負壓創(chuàng)面療法聯(lián)合運用莫匹羅星溶液促進創(chuàng)面修復的臨床研究
發(fā)布時間：2018-07-14 19:23
【摘要】：目的:通過觀察負壓封閉引流技術與莫匹羅星溶液應用于創(chuàng)面修復的治療效果,研究兩者的聯(lián)合應用對改善創(chuàng)面情況的影響。方法:收集我整形燒傷科2013年6月至2014年12月因外傷、燒燙傷、感染等原因導致的四肢及軀干全層皮膚缺損的住院病例46例。所有病例均為面積大于5*5cm、無法自行愈合、需后期行植皮或者皮瓣的方法修復的創(chuàng)面。將符合條件病例隨機分成三組,聯(lián)合組、單純負壓組、單純外用莫匹羅星換藥組。聯(lián)合組以莫匹羅星溶液經負壓裝置沖洗創(chuàng)面,單純負壓組僅單純負壓吸引治療,莫匹羅星組行常規(guī)換藥并使用莫匹羅星溶液治療創(chuàng)面。在臨床觀察過程中記錄患者創(chuàng)面情況變化、創(chuàng)面面積大小改變、創(chuàng)面達到手術條件的時間,創(chuàng)面壞死組織殘留率,創(chuàng)面細菌清除率,II期手術植皮或皮瓣存活率,創(chuàng)面新鮮肉芽組織行HE鏡下及免疫組織化學染色后觀察以CD34標記的新生微血管密度(MVD),負壓治療過程中堵管等并發(fā)癥發(fā)生情況,運用SPSS軟件對部分觀察指標進行分析。結果:1、負壓治療聯(lián)合莫匹羅星溶液沖洗組(聯(lián)合組)在治療7天后肉芽組織的各項指標均優(yōu)于單純負壓治療組及莫匹羅星換藥組。三組分別于治療前后在HE染色后鏡下觀察創(chuàng)面肉芽組織情況,聯(lián)合組較之單純負壓治療組及莫匹羅星組可見炎性細胞侵潤程度較低,新生血管及成纖維細胞增生活躍,膠原纖維等細胞外基質豐富而規(guī)則。2、通過對比三組創(chuàng)面壞死組織及肉芽組織覆蓋面積的變化,聯(lián)合組在治療7天后壞死組織殘留率低于單純負壓組及莫匹羅星組,差異有統(tǒng)計學意義(p0.01)。聯(lián)合組于7天后對比其余二組在創(chuàng)面組織新生血管增生明顯,以CD34標記之MVD值在治療后高于單純負壓組及莫匹羅星組,差異有統(tǒng)計學意義(p0.05)。3、三組在創(chuàng)面達到手術條件即“創(chuàng)面清潔”標準[1]所用時間存在差異,聯(lián)合組較之單純負壓治療組及莫匹羅星組時間更短,差異有統(tǒng)計學意義(p0.05)。通過對比三組在治療前后所做創(chuàng)面組織細菌培養(yǎng)計數(shù),聯(lián)合組創(chuàng)面細菌清除率[2,3,4]高于單純負壓組及莫匹羅星組,差異有統(tǒng)計學意義(p0.05)。4、三組創(chuàng)面經治療后7天在創(chuàng)面首次植皮及皮瓣移植存活率上存在差異,聯(lián)合組高于單純負壓組及莫匹羅星組,差異有統(tǒng)計學意義(p0.05)。同時聯(lián)合組對比單純負壓組在治療中發(fā)生堵管等并發(fā)癥的發(fā)生率較低,差異有統(tǒng)計學意義(p0.05)。結論:1、負壓創(chuàng)面療法聯(lián)合莫匹羅星溶液沖洗與單純負壓治療及莫匹羅星溶液換藥治療相比,能縮短達到創(chuàng)面達到手術條件所用時間,更好地控制創(chuàng)面感染,并且能減少負壓創(chuàng)面療法并發(fā)癥的發(fā)生率。2、負壓創(chuàng)面療法聯(lián)合莫匹羅星溶液沖洗較之單純負壓治療及莫匹羅星換藥治療,能降低壞死組織殘留率,控制創(chuàng)面感染,更好地促進組織微血管的增生及創(chuàng)面肉芽組織生長,改善創(chuàng)面情況,提高II期創(chuàng)面首次植皮或皮瓣移植存活率,更加利于后期創(chuàng)面修復。
[Abstract]:Objective: to observe the effect of negative pressure sealing drainage and mupiroxine solution on wound healing and to study the effect of combined application of the two methods on the improvement of wound condition. Methods: from June 2013 to December 2014, 46 cases of full-thickness skin defects in limbs and trunk caused by trauma, burn and infection were collected. All cases were more than 5 ~ 5 cm in area and could not heal by themselves. Skin grafting or skin flap was needed to repair the wound. The eligible cases were randomly divided into three groups: combination group, negative pressure group and mupiroxine group. In the combined group, the wounds were flushed with the solution of mupiroxine, the wounds in the group of pure negative pressure were only treated by negative pressure suction, and the wounds in the group of mupiroxine were treated by routine change of medicine and treatment with the solution of mupiroxine. In the course of clinical observation, the changes of the wound condition, the size of the wound surface, the time when the wound reached the operative condition, the residual rate of necrotic tissue, the bacterial clearance rate of the wound and the survival rate of the skin graft or flap were recorded. The microvessel density (MVD) labeled by CD34 and the complications of occluding tube during the treatment of negative pressure were observed under HE microscope and immunohistochemical staining of fresh granulation tissue of the wound. Some of the observed indexes were analyzed by SPSS software. Results after 7 days of treatment, the granulation tissue