【摘要】：目的：建立爆炸傷導(dǎo)致的全層腹壁缺損動(dòng)物模型，探討在豬腹部爆炸傷合并內(nèi)臟外露時(shí)，使用封閉負(fù)壓引流控制腹腔、創(chuàng)面感染的作用以及對(duì)腹部爆炸創(chuàng)面愈合是否有促進(jìn)作用，尋求腹部爆炸傷傷口最合適的二期手術(shù)閉合創(chuàng)面時(shí)機(jī)。 方法：12只清潔健康的小型白家豬，每只豬都采用自制腹腔內(nèi)臟防護(hù)裝置及1g超細(xì)太安炸藥，在豬左側(cè)腹部距中線處造成1個(gè)約4×5cm的爆炸傷創(chuàng)面，共計(jì)12個(gè)相同位置的爆炸傷創(chuàng)面，傷后觀察動(dòng)物大體情況。所有實(shí)驗(yàn)動(dòng)物隨機(jī)分為實(shí)驗(yàn)組（VSD組）和對(duì)照組（鹽水紗布組）：實(shí)驗(yàn)組（VSD組）為在6小時(shí)清創(chuàng)后并置入壓力為-125mmHg VSD裝置；對(duì)照組（鹽水紗布組）為在6小時(shí)清創(chuàng)后并使用鹽水紗布覆蓋爆炸創(chuàng)面，常規(guī)換藥治療。分別采集治療前第6小時(shí)和治療后第1、3、5、7天的創(chuàng)面肌肉組織進(jìn)行細(xì)菌檢測(cè)，分析兩組的細(xì)菌量；再采集兩組傷后第1、3、5、7天的腹部引流液進(jìn)行Elisa試劑盒檢測(cè)炎性因子腫瘤壞死因子-a（Tumor necrosis factor-a，TNF-a），白介素-1（Interleukin-1，IL-1）、白介素-6（Interleukin-6，IL-6）的表達(dá)量；最后采集兩組治療后第7天皮膚、肌肉軟組織標(biāo)本，用實(shí)時(shí)定量PCR分析目的基因，即血管內(nèi)皮細(xì)胞生長(zhǎng)因子（vascularendothelial cell growth factor，VEGF）、堿性成纖維細(xì)胞生長(zhǎng)因子（basic fibroblastgrowth factor，bFGF）、表皮生長(zhǎng)因子（epidermal growth factor，EGF）及金屬基質(zhì)蛋白酶-9（Matrix metalloproteinase-9）相對(duì)表達(dá)量。 結(jié)果：所有實(shí)驗(yàn)動(dòng)物在致傷后均形成傷情一致的全層腹壁缺損合并內(nèi)臟外露腹部爆炸傷動(dòng)物模型，治療前實(shí)驗(yàn)動(dòng)物的細(xì)菌量均為107。VSD組和對(duì)照組在治療后第1、3、5、7天創(chuàng)面的細(xì)菌數(shù)（CUF/g）分別為（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），兩組比較有統(tǒng)計(jì)學(xué)差異（P＜0.01）。豬腹部引流液中TNF-α，IL-1，IL-6濃度在傷后治療第1天兩組沒(méi)有顯著性差異（P㧐0.05）。腹部爆炸傷創(chuàng)面的引流液中TNF-α、IL-1、IL-6的表達(dá)量在第3、5、7天VSD組分別為(154.26±3.16ng/L、135.00±3.40ng/L、135.92±2.97ng/L)明顯低于同時(shí)間對(duì)照組(215.±6.02ng/L,189.83±1.70ng/L,200.68±3.19ng/L)，三個(gè)時(shí)間點(diǎn)兩組比較均有統(tǒng)計(jì)學(xué)上的顯著性差異（P＜0.001）。VSD組在第7天皮膚軟組織中VEGFEGF BFGF的表達(dá)量均高于對(duì)照組（P＜0.01），但MMP-9的表達(dá)無(wú)明顯差異，兩組比較無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 結(jié)論：實(shí)驗(yàn)中所建立的腹部爆炸傷合并內(nèi)臟器官暴露動(dòng)物模型創(chuàng)傷及污染較重，但致傷后生命體征較平穩(wěn)，實(shí)驗(yàn)動(dòng)物可以較長(zhǎng)時(shí)間固定和存活，，初步證實(shí)該模型的可靠性和重復(fù)性。據(jù)實(shí)驗(yàn)而知，VSD早期應(yīng)用于腹部爆炸創(chuàng)面可以有效控制創(chuàng)面的細(xì)菌量，減少腹腔引流液中炎性因子TNF-a,IL-1,IL-6的表達(dá)量，有利于致傷早期控制創(chuàng)面和腹腔感染并且減少豬腹部爆炸傷創(chuàng)面“間生態(tài)組織”繼發(fā)壞死的可能。其次，VSD不僅使創(chuàng)面腫脹消退，同時(shí)促進(jìn)創(chuàng)面生長(zhǎng)因子表達(dá)、肉芽組織形成、縮短創(chuàng)面愈合時(shí)間。因此，在腹部爆炸傷創(chuàng)面使用VSD7天左右，以上這些因素都為二期通過(guò)手術(shù)閉合腹部爆炸傷創(chuàng)面提供良好的創(chuàng)基準(zhǔn)備及最佳關(guān)閉腹部創(chuàng)面的時(shí)機(jī)。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R-332;R622

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