發(fā)布時(shí)間：2018-08-04 19:14

【摘要】：目的探討自體富血小板血漿凝膠(APG)局部應(yīng)用治療燒傷殘余創(chuàng)面的臨床療效。方法選取在甘肅省人民醫(yī)院2015年3月—2016年9月期間住院治療的燒傷殘余創(chuàng)面患者,將符合入組標(biāo)準(zhǔn)的60例患者隨機(jī)分為兩組,每組30人。兩組患者創(chuàng)面經(jīng)過常規(guī)處理后,治療組使用自體富血小板血漿凝膠(APG)涂抹創(chuàng)面,對照組使用凝膠基質(zhì)成分涂抹創(chuàng)面,外面均使用無菌透明膜粘貼后固定,創(chuàng)面隔日換藥一次。分別記錄兩組第一次換藥后6d、12d肉芽組織成熟程度、創(chuàng)面愈合時(shí)間,觀察比較不同時(shí)間點(diǎn)兩組創(chuàng)面愈合率、創(chuàng)面細(xì)菌陽性培養(yǎng)率及測定不同時(shí)間點(diǎn)創(chuàng)面組織中表皮生長因子、成纖維細(xì)胞生長因子水平。并對患者治療前后血尿常規(guī)、肝腎功能進(jìn)行檢測。結(jié)果使用SPSS17.0軟件進(jìn)行數(shù)據(jù)處理和統(tǒng)計(jì)分析,其結(jié)果:治療組在第一次換藥后6d、12d肉芽組織成熟程度明顯高于對照組(P0.01)。治療組創(chuàng)面愈合時(shí)間(20.6±6.3)d少于對照組(28.5±7.8)d,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。不同時(shí)間點(diǎn)創(chuàng)面愈合率比較:第一次換藥后6d創(chuàng)面愈合率,治療組(16.17±5.01)%較對照組(14.16±5.5)%差異無統(tǒng)計(jì)學(xué)意義(P0.05);第一次換藥后12d創(chuàng)面愈合率,治療組(41.06±22.44)%較對照組(29.01±19.03)%差異具有統(tǒng)計(jì)學(xué)意義(P0.05);第一次換藥后18d創(chuàng)面愈合率,治療組(71.74±24.04)%較對照組(52.82±29.56)%差異具有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。第一次換藥后18天,兩組創(chuàng)面細(xì)菌感染率有統(tǒng)計(jì)學(xué)意義(P0.05)。第一次換藥后6d、12d治療組創(chuàng)面組織中表皮生長因子、成纖維細(xì)胞生長因子水平明顯高于對照組(P0.05)。治療過程中治療組患者無局部或全身不適反應(yīng),相關(guān)實(shí)驗(yàn)室檢查未見明顯異常。結(jié)論自體富血小板血漿凝膠(APG)治療燒傷殘余創(chuàng)面臨床療效顯著,可以增加創(chuàng)面局部生長因子水平,明顯促進(jìn)肉芽組織生長,加速創(chuàng)面愈合,有效縮短愈合時(shí)間,具有較好的安全性,在抑菌抗感染方面也起到一定的作用。
[Abstract]:Objective to investigate the clinical effect of autogenous platelet-rich plasma gel (APG) in treating residual burn wounds. Methods 60 patients with residual burn wounds who were hospitalized in Gansu Provincial people's Hospital from March 2015 to September 2016 were randomly divided into two groups with 30 patients in each group. After routine treatment, the patients in the treatment group were smeared with autologous platelet-rich plasma gel (APG), the control group was smeared with gel matrix component, the external surface was fixed with aseptic hyaline membrane, and the wound was changed once every other day. The granulation tissue maturation and wound healing time were recorded 6 days after the first dressing change in both groups. The wound healing rate, bacterial positive culture rate and epidermal growth factor (EGF) in wound tissue at different time points were observed and compared. Fibroblast growth factor level. The blood and urine routine, liver and kidney function were measured before and after treatment. Results SPSS17.0 software was used for data processing and statistical analysis. The results showed that the mature degree of granulation tissue in the treatment group was significantly higher than that in the control group at 6 days after the first dressing change (P0.01). The wound healing time in the treatment group (20.6 鹵6.3) days was significantly lower than that in the control group (28.5 鹵7.8) days (P0.01). Comparison of wound healing rate at different time points: the wound healing rate of the treatment group (16.17 鹵5.01)% was not significantly different from that of the control group (14.16 鹵5.5)% on the 6th day after the first dressing change (P0.05), and the wound healing rate was 12 days after the first change of dressing. (41.06 鹵22.44)% in the treatment group and (29.01 鹵19.03)% in the control group (P0.05), and the wound healing rate in the treatment group (71.74 鹵24.04)% was significantly higher than that in the control group (52.82 鹵29.56)% (P0.01). The infection rate of wound bacteria in the two groups was statistically significant 18 days after the first dressing change (P0.05). The levels of epidermal growth factor (EGF) and fibroblast growth factor (FGF) in the wound tissue of the treatment group were significantly higher than those in the control group (P0.05). In the treatment group, there was no local or systemic discomfort, and there was no obvious abnormality in laboratory examination. Conclusion Autologous platelet-rich plasma gel (APG) is effective in treating residual burn wounds. It can increase the level of local growth factor, promote the growth of granulation tissue, accelerate wound healing and shorten the healing time. It has good safety and plays a certain role in bacteriostasis and infection.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R644

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