封闭负压引流技术对猪皮肤软组织爆炸伤感染创面的疗效

目的 了解封闭负压引流(VAC)技术对猪皮肤软组织爆炸伤感染创面的疗效. 方法 用电雷管在4只小白家猪双侧肩胛及双侧臀部共造成16个爆炸伤创面,将创面分为对照组和负压治疗组.2组创面伤后前2 d不作任何处理任其感染;第3天起,对照组创面用油纱换药,负压治疗组创面行VAC治疗.于治疗前(伤后第3天)及开始治疗后1、3、6、9、14、19、24 d测量并计算创面的面积、深度;取创面组织进行病理形态学观察,检测细胞增殖指数、血管内皮细胞数、髓过氧化物酶(MPO)活性和细菌计数.记录创面愈合时间. 结果 开始治疗后第1、3天,负压治疗组创面面积和创面深度不再扩大和加深,创面内炎性细胞、血管内皮细胞和增殖细胞数目均增多,MPO活性明显增高,细菌数明显减少;此期间对照组各指标变化情况与该组相反.治疗后1～19 d,2组创面的面积、深度、血管内皮细胞数以及细菌数比较,差异有统计学意义(P＜0.01);治疗后1～9 d,2组创面细胞增殖指数差异有统计学意义(P＜0.01);治疗后3、6 d,2组创面MPO活性比较,差异有统计学意义(P＜0.01).对照组创面愈合时间为(32.8±1.6)d,明显长于负压治疗组的(25.8±1.0)d(P＜0.01).结论与常规换药相比,VAC能明显减少猪皮肤软组织爆炸伤感染创面的细菌数量,减轻继发性坏死,促进炎性反应,快速启动肉芽组织生成,缩短创面愈合时间.

Therapeutic effect of vacuum-assisted closure technology on infected explosion wound of pig

OBJECTIVE: To investigate the effect of vacuum-assisted closure (V. A. C.) technology in the treatment of infected wound of skin and soft tissue as a result of explosion injury in pig. METHODS: Sixteen explosion wounds were established by electric detonators on the shoulders and hips on both sides of 4 small white domestic pigs ,and they were divided into A group [(without treatment and infection occurred on 1-2 post burn day (PBD), then treated with vaseline gauze on 3 (PBD)], and B group (with the same treatment as in A group, except for treatment of vacuum assisted closure (V. A. C) with pressure of - 15 kPa after 3 PBD). The data of wound depth, wound area, wound healing time were collected and analyzed at 3 PAD and 1, 3, 6, 9, 14, 19, 24 days after treatment. Specimens from wounds were collected for histopathology observation, including also cell proliferation index, the number of vascular endothelial cells, the activity of myeloperoxidase (MPO) and the number of bacteria. RESULTS: Compared with those in A group on land 3 days after treatment, wound area, wound depth were not enlarged or deepened in B group, while the number of inflammatory cells, vascular endothelial cells, proliferative cells were increased, the activity of MPO was enhanced and the number of bacteria was decreased. There were obvious differences between two groups in following indices: wound area ,wound depth, the number of vascular endothelial cells and bacteria during 1 to 19 days after treatment (P < 0.01)), the number of cell proliferation from 1 - 9 days after treatment (P < 0.01)), and the activity of MPO on 3, 6 days after treatment (P < 0. 01). The wound healing time was (32.8 +/- 1.6) d in A group, which was longer than that in B group (25.8 +/- 1.0 d, P < 0.01). CONCLUSION: Compared with conventional dressing change, V. A. C can decrease bacteria load, lessen secondary necrosis, prompt the inflammatory response, accelerate the formation of granulation tissue, shorten wound healing time in infectious wound of porcine skin and soft tissue resulted from explosion injury.