海藻酸盐敷料止血作用及生物相容性研究

摘要：目的 研究海藻酸盐敷料的止血性能,并初步探究其生物相容性。方法 采用凝血指数试验测定体外凝血性能。采用新西兰兔耳和背部创伤止血试验测定止血性能。采用溶血试验和细胞毒性试验进行初步安全性评价。结果海藻酸盐敷料、明胶海绵的凝血指数BCI分别为33.1±4.9、72.0±3.3,海藻酸盐敷料凝血效果优于明胶海绵。在背部创伤出血模型中,海藻酸盐敷料、明胶海绵、纱布的平均止血时间为（55.3±5.1）s、（80.2±7.4）s、（101±14.7）s,Hb光度吸收值分别为1.5±0.7、2.5±0.5、3.8±0.7。与明胶海绵比较,海藻酸盐敷料的平均止血时间缩短了31.05%,Hb光度吸收值降低了40.00%;与纱布比较,海藻酸盐敷料的平均止血时间缩短了45.25%,Hb光度吸收值降低了60.53%。在兔耳动脉止血实验中,海藻酸盐敷料、明胶海绵、纱布的出血量分别为（2.4±0.2）g、（3.0±0.2）g、（3.9±0.2）g,止血时间分别为（226.3±6.5）s、（332.3±14.2）s、（466.5±19.1）s。与明胶海绵组比较,海藻酸盐敷料的出血量降低了20.00%,止血时间分别为缩短了31.90%;与纱布比较,海藻酸盐敷料的出血量降低了38.46%,出血时间缩短了51.49%。海藻酸盐敷料的溶血率低于5%。细胞毒性实验中各浓度的海藻酸盐敷料浸提液为0级或1级,提示其对细胞无明显毒性。结论 海藻酸盐敷料具有良好的止血效果,溶血率符合国标要求,且对皮肤成纤维细胞无细胞毒性。     

鱼皮胶原蛋白-壳聚糖复合海藻酸盐水凝胶敷料对烧烫伤创面的促愈合作用

本文以海藻酸钠为原料,复配壳聚糖、鱼皮胶原蛋白,通过Ca2+离子交联制备成海藻酸盐水凝胶敷料。测试了该敷料的物理机械性能及其对大白兔浅Ⅱ度烧烫伤创面的促愈合作用。结果表明：鱼皮胶原蛋白-壳聚糖复合海藻酸盐水凝胶的含水量≥80%,具有良好的吸湿保湿和机械性能,是一种理想的伤口创面敷料;对浅Ⅱ度烧烫伤的愈合周期远远少于医用纱布、市售聚氨酯水凝胶敷料,且能消除伤口炎症,抑制瘢痕的生成,在伤口护理方面有着良好的前景和应用方向。     

鲨鱼皮胶原海绵的体外抗氧化及其促创伤愈合作用研究△

目的 研究鲨鱼皮胶原(Shark skin collagen,SSC)海绵的体外抗氧化功效并研究其体内促伤口愈合作用。方法 采用醋酸溶胀法分离酸溶性Ⅰ型胶原,真空冷冻干燥技术制备SSC海绵,化学分光光度法检测其体外抗氧化活性;采用SD 大鼠背部创伤模型,检测SSC海绵的促愈合作用,HE染色观察组织病理学变化,免疫组织化学染色检测愈合过程中CD31,EGF和TGF-β表达变化。结果 20 mg/mL SSC溶液对HO? 具有显著的清除作用,清除率为84%±0.021。术后第3、5天,SSC 海绵处理组愈合率分别为52.1%±0.057、57.1%±0.080,显著优于纱布(gauze,GZ)组的15.9%±0.083、28.4%±0.066 (p＜0.01)和壳聚糖(chitosan,CS)组的22.2%±0.095、36.5%±0.033(p＜0.05)。组织病理HE染色显示,SSC海绵能在创伤愈合早期显著促进毛细血管生成,新生肉芽组织形成,促进愈合上皮生成,加速创面愈合。免疫组化检测显示,术后第3天,SSC 海绵处理组CD31表达数为38±4.73,显著高于CS组的27±3.06和GZ组的26±3.61(P<0.05);SSC海绵处理组TGF-β表达率为20.1%±3.17,显著高于GZ组的6.7%±0.739和CS组的10.7%±0.502(p＜0.05); SSC海绵处理组和CS处理组EGF表达率分别为12.1%±0.447和12.2%±1.91,显著高于GZ处理组的9.3%±1.23( p＜0.05)。结论 SSC具有显著的清除羟自由基功效,SSC海绵能够显著促进创伤愈合早期CD31、TGF-β和EGF的高表达,进而促进早期新生血管生成和肉芽组织的形成,加快伤口愈合过程。     

