VSD联合胰岛素溶液局部冲洗治疗慢性创面的疗效观察

目的观察封闭式负压引流(vacuum sealing drainage,VSD)联合胰岛素溶液局部冲洗治疗慢性创面的疗效。方法选择2012年1月-2018年12月收治的60例慢性创面患者,按住院先后分为VSD组(A组)、生理盐水+VSD组(B组)、胰岛素溶液+VSD组(C组),每组20例。3组患者性别构成、年龄、病程、创面面积、创面深度等一般资料比较,差异均无统计学意义(P 0.05),具有可比性。清创后A组行VSD持续引流治疗,B组和C组分别行VSD持续引流加等量的生理盐水或胰岛素溶液间断冲洗治疗。治疗期间监测每日引流组织行成纤维细胞生长因子-2(FGF-2)、肿瘤生长因子α(TNF-α)、α-平滑肌肌动蛋白(α-SMA)含量;计算治疗6 d后肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率;治疗6 d后取创面肉芽组织行HE和Masson染色病理学观察。结果治疗6 d后C组肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率均明显高于A、B组(P0.05)。与A组相应时间点比较,B组FGF-2、α-SMA含量明显增高,TNF-α含量明显下降(P0.05);与B组比较,C组FGF-2、α-SMA含量明显增高,TNF-α含量明显下降(P0.05)。病理结果:A组治疗后新生毛细血管、成纤维细胞及胶原蛋白较少;B组新生毛细血管、成纤维细胞及胶原蛋白较多;C组大量新生毛细血管、成纤维细胞及胶原蛋白。结论 VSD联合胰岛素溶液局部冲洗治疗慢性创面可促进肉芽组织生长,加速创面修复,显著提高创面愈合率和愈合速度。

Effects of irrigation of insulin solution combined with VSD in chronic wounds

Objective To investigate the effects of irrigation of insulin solution combined with vacuum sealing drainage （VSD） in chronic wounds. Methods Between January 2012 and December 2018， 60 patients with chronic wounds were treated with VSD （group A， n=20）， with VSD combining irrigation of normal saline （group B， n=20）， and with VSD combining irrigation of insulin solution （group C， n=20） after debridement. There was no significant difference in gender， age， course of ulcers， area and depth of wound among 3 groups （P>0.05）， and the data were comparable. The contents of fibroblast growth factors 2 （FGF?2）， tumor growth factor α （TNF?α）， and a?smooth muscle actin （α?SMA） in drainage of fluid were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated， the granulation tissue in the center of the wound was harvested for pathological observation with HE and Masson staining after 6 days of treatment. Results The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment （P<0.05）. The contents of FGF?2 and α?SMA were significantly increased and TNF?α was significantly decreased in group B when compared with those in group A（P<0.05）. Compared with group B， FGF?2 and Α?SMA contents were significantly increased and TNF?α content was significantly decreased in group C（P<0.05）. The pathological staining showed that there were fewer new capillaries， fibroblasts and collagen in group A after treatment，many new capillaries， fibroblasts and collagen in group B and a large number of new capillaries， fibroblasts and collagens were found in group C. Conclusion VSD combined with local irrigation of insulin solution in the treatment of chronic wounds can promote the growth of granulation tissue， enhance tissue repair function， and significantly improve wound healing rate and speed.