【摘要】：目的:通過中西藥創(chuàng)面局部聯(lián)合用藥對大鼠體表瘺模型術(shù)后創(chuàng)面影響的實驗研究,是為了將此方法運用于臨床,促進高位復雜性肛瘺患者術(shù)后創(chuàng)面的愈合。方法:通過埋置彈簧紗條,制作大鼠體表瘺模型。成功建立大鼠體表瘺術(shù)后模型后,隨機分為A組(空白對照生理鹽水組)、B組(阿米卡星洗劑組)、C組(龍血竭組)及D組(龍血竭+阿米卡星洗劑組)各20只,單籠飼養(yǎng)。各組大鼠創(chuàng)面分別、同時于造模成功術(shù)后第二天開始予以相對應的治療換藥,1次/日。分別于造模成功術(shù)后第3天、第7天、第14天每組隨機選取5只大鼠創(chuàng)面,采用HE染色方法觀察大鼠創(chuàng)面組織的炎癥變化情況,采用Masson三色染色觀察大鼠創(chuàng)面肉芽組織中膠原纖維增生情況,采用CD34染色觀察大鼠創(chuàng)面肉芽組織中新生血管數(shù)量;余下各組大鼠分別記錄創(chuàng)面完全愈合即創(chuàng)面達上皮化的時間和創(chuàng)面愈合率。結(jié)果:(1)創(chuàng)面愈合率,分別對比不同觀察時間各組大鼠創(chuàng)面平均愈合率,D組與A組、B組、C組相比,均得到P0.05;(2)HE染色法分別觀察創(chuàng)面術(shù)后第3天炎癥反應情況,D組較A組、B組、C組炎癥反應較輕,有一定量的新生血管和成纖維細胞及纖維組織增生;術(shù)后第7天D組較A組、B組、C組可見大量新生血管增生,成纖維細胞數(shù)量較多;術(shù)后第14天可見少量炎性細胞浸潤,成纖維細胞數(shù)量較多,纖維組織面積擴大,創(chuàng)面處可見結(jié)痂。(3)Masson三色染色法觀察不同觀察時間創(chuàng)面膠原纖維數(shù)量,術(shù)后第3天,D組、B組與A組相比,P0.05;術(shù)后第7天,D組、B組及C組與A組相比,P0.05,D組、C組與B組相比,P0.05,D組與C組相比,P0.05;術(shù)后第14天,D組與A組、B組、C組相比,P0.05。(4)CD34染色法分別檢測不同觀察時間點創(chuàng)面新生血管數(shù)量,術(shù)后第3天,D組、B組及C組與A組相比,P0.05,D組、C組與B組相比,P0.05;術(shù)后第7天,D組、B組及C組與A組相比,P0.05,D組、C組與B組相比,P0.05,D組與C組相比,P0.05;術(shù)后第14天,D組、B組及C組與A組相比,P0.05,D組與B組相比,P0.05。(5)愈合時間,D組與A組、B組級C組相比,P0.05。結(jié)論:龍血竭聯(lián)合阿米卡星洗劑局部外用于感染創(chuàng)面組織有利于促進傷口愈合,縮短創(chuàng)面愈合的時間。其作用機理可能與血竭中黃酮類有效成分能促進成纖維細胞增殖,從而增加膠原纖維的合成有關(guān);同時,血竭中多酚類有效成分具有抗炎、殺菌等一定的作用,對感染創(chuàng)面炎癥的消退有促進作用。聯(lián)合阿米卡星洗劑的運用,加大了對感染創(chuàng)面組織抗感染能力,減輕創(chuàng)面炎癥反應,為新生肉芽組織增生提供良好的增生環(huán)境。故二者聯(lián)合局部外用于高位復雜性肛瘺術(shù)后創(chuàng)面,減少了創(chuàng)面分泌物,提高了創(chuàng)面愈合率,明顯縮短了創(chuàng)面愈合的時間,并能一定程度減少術(shù)后復發(fā),是完全可行的。
[Abstract]:Objective: to study the effect of local combined use of traditional Chinese and western medicine on the wound surface of rats after operation in order to apply this method to clinical practice and promote the wound healing of patients with high complex anal fistula. Methods: the rat model of surface fistula was made by embedding spring gauze. After successful establishment of the model after operation, the rats were randomly divided into two groups: group A (control saline group), group B (amikacin lotion group), group C (Dragon's blood solution group) and group D (Armikacin lotion group). The wounds of each group were treated with the corresponding treatment and dressing change once a day after successful operation. On the 3rd, 7th and 14th day after successful operation, 5 rats in each group were randomly selected, and the inflammatory changes of the wound tissue were observed by HE staining. The proliferation of collagen fibers in granulation tissue was observed by Masson staining and the number of neovascularization in granulation tissue was observed by CD34 staining. The time of complete wound healing and wound healing rate were recorded. Results: (1) the average wound healing rate of each group was compared with that of group A and B, respectively. (2) the inflammatory reaction in group D was lighter than that in group A and B on the 3rd day after operation, and there were a certain amount of neovascularization, fibroblast and fibrous tissue proliferation. On the 7th day after operation, a large number of neovascularization and fibroblasts were observed in group D as compared with those in group A and B, and a small number of inflammatory cells were observed in group D on the 14th day after operation, the number of fibroblasts was more and the area of fibrous tissue was enlarged. (3) Masson trichrome staining method was used to observe the number of collagen fibers in wound at different observation time. On the 3rd day after operation, group D and group A were compared with group A (P 0.05); group D (group D) and group C (group C) were compared with group A (P 0.05) on the 7th day after operation; group C (group C) was compared with group B (group B) compared with group C (P 0.05); group D (group D) was compared with group C (group C) by P0.05 (P 0.05); group D (group D) was compared with group A (group C) by CD34 staining on the 14th day after operation. Do not detect the number of neovascularization at different observation time points, On the 3rd day after operation, group B and group C were compared with group A and group A, group C and group B were compared with group B, and group B and group C were compared with group A on the 7th day after operation (P 0.05D and group C compared with group A; P 0.05D vs group C; P 0.05D vs group C; 14 days after operation). (5) the healing time of group D was higher than that of group A (P 0.05), and that of group B (group C) was higher than that of group B (P 0.05), and that of group C (group C) was higher than that of group B (P < 0.05). Conclusion: the combination of Dragon's Blood and Amikacin lotion can promote wound healing and shorten wound healing time. The mechanism may be related to the effect of flavonoids on fibroblast proliferation and collagen synthesis, and the anti-inflammatory and bactericidal effects of polyphenols. It can promote the subsiding of infection wound inflammation. Combined with Amikacin lotion, the anti-infection ability of infected wound tissue was increased, the inflammatory reaction of wound was alleviated, and a good proliferative environment was provided for the proliferation of neonate granulation tissue. Therefore, it is feasible to combine the two methods to reduce wound secretion, improve wound healing rate, shorten wound healing time and reduce postoperative recurrence to a certain extent.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.16;R-332

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