藻酸钙钠盐敷料在2 型糖尿病患者下肢血管病变伤口的应用

摘要 目的 观察藻酸钙钠盐敷料对2 型糖尿病患者下肢血管病变伤口的疗效。方法2型糖尿病下肢血管病变伤口患者120例,随机分为治疗组和对照组各60例,在全身系统治疗的基础上,治疗组应用藻酸钙钠盐敷料,对照组选用单纯常规敷料换药。结果对照组和治疗组创面止血时间分别为（3.35±1.52）,（2.98±1.23） min;创面愈合时间分别为（32.73±5.21）,（27.57±4.61） d（P＜0.05）。治疗组疗效明显优于对照组。结论藻酸钙钠盐敷料能明显促进2 型糖尿病患者下肢血管病变伤口愈合。     

头花蓼纳米纤维功能敷料的药效评价

目的 评价头花蓼纳米纤维功能敷料（P-PVP-PCL）的药效。方法 利用静电纺丝技术制备P-PVP-PCL,观察其微观形貌;考察P-PVP-PCL的抑菌活性、抗氧化活性和对小鼠成纤维L929细胞存活率、黏附性及迁移率的影响。通过建立大鼠背部皮肤伤口模型,考察医用纱布敷料、空白纳米纤维敷料（PVP-PCL）和P-PVP-PCL对创面愈合率的影响,观察创面组织病变和胶原纤维沉积情况,以及创面组织中血小板内皮细胞黏附分子1(CD31)阳性血管数量和转化生长因子β(TGF-β)蛋白表达。结果 制得的PPVP-PCL表面光滑,断面处可见双层结构,对金黄色葡萄球菌和大肠埃希菌的抑制率分别为（98.88±0.66）%、（94.75±1.41）%,抗氧化活性为（83.69±1.56）%,且P-PVP-PCL组的细胞活性均显著高于对照组和PVP-PCL组（P<0.05）。与医用纱布敷料相比,PPVP-PCL更有利于L929细胞黏附;在48 h时,该组的细胞划痕已基本愈合。与医用纱布敷料组比较,PVP-PCL组和P-PVP-PCL组的大鼠创面愈合率均显著升高（P<0.05）。干预第14天时,P...     

O-羧甲基壳聚糖止血海绵止血和愈创效果研究

目的:考察自制O-羧甲基壳聚糖止血海绵的止血效果及愈创效果。方法:建立兔耳动、静脉创伤出血模型,以市售可吸收明胶海绵作阳性对照,以医用纱布作阴性对照,比较自制O-羧甲基壳聚糖止血海绵组与对照组的止血效果,并观察止血可靠性。通过组织学切片及测量创面大小,考察自制O-羧甲基壳聚糖止血海绵对兔背部全厚层皮肤创面模型的愈合效果。结果:自制O-羧甲基壳聚糖止血海绵对兔耳动、静脉创伤出血模型的平均止血时间、创面收缩性及愈合情况均明显优于对照组(P<0.01),无1例发生再出血,止血效果可靠:且创面干净,渗出物少,创面愈合后接近正常组皮肤。结论:自制O-羧甲基壳聚糖止血海绵具有良好的止血效果,并能有效地促进创面愈合。     

海藻酸盐医用敷料的研究进展

海藻酸盐(alginate)是一类从褐藻中提取的天然线性多糖,具有无毒、可生物降解、生物相容性高的特点,海藻酸盐的高吸湿性和凝胶性,使其在现代伤口敷料方面得到了广泛应用。海藻酸盐敷料则具有成本低、使用方便、能促进伤口愈合的特点,有海绵形式、纤维形式和水凝胶等形式,作为医用敷料有广阔应用前景。本文对海藻酸医用辅料的主要特点和不同形式的应用进行了综述,并展望了其应用前景。     

羧甲基壳聚糖锌促进III度烫伤伤口愈合作用的研究

目的 评价羧甲基壳聚糖锌对III度烫伤伤口愈合过程的影响。方法 将75只雌性的Wistar大鼠随机分为3组,分别设阴性对照组,羧甲基壳聚糖锌组和海藻酸钙组,所有大鼠背部同样位置用98°热水烫伤20s造成III度烫伤伤口,分别覆盖纱布、羧甲基壳聚糖锌和海藻酸钙,观察不同组大鼠伤口愈合情况,第2天、第6天、第11天、第17天以及第26天计算伤口愈合率、取样测定组织中羟脯氨酸、转化生长因子β（TGF-β）和白介素-6（IL-6）的含量,并对伤口组织病理切片进行观察。结果 羧甲基壳聚糖锌有效促进烫伤创面愈合前期的TGF-β和IL-6的分泌,促进愈合前期羟脯氨酸的合成和胶原的沉积,进而加快III度烫伤伤口的愈合速度,减少创面愈合后期瘢痕的形成,提高愈合质量。     