indexes in the combined group treated with negative pressure therapy combined with mupiroxine solution irrigation were superior to those in the control group and the mupiroxine replacement group after 7 days of treatment. The granulation tissue of wound was observed before and after treatment with HE staining in the three groups. The degree of infiltration of inflammatory cells was lower and the proliferation of neovascularization and fibroblast was active in the combined group than that in the control group and mupiroxin group. Collagen fibers and other extracellular matrix were abundant and regular. By comparing the changes of wound necrosis tissue and granulation tissue coverage in the three groups, the residual rate of necrotic tissue in the combined group was lower than that in the negative pressure group and mupiroxin group after 7 days of treatment. The difference was statistically significant (p 0.01). After 7 days, the MVD labeled by CD34 in the combined group was significantly higher than that in the negative pressure group and mupiroxine group, compared with the other two groups, and the MVD of the combined group was higher than that of the single negative pressure group and the mupiroxine group. The difference was statistically significant (p0.05) .3.There was significant difference in the time between the three groups when the wound reached the standard of "wound cleaning", and the time in the combined group was shorter than that in the single negative pressure group and mupiroxine group (p0.05). By comparing the bacterial culture of wound tissue in the three groups before and after treatment, the bacterial clearance rate of wound in the combined group was higher than that in the negative pressure group and mupiroxin group. The difference was statistically significant (p0.05). There was significant difference in the survival rate of the first skin graft and flap graft 7 days after treatment in the three groups, and the difference was statistically significant in the combined group than in the negative pressure group and mupiroxin group (p0.05). At the same time, the incidence of complications such as catheter occlusion in the combined group was lower than that in the negative pressure group (p0.05). Conclusion compared with simple negative pressure therapy and mupiroxine solution replacement therapy, the treatment of negative pressure combined with flushing of mupiroxine solution can shorten the time to reach the operation condition and control the infection of the wound better than that of the simple negative pressure therapy and the change of medicine with mupiroxine solution. In addition, it can reduce the incidence of complications of negative pressure wound therapy. The negative pressure wound therapy combined with mupiroxine solution washing can reduce the residual rate of necrotic tissue and control the infection of the wound, compared with the simple negative pressure therapy and the change of medicine treatment of mupiroxine. It can promote the proliferation of tissue microvessels and the growth of granulation tissue, improve the condition of wound, increase the survival rate of the first time skin graft or flap transplantation of stage II wound, which is more favorable to the later wound repair.
