的：研究封闭负压引流技术(Vacuum Sealing Drainage, VSD)治疗肢体多发枪伤后血清中炎症因子的变化；探讨VSD联合灌洗治疗感染火器伤的早期疗效。方法及结果：实验分两部分：第一部分：12头猪枪击致伤双后肢,6h内彻底清创,随机分为对照组(传统方法治疗)、实验组(VSD治疗)。用ELISA法测定两组不同时间点血清中CRP和IL-6的含量,进行统计学分析。结果显示致伤前、伤后6h CRP和IL-6含量无显著性差异(P0.05)。随时间延长两组CRP和IL-6的含量均呈上升趋势。实验组与对照组的CRP和IL-6含量分别在伤后48h、24h达高峰,实验组含量明显低于对照组(P0.01)。第二部分：18头猪枪击致伤右后肢,前2天不做任何治疗以造成火器伤感染。第3天行有限清创后,随机分为对照组(常规处理)、VSD组和实验组(VSD联合灌洗治疗),每组6头。比较三组不同时间点伤道细菌计数、外周血中白细胞和内毒素含量的变化,并行常规病理学观察和伤道组织中羟脯氨酸含量的检测。结果显示：与对照组和VSD组比较,实验组伤道细菌计数、外周血白细胞和内毒素含量迅速下降(P0.01),肉芽组织中含有更多的羟脯氨酸(P0.01),病理学观察显示组织炎症反应明显减轻、组织修复快。结论：VSD治疗肢体多发枪伤可明显降低血清中炎症因子的含量,减轻全身炎症反应；采用VSD联合灌洗对感染火器伤进行早期救治,能迅速控制感染、减轻全身反应、为尽早修复重建创造良好的软组织条件。
[Abstract]:Objective: to study the changes of inflammatory factors in serum after treatment of multiple gunshot wounds in extremities by blocking negative pressure drainage technique (Vacuum Sealing Drainage, VSD) and to explore the early efficacy of VSD combined with lavage in the treatment of firearm injuries. Methods and results: the experiment was divided into two parts: the first part: 12 pigs were injured by gunshot, debridement completely within 6 hours. They were randomly divided into control group (traditional treatment) and experimental group (VSD treatment). The contents of CRP and IL-6 in serum of two groups at different time points were determined by ELISA method. The results showed that there was no significant difference in CRP and IL-6 levels before and 6 hours after injury (P0.05). The contents of CRP and IL-6 increased with time. The contents of CRP and IL-6 in the experimental group and the control group reached the peak at 48h after injury, and the content of IL-6 in the experimental group was significantly lower than that in the control group (P0.01). Part two: 18 pigs with gunshot wounds to the right hind limb without any treatment 2 days ago to cause firearm infection. After limited debridement on the 3rd day, the rats were randomly divided into control group (routine), VSD group and experimental group (VSD combined with lavage therapy), 6 heads in each group). The changes of bacterial count, leukocyte and endotoxin content in peripheral blood at different time points, routine pathological observation and hydroxyproline content in wound tissue were compared among the three groups. The results showed that compared with the control group and VSD group, the bacterial count, the contents of leukocyte and endotoxin in peripheral blood of the experimental group decreased rapidly (P0.01), and the granulation tissue contained more hydroxyproline (P0.01). Histopathological observation showed that the inflammatory reaction was obviously alleviated and the tissue was repaired quickly. Conclusion: the treatment of multiple gunshot wounds in limbs with VSD can significantly reduce the content of inflammatory factors in serum and alleviate systemic inflammatory reaction. The use of VSD combined with lavage for early treatment of infected firearm injuries can quickly control infection, reduce systemic reaction, and create good soft tissue conditions for early repair and reconstruction.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R826.68

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