不同方法处理糖尿病足溃疡的效果观察

目的：评价三种方法处理糖尿病足溃疡的治疗效果。方法将门诊换药室就诊的60例Wangner分级Ⅱ～Ⅲ级糖尿病足溃疡的患者采用随机数字表法分为生物活性敷料组、新型敷料组和传统敷料组。生物活性敷料组采用联合清创,银离子敷料控制感染,藻酸盐敷料和泡沫敷料管理渗液的换药方法,另外加用生物活性敷料（皮肤创面无机诱导活性敷料德莫林）促进肉芽生长;新型敷料组前期处理同生物活性敷料组,只是未加用生物活性敷料;传统敷料组选用碘仿纱条和凡士林纱布换药。结果伤口处理6周时,伤口愈合总有效率生物活性敷料组明显优于传统敷料组（ P ＜0．01）,且生物活性敷料组优于新型敷料组（ P ＜0．05）;伤口面积减小率,伤口愈合计分生物活性敷料组明显优于传统敷料组（ P ＜0．01）。溃疡愈合时间较传统敷料组明显缩短（ P ＝0．000）,且优于单纯应用新型敷料换药（ P ＝0．002）。结论新型敷料联合生物活性敷料（皮肤创面无机诱导活性敷料德莫林）治疗糖尿病足溃疡总有效率明显高于传统敷料组,溃疡愈合速率较传统敷料组明显加快,取得满意疗效。     

猪源纤维蛋白贴对大鼠肝脏及肝素化兔臀大肌创面的止血作用

目的:研究猪源纤维蛋白贴(DBT)对大鼠肝脏和肝素化兔臀大肌出血创面的止血效果。方法:48只大鼠和24只兔均随机分为假手术组、手术对照组(纱布止血)、医用胶原蛋白海绵组和DBT组,除假手术组外,其他各组动物分别建立大鼠肝脏出血模型或肝素化兔臀大肌静脉出血模型。记录各组动物止血时间、计算出血量;观察大鼠术后3、13周DBT降解、肝脏创面愈合及粘连情况;考察医用胶原蛋白海绵组和DBT组肝素化兔的再渗血率。结果:与假手术组比较,手术对照组动物的止血时间和出血量均显著升高(P<0.01);与手术对照组比较,DBT组和医用胶原蛋白海绵组动物的止血时间和出血量均显著减少(P<0.01)。术后3周和13周,各组大鼠创面均有不同程度粘连,但粘连评分比较差异无统计学意义(P>0.05);术后13周两给药组大鼠肝脏肝缘稍钝,但基本已恢复至术前状态,愈合状况良好;DBT能降解、吸收完全。DBT组兔的再渗血率为33.3%,医用胶原蛋白海绵组为66.7%。结论:DBT对脆性脏器和凝血功能障碍机体具有较好的止血效果,且能降解吸收;其作用效果与医用胶原蛋白海绵相当,且黏合强度略强于后者。     

Role of phenytoin in wound healing--a wound pharmacology perspective

Topical agents used for the enhancement of wound healing are designed to act locally and, therefore, do not undergo classic systemic metabolic modification. This commentary reviews the potential role of a vulnerary agent, phenytoin, (PHT), from a wound pharmacology perspective. This agent may have the potential to alter the dynamics of wound healing, suggesting a therapeutic use for the stimulation of chronic wounds. Oral PHT therapy is used widely for the treatment of convulsive disorders, and about half the patients treated develop gingival overgrowth as a side-effect. This apparent stimulatory effect has prompted its assessment in wound healing. Investigations into the mechanisms of gingival overgrowth also provide clues to its action in wound healing, and important similarities and differences are discussed. It appears also that both gingiva and skin are important extrahepatic sites for xenobiotic metabolism, and analysis of the biochemical mechanisms should lead to the design of safer analogues for wound healing. On the other hand, differences between the pharmacokinetics of topical PHT in these tissue situations indicate that different formulations are required for gingival and cutaneous wound healing and during the changing course of wound healing itself.     

鱼油伤口护理软膏的制备及其对皮肤切线伤的促愈合作用

鱼油中的多不饱和脂肪酸具有促进皮肤损伤修复的功能。以富含多不饱和脂肪酸的鱼油为原料，复配黄凡士林、液体石蜡，制备油性伤口护理软膏敷料。测试了该软膏敷料的细胞相容性、阻水性、阻菌性及其对Sprague Dawley（SD）大鼠切线伤的促愈合作用。结果表明，软膏浸提液培养的L929细胞相对存活率为（99.5 ± 2.2）%，具有优异的细胞相容性；软膏具有优异的阻水性和阻菌性；在切线伤护理中，所制备膏状敷料能够促进创面胶原的沉积与重排，减轻瘢痕的生成。鱼油伤口护理软膏在浅表性皮肤创面护理方面有着良好的应用前景。     

