【摘要】：目的:研究富血小板血漿(platelet-rich plasma,PRP)在治療四肢皮膚缺損中的治療特點,得出最適宜老年病人且合并心肺疾病無法進行手術(shù)治療四肢皮膚缺損的治療方式。方法:將四肢皮膚缺損的病例按照皮膚缺損面積的大小進行分組,實驗組分別設(shè)定為面積8cm2組(A組)、12cm2組(B組),每組15例,其中車禍傷導(dǎo)致皮膚缺損16例,高處墜落傷致皮膚缺損14例,對照組選取皮膚缺損面積8cm2組(C組)、12cm2組(D組),每組15例,其中車禍傷導(dǎo)致皮膚缺損18例,高處墜落傷致皮膚缺損12例,所有病例納入標(biāo)準(zhǔn)需排除:1)血液系統(tǒng)疾病2)糖尿病3)全身感染4)傷口感染。四組患者一般情況(根據(jù)入選及排除標(biāo)準(zhǔn))比較無統(tǒng)計學(xué)意義(P0.05)。實驗組通過抽取肘部外周靜脈血制備PRP,具體方法為于患者肘部取外周靜脈血50ml,經(jīng)3500轉(zhuǎn)/分離心10min,去除底層紅細胞,將其剩余20ml再次以3700轉(zhuǎn)/分離心10min,離心濃縮為10ml,制備成PRP,將制備好的PRP放于缺損的皮膚處,表面放置可吸收止血紗,7天后去除殘存止血紗及血痂殼,14天后逐漸去除血痂殼,觀察創(chuàng)面愈合情況。對照組采用常規(guī)傷口清洗、消毒,用重組人表皮生長因子凝膠覆蓋皮膚缺損處,在第7天和第14天時觀察皮膚缺損面積變化情況。在治療過程中記錄兩組患者皮膚缺損面積變化情況,另在治療前、治療時第7天、14天靜脈采血,分析血常規(guī)白細胞總數(shù)、血沉數(shù)據(jù),并同時送傷口分泌物送檢,記錄回示結(jié)果。結(jié)果:(1)A組、B組在第7天觀察創(chuàng)面,見各組皮膚缺損處結(jié)痂,創(chuàng)面無滲出,由邊緣向中心去除部分痂殼,痂下表皮紅潤,其中A組面積縮小約1/2,B組面積縮小約1/3。C、D組在第7天時傷口進行換藥,見創(chuàng)面邊緣少許表皮生長,肉芽組織紅潤,C組面積縮小約1/5,D組面積縮小約1/6,A、B組在第7天時經(jīng)過PRP治療后面積較C、D組經(jīng)過重組人表皮生長因子治療后面積縮小明顯,各組之間差異明顯(P0.05)。(2)A組、B組、C組、D組病例在第14天觀察創(chuàng)面,A組去除剩余痂殼,創(chuàng)面愈合良好,大部份表皮生長紅潤,傷口愈合情況較好,B組見創(chuàng)面明顯縮小,約3.0-3.6cm2皮膚缺損未愈合,表皮周圍肉芽組織紅潤,C組創(chuàng)面縮小約2.0cm2,創(chuàng)面未愈合,創(chuàng)面少許滲液,D組創(chuàng)面縮小約2.4cm2,創(chuàng)面未愈合,表皮周圍肉芽組織紅潤,創(chuàng)面少許滲液。A、B、C、D組在第14天時經(jīng)過治療后皮膚缺損面積變化明顯,各組之間差異明顯(P0.05)。(3)A、B、C、D四組患者一般資料(年齡、性別、皮膚缺損部位)比較無統(tǒng)計學(xué)差異(P0.05)。結(jié)論(1)PRP治療8cm2、12cm2四肢皮膚缺損面積時較重組人表皮生長因子凝膠治療8cm2、12cm2四肢皮膚缺損面積時具有較好的優(yōu)勢。(2)PRP在治療皮膚缺損合并高齡、呼吸系統(tǒng)疾病的患者時,能夠促進創(chuàng)面早期愈合,縮短住院時間,減少臥床并發(fā)癥,減輕經(jīng)濟負擔(dān)。
[Abstract]:Objective: to study the characteristics of platelet-rich plasma (platelet-rich plasma,PRP) in the treatment of skin defects in extremities, and to find out the most suitable treatment for skin defects of extremities in elderly patients and complicated with cardiopulmonary diseases. Methods: according to the size of skin defect, the patients were divided into two groups: 8cm2 group (group A) and 12cm2 group (group B). There were 15 cases in each group. There were 14 cases of skin defect caused by falling injury from high places. In control group, 15 cases were skin defect caused by 8cm2 group (group C) and 15 cases by 12cm2 group (group D), including 18 cases of skin defect caused by accident injury and 12 cases of skin defect caused by falling injury. All cases should be excluded from the criteria: 1) hematological diseases 2) diabetes mellitus 3) systemic infection 4) wound infection. The general condition of the four groups (according to the criteria of inclusion and exclusion) was not statistically significant (P0.05). In the experimental group, the PRP, was prepared by extracting the peripheral venous blood of the elbow. The blood of the peripheral vein was taken from the elbow of the patient. The blood was collected from the peripheral vein of the patient by 3500 rpm / 10 min, the bottom red blood cells were removed, and the remaining 20ml was concentrated into 10ml at 3700 rpm / 10min again. The