【學位授予單位】：四川醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R64
本文編號：2122697
[Abstract]:Objective: to observe the effect of negative pressure sealing drainage and mupiroxine solution on wound healing and to study the effect of combined application of the two methods on the improvement of wound condition. Methods: from June 2013 to December 2014, 46 cases of full-thickness skin defects in limbs and trunk caused by trauma, burn and infection were collected. All cases were more than 5 ~ 5 cm in area and could not heal by themselves. Skin grafting or skin flap was needed to repair the wound. The eligible cases were randomly divided into three groups: combination group, negative pressure group and mupiroxine group. In the combined group, the wounds were flushed with the solution of mupiroxine, the wounds in the group of pure negative pressure were only treated by negative pressure suction, and the wounds in the group of mupiroxine were treated by routine change of medicine and treatment with the solution of mupiroxine. In the course of clinical observation, the changes of the wound condition, the size of the wound surface, the time when the wound reached the operative condition, the residual rate of necrotic tissue, the bacterial clearance rate of the wound and the survival rate of the skin graft or flap were recorded. The microvessel density (MVD) labeled by CD34 and the complications of occluding tube during the treatment of negative pressure were observed under HE microscope and immunohistochemical staining of fresh granulation tissue of the wound. Some of the observed indexes were analyzed by SPSS software. Results after 7 days of treatment, the granulation tissue indexes in the combined group treated with negative pressure therapy combined with mupiroxine solution irrigation were superior to those in the control group and the mupiroxine replacement group after 7 days of treatment. The granulation tissue of wound was observed before and after treatment with HE staining in the three groups. The degree of infiltration of inflammatory cells was lower and the proliferation of neovascularization and fibroblast was active in the combined group than that in the control group and mupiroxin group. Collagen fibers and other extracellular matrix were abundant and regular. By comparing the changes of wound necrosis tissue and granulation tissue coverage in the three groups, the residual rate of necrotic tissue in the combined group was lower than that in the negative pressure group and mupiroxin group after 7 days of treatment. The difference was statistically significant (p 0.01). After 7 days, the MVD labeled by CD34 in the combined group was significantly higher than that in the negative pressure group and mupiroxine group, compared with the other two groups, and the MVD of the combined group was higher than that of the single negative pressure group and the mupiroxine group. The difference was statistically significant (p0.05) .3.There was significant difference in the time between the three groups when the wound reached the standard of "wound cleaning", and the time in the combined group was shorter than that in the single negative pressure group and mupiroxine group (p0.05). By comparing the bacterial culture of wound tissue in the three groups before and after treatment, the bacterial clearance rate of wound in the combined group was higher than that in the negative pressure group and mupiroxin group. The difference was statistically significant (p0.05). There was significant difference in the survival rate of the first skin graft and flap graft 7 days after treatment in the three groups, and the difference was statistically significant in the combined group than in the negative pressure group and mupiroxin group (p0.05). At the same time, the incidence of complications such as catheter occlusion in the combined group was lower than that in the negative pressure group (p0.05). Conclusion compared with simple negative pressure therapy and mupiroxine solution replacement therapy, the treatment of negative pressure combined with flushing of mupiroxine solution can shorten the time to reach the operation condition and control the infection of the wound better than that of the simple negative pressure therapy and the change of medicine with mupiroxine solution. In addition, it can reduce the incidence of complications of negative pressure wound therapy. The negative pressure wound therapy combined with mupiroxine solution washing can reduce the residual rate of necrotic tissue and control the infection of the wound, compared with the simple negative pressure therapy and the change of medicine treatment of mupiroxine. It can promote the proliferation of tissue microvessels and the growth of granulation tissue, improve the condition of wound, increase the survival rate of the first time skin graft or flap transplantation of stage II wound, which is more favorable to the later wound repair.
【學位授予單位】：四川醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R64
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