【摘要】：目的：研究封閉負壓引流技術(Vacuum Sealing Drainage, VSD)治療肢體多發(fā)槍傷后血清中炎癥因子的變化；探討VSD聯(lián)合灌洗治療感染火器傷的早期療效。 方法及結果：實驗分兩部分： 第一部分：12頭豬槍擊致傷雙后肢,6h內徹底清創(chuàng),隨機分為對照組(傳統(tǒng)方法治療)、實驗組(VSD治療)。用ELISA法測定兩組不同時間點血清中CRP和IL-6的含量,進行統(tǒng)計學分析。結果顯示致傷前、傷后6h CRP和IL-6含量無顯著性差異(P0.05)。隨時間延長兩組CRP和IL-6的含量均呈上升趨勢。實驗組與對照組的CRP和IL-6含量分別在傷后48h、24h達高峰,實驗組含量明顯低于對照組(P0.01)。 第二部分：18頭豬槍擊致傷右后肢,前2天不做任何治療以造成火器傷感染。第3天行有限清創(chuàng)后,隨機分為對照組(常規(guī)處理)、VSD組和實驗組(VSD聯(lián)合灌洗治療),每組6頭。比較三組不同時間點傷道細菌計數(shù)、外周血中白細胞和內毒素含量的變化,并行常規(guī)病理學觀察和傷道組織中羥脯氨酸含量的檢測。結果顯示：與對照組和VSD組比較,實驗組傷道細菌計數(shù)、外周血白細胞和內毒素含量迅速下降(P0.01),肉芽組織中含有更多的羥脯氨酸(P0.01),病理學觀察顯示組織炎癥反應明顯減輕、組織修復快。 結論：VSD治療肢體多發(fā)槍傷可明顯降低血清中炎癥因子的含量,減輕全身炎癥反應；采用VSD聯(lián)合灌洗對感染火器傷進行早期救治,能迅速控制感染、減輕全身反應、為盡早修復重建創(chuàng)造良好的軟組織條件。
[Abstract]:Objective: to study the changes of inflammatory factors in serum after treatment of multiple gunshot wounds in extremities by blocking negative pressure drainage technique (Vacuum Sealing Drainage, VSD) and to explore the early efficacy of VSD combined with lavage in the treatment of firearm injuries. Methods and results: the experiment was divided into two parts: the first part: 12 pigs were injured by gunshot, debridement completely within 6 hours. They were randomly divided into control group (traditional treatment) and experimental group (VSD treatment). The contents of CRP and IL-6 in serum of two groups at different time points were determined by ELISA method. The results showed that there was no significant difference in CRP and IL-6 levels before and 6 hours after injury (P0.05). The contents of CRP and IL-6 increased with time. The contents of CRP and IL-6 in the experimental group and the control group reached the peak at 48h after injury, and the content of IL-6 in the experimental group was significantly lower than that in the control group (P0.01). Part two: 18 pigs with gunshot wounds to the right hind limb without any treatment 2 days ago to cause firearm infection. After limited debridement on the 3rd day, the rats were randomly divided into control group (routine), VSD group and experimental group (VSD combined with lavage therapy), 6 heads in each group). The changes of bacterial count, leukocyte and endotoxin content in peripheral blood at different time points, routine pathological observation and hydroxyproline content in wound tissue were compared among the three groups. The results showed that compared with the control group and VSD group, the bacterial count, the contents of leukocyte and endotoxin in peripheral blood of the experimental group decreased rapidly (P0.01), and the granulation tissue contained more hydroxyproline (P0.01). Histopathological observation showed that the inflammatory reaction was obviously alleviated and the tissue was repaired quickly. Conclusion: the treatment of multiple gunshot wounds in limbs with VSD can significantly reduce the content of inflammatory factors in serum and alleviate systemic inflammatory reaction. The use of VSD combined with lavage for early treatment of infected firearm injuries can quickly control infection, reduce systemic reaction, and create good soft tissue conditions for early repair and reconstruction.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R826.68

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