prepared PRP was prepared by PRP, and placed on the skin of the defect. The absorbable hemostatic yarn was placed on the surface. After 7 days, the residual hemostatic yarn and the blood crusts were removed. After 14 days, the blood crusts were gradually removed to observe the healing of the wounds. In the control group, the skin defect was covered with recombinant human epidermal growth factor gel. The area of skin defect was observed on the 7th and 14th day. In the course of treatment, the changes of skin defect area were recorded in the two groups. Venous blood was collected before treatment, on the 7th day and on the 14th day after treatment. The total number of white blood cells (WBC), erythrocyte sedimentation rate (ESR) data were analyzed, and the wound secretion was sent for examination at the same time. Record the results of the review. Results: (1) in group A and group B, the wound was observed on the 7th day. There was no exudation in the skin defect in each group, and part of the crust was removed from the edge to the center, and the skin was ruddy under the callus, in which the area of group A was reduced by about 1 / 2. The area of group B was reduced by about 1 / 3. The area of group D was changed on the 7th day, and a little epidermis was found on the edge of the wound, the granulation tissue was ruddy, and the area of group C was reduced by about 1 / 5%, and the area of group D was reduced by about 1 / 6 A. On the 7th day, the area of group B after PRP treatment was significantly smaller than that of group C D treated with recombinant human epidermal growth factor (P0.05). (2). The wounds of group D were observed on the 14th day. The wounds in group A healed well, most of the epidermis grew ruddy, and the wound healed well. In group B, the wound was obviously reduced, and the skin defect of 3.0-3.6cm2 was not healed. The granulation tissue around the epidermis was ruddy. In group C, the wound was reduced about 2.0 cm ~ 2, the wound was not healed, the wound surface was slightly exudate, the wound in group D was reduced about 2.4 cm ~ 2, the wound was not healed, the granulation tissue around the epidermis was ruddy, the wound surface was a little effusion. On the 14th day after treatment, the area of skin defect in group D changed significantly (P0.05). (3). The general data (age, sex) of four groups of patients (age, sex) were significantly different from those in group D (P0.05). There was no statistical difference in the skin defect (P0.05). Conclusion (1) PRP is superior to recombinant human epidermal growth factor gel in the treatment of skin defect in extremities of 8 cm ~ 2 ~ (12) cm ~ 2. (2) PRP is an effective method in treating skin defects in elderly patients with respiratory diseases. It can promote the early healing of wound, shorten the hospitalization time, reduce the complications of bed rest and reduce the economic burden.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R658

