【作者】 徐鲲；

【导师】 杨敏； 李芳邻；

【作者基本信息】 山东大学 ， 护理学， 2013， 硕士

【摘要】 [目的]通过术前及术后不同时间应用化疗药物对切口愈合的影响,以及对切口部位组织VEGF表达及外周血TNF-α水平的观察,研究不同时间应用化疗药物对手术切口愈合的影响,探索最佳的手术联合化疗的时间；同时在此基础上,观察局部外用重组人粒细胞集落刺激因子、康复新液进行护理干预对皮肤切口愈合的影响,探讨其作用机理,为临床切口的愈合及护理提供理论依据。[方法]1、将实验用大白兔48只,随机分为6组,空白对照组不进行化疗药物注射,另外5组分别于手术前3、0天和手术后2、4、6天于耳缘静脉注射表阿霉素,观察手术后1、3、5、7天切口VEGF和外周血TNF-α水平,术后7天观察各组切口愈合情况2、选择对切口愈合影响最大的化疗时间进行护理干预研究,将大白兔40只,随机分为5组,空白组、对照组、重组人粒细胞集落刺激因子组、康复新高剂量组、康复新低剂量组。手术后7天分别取切口部位组织,分析两种干预对切口愈合的影响。[结果]1、手速前当日给予化疗组中化疗药物对切口愈合等级影响最大,切口愈合明显低于空白组(P<0.05);而术前3天,术后第2、4天应用化疗组虽愈合等级低于空白对照组,但无统计学意义。手术前当日应用化疗药物的感染程度明显高于空白组(P<0.05)。各组免疫组化染色,可见第1、3、5、7天VEGF免疫组化染色与空自组相比差别无意义。手术后第7天测TNF-α显示,手术前当日化p疗组9.8±4.31pg/mL.手术后2天化疗组11.1±3.8pg/mL.手术后4天化疗组11.3±3.18pg/mL,均低于空白组(P<0.05)。2、对于手术前当天应用化疗药物,可见空白组、粒细胞集落刺激因子组及康复新液高剂量组术后第7天感染率均低于对照组(p<0.05)。免疫组化显示粒细胞集落刺激因子组和康复新液高剂量组明显高于空白组和对照组(P<0.05)。各组TNF-α水平无统计学差异(P>0.05)。[结论]1.手术前当日给予化疗对切口愈合影响最大。2.手术前当天、手术后2、4天应用化疗药物会显著降低第7日外周血TNF-α水平,而各组切口部位VEGF表达无明显差异。3.粒细胞集落刺激因子及高浓度康复新液可以促进切口部位VEGF表达,从而促进切口愈合。更多还原

【Abstract】 Objective To observe the influence of chemotherapy in different time on wound healing, the VEGF express in tissue at wound and TNF-a level in serum in order to define the optimal time of chemotherapy during operation. Furthermore, observe the effect of G-CSF and Kangfuxinye to wound healing, and explore mechanism for providing theoretical bases.Methods Part1. New Zealand white rabbits (48cases), were randomly divided into6groups:normal group(8cases) was given surgery, other groups(8cases every group) were given infusion of epirubicin respectively on the day before the operation, three days before operation, two days after operation, four days after operation and six days after operation. At the same time to observe the VEGF express, TNF-a level and states of wound at the1st day,3rd day,5th day and7th day.Part2. The rabbit(40cases) were randomly divided into5groups:normal group,control group, G-CSF group and Kangfuxinye high close treated group, Kangfuxinye low dose treat group. After7days of operation combing with chemotherapy, the grade of incision, the status of pathology, the level of VEGF and the level of TNF-a were observed.Results Part1. There was worse effect of chemotherapy to wound healing on the day before the operation (p<0.05), the infected degree is higher than normal group. But there was no significant difference at three day before, two days after or three days after operation. For the VEGF levels, no difference was found in various groups. The TNF-α levels,9.8±4.31pg/mL on the day before the operation group,11.1±3.8pg/mL on two days after operation group,11.3±3.18pg/mL on four days after operation group, were lower than normal group (p<0.05)Part2. The differences were observed including wound healing, VEGF and TNF-a in7th day after surgery. The VEGF in G-CSF group and Kangfuxinye high dose treated group were increased and the wound healing was better than the control group, but there was no difference of TNF-a in them.Conclusion1. The chemotherapy on the day before the operation would cause the greatest worse effect of wound healing.2. No difference of VEGF level were found in various time of operation with chemotherapy, but the TNF-α levels on the day before the operation group, two days after operation, four days after operation group were lower than normal group.3. The G-CSF and Kangfuxinye can increase the VEGF expression of incision sites, and it is helpful to wound healing after treatment with both chemotherapy and surgery.更多还原