An innovative bi-layered wound dressing made of silk and gelatin for accelerated wound healing

In this study, the novel silk fibroin-based bi-layered wound dressing was developed. Wax-coated silk fibroin woven fabric was introduced as a non-adhesive layer while the sponge made of sericin and glutaraldehyde-crosslinked silk fibroin/gelatin was fabricated as a bioactive layer. Wax-coated silk fibroin fabrics showed improved mechanical properties compared with the non-coated fabrics, but less adhesive than the commercial wound dressing mesh. This confirmed by results of peel test on both the partial- and full-thickness wounds. The sericin-silk fibroin/gelatin spongy bioactive layers showed homogeneous porous structure and controllable biodegradation depending on the degree of crosslinking. The bi-layered wound dressings supported the attachment and proliferation of L929 mouse fibroblasts, particularly for the silk fibroin/gelatin ratio of 20/80 and 0.02% GA crosslinked. Furthermore, we proved that the bi-layered wound dressings promoted wound healing in full-thickness wounds, comparing with the clinically used wound dressing. The wounds treated with the bi-layered wound dressings showed the greater extent of wound size reduction, epithelialization, and collagen formation. The superior properties of the silk fibroin-based bi-layered wound dressings compared with those of the clinically used wound dressings were less adhesive and had improved biological functions to promote cell activities and wound healing. This novel bi-layered wound dressing should be a good candidate for the healing of full-thickness wounds.     

Studies on wound healing

Factors affecting the rate of healing of experimental skin wounds in rats have been investigated. The effectiveness of healing was measured by determining the tensile strengths of the incised skin after various time intervals. When the skin histamine content was lowered by treatment with polymyxin B or with compound 48/80, retardation of the healing process was evident from the reduced tensile strengths. When the skin 5-hydroxytryptamine content was lowered by treatment with reserpine, retardation of healing was also found. Heparin increased the rate of healing and more rapid healing was obtained by giving histamine before each dose of heparin. On the other hand, some glucocorticoids markedly inhibited the healing process. Of the constituents of the tissue mast cells, heparin appears to be more important than histamine and 5-hydroxytryptamine in promoting the healing of experimental skin wounds in rats.     

丝蛋白创面敷料促进Ⅱ度创面愈合的临床疗效

目的 评价丝蛋白创面敷料治疗Ⅱ度烧伤创面的临床疗效与安全性.方法 48例Ⅱ度烧伤患者随机均分为治疗组(用丝蛋白创面敷料覆盖,B组)及对照组(用灭菌凡士林纱布覆盖,A组),观察创面愈合时间、创面边缘炎性反应程度和疼痛程度.结果 与A组比较,B组创面愈合时间短、疼痛程度评分低(P＜0.01)；两组炎性反应程度评分差异无统计学意义(P＞0.05).结论 丝蛋白创面敷料能明显促进Ⅱ度创面的愈合.     

Effect of aged garlic extract on wound healing: A new frontier in wound management

Successful wound healing depends upon angiogenesis, and impaired angiogenesis is a hallmark of the chronic wounds encountered with diabetes and venous or arterial insufficiency. To intervene and improve wound closure, it is essential to investigate the effects of different natural remedies in wound healing. The chicken dorsum skin excisional wound assay was used to investigate the influence of different concentrations of aged garlic solution (AGS) on wound healing. Gross, histopathology, scanning electron microscopy (SEM) and computer-based three-dimensional (3D) image-probing techniques were utilized to determine the effects of AGS on wound closure, re-epithelialization, dermal matrix regeneration, and angiogenesis. Ninety chicks, aged 1 week and divided in 6 groups, were topically exposed to different concentrations of AGS for 6 days: control (group A), 1% (group B), 5% (group C), 10% (group D), 15% (group E), and skin lotion (group F). Different patterns, ranging from incomplete to almost complete wound closure, were observed among different groups with highly significant results (P?<?0.001) in group E. Histological investigations revealed a positive augment in the re-epithelialization of all AGS exposed wounds. An increase in the number of new loosely packed collagen and maturation of collagen bundles was observed in all treated wounds at days 4 and 6 post-wounding, respectively. Similar results were achieved through SEM of treated wounds. Histological investigations revealed the profuse dose-dependent neovascularization among AGS-treated wounds. Abbott curve, angular spectrum, and different parameters of 3D surface roughness of wounds were also measured for the precise quantification of angiogenesis. A very highly significant (P?<?0.001) increase in angiogenesis was observed among all treated groups. No significant change was observed among control and skin lotion–treated groups. These observations substantiate the beneficial use of AGS in the treatment of wounds. Additional studies are needed to study the specific wound-healing mechanisms of chemical, or group of chemicals, present in AGS.