【參考文獻】

相關(guān)期刊論文 前10條

1 金長鑫;吳瓊;劉燁;劉波;劉衛(wèi);黃進軍;;富血小板血漿凝膠聯(lián)合脂肪干細胞促進大鼠創(chuàng)面修復(fù)的實驗研究[J];東南國防醫(yī)藥;2016年04期

2 岳勇;帕爾哈提·熱西提;王強;伊力夏提·阿力甫;魯杰;韓雪瑩;李明珍;徐曉雄;李波;居來提·吉力力;李景挺;潘杰;趙麗英;孫改生;;自體富血小板血漿結(jié)合自體骨移植治療四肢骨干粉碎性骨折[J];中國骨與關(guān)節(jié)損傷雜志;2014年06期

3 岳勇;帕爾哈提·熱西提;王強;魯杰;伊力夏提·阿力甫;韓雪瑩;徐曉雄;阿德力·阿布都熱西提;居來提·吉力力;李景挺;潘杰;趙麗英;孫改生;;自體富血小板血漿與自體骨移植治療粉碎性骨折:隨機對照隨訪[J];中國組織工程研究;2014年22期

4 趙繼宏;方昕;;負壓封閉引流及皮片移植修復(fù)脛腓骨骨折的皮膚軟組織缺損[J];中國組織工程研究;2014年20期

5 廖懷偉;韓超;劉麗忠;曹閩軍;;富血小板血漿凝膠對脂肪干細胞修復(fù)皮膚軟組織缺損創(chuàng)面的影響[J];重慶醫(yī)學(xué);2013年32期

6 黃東平;池達智;羅晶;陳江;;急診外固定架結(jié)合負壓引流術(shù)在小腿骨折合并嚴重軟組織損傷的療效觀察[J];重慶醫(yī)學(xué);2012年20期

7 于虎;趙國梁;張中林;楊徐松;吳照發(fā);張洪;;封閉式負壓吸引聯(lián)合內(nèi)外固定治療脛腓骨骨折合并皮膚缺損[J];浙江創(chuàng)傷外科;2012年01期

8 付微平;王楨;;帶真皮血管網(wǎng)植皮術(shù)對缺損創(chuàng)面的治療研究[J];骨科;2011年03期

9 郭彥杰;仇建軍;張長青;;富血小板血漿治療下肢慢性難愈合傷口47例隨訪研究[J];中國修復(fù)重建外科雜志;2008年11期

10 劉云召;郝杰;趙洪文;楊云霞;;重組人表皮細胞生長因子對人皮膚細胞增殖作用的研究[J];四川生理科學(xué)雜志;2008年03期

相關(guān)博士學(xué)位論文 前2條

1 孫淑芬;靜電紡PBS納米纖維膜及緩釋血小板內(nèi)生長因子的PBS納米纖維膜的制備及生物活性評價[D];吉林大學(xué);2012年

2 程文俊;復(fù)合富血小板血漿可注射型組織工程骨的構(gòu)建與實驗研究[D];第一軍醫(yī)大學(xué);2007年

相關(guān)碩士學(xué)位論文 前8條

1 唐艷姣;凍干血小板促進創(chuàng)傷愈合及止血作用的實驗研究[D];南方醫(yī)科大學(xué);2016年

2 高慶峰;應(yīng)用去細胞真皮基質(zhì)聯(lián)合富血小板血漿重建兔巨大肩袖損傷的實驗研究[D];蘇州大學(xué);2014年

3 劉宸;富血小板血漿對糖尿病大鼠創(chuàng)面巨噬細胞浸潤變化的影響[D];南京醫(yī)科大學(xué);2014年

4 彭艷;富血小板血漿激活PI3K/AKT/NF<kappa>B信號通路促進骨髓間充質(zhì)干細胞再生及修復(fù)功能的相關(guān)研究[D];南方醫(yī)科大學(xué);2013年

5 廖懷偉;脂肪來源干細胞聯(lián)合富血小板血漿凝膠修復(fù)皮膚軟組織缺損創(chuàng)面的實驗研究[D];南昌大學(xué);2012年

6 潘思璇;富血小板血漿促進組織工程皮膚創(chuàng)面修復(fù)的實驗研究[D];復(fù)旦大學(xué);2010年

7 李靜;微粒型血小板干粉制劑的制備及其促進小鼠皮膚創(chuàng)面愈合的實驗研究[D];第三軍醫(yī)大學(xué);2009年

8 柯希煌;富血小板血漿復(fù)合脫蛋白異種骨的臨床應(yīng)用研究[D];福建中醫(yī)學(xué)院;2006年

，

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