【作者】 刘金超；

【导师】 徐刚；

【作者基本信息】 河北医科大学 ， 外科学， 2010， 硕士

【摘要】 目的:探讨封闭负压引流技术(Vacuum-assisted closure ,V.A.C)在慢性创面愈合中的作用机制。方法:1选取因慢性创面住院患者(病程超过1个月,包括褥疮、烧伤、糖尿病足、慢性溃疡)30例,分为两组,每组15人,一组创面用封闭负压引流治疗(实验组),一组常规换药治疗(对照组),两组患者的其他治疗基本一致。2实验组于负压引流治疗前清创时自创面取材0.3cmx0.3cm(治疗前标本),于负压引流治疗7天后取同样大小标本(治疗后标本),均置于10%甲醛溶液中固定备用,对照组在入院初取材(治疗前标本),经过7天常规换药后再次取材(治疗后标本)每组对15例患者共取材30次。3两组共30例标本分别固定,石蜡包埋,每份石蜡切片分别进行HE染色、TP/PD-ECGF以及CD34免疫组化染色,显微镜下对染色切片进行观察,计数MVD(微血管密度microvessel density MVD)值和TP值,结果所得数据采用SPSS13.0统计软件分析,MVD值经方差正态齐性检验后用t检验分析,TP/PD-ECGF值用卡方检验,P<0.05有统计学意义。结果:1 HE染色:与对照组比较,实验组治疗前后HE染色变化明显,即实验组治疗后组织切片中蓝染部分增加明显多于对照组。2 CD34染色:两组治疗后组织切片中MVD值均较各组治疗前有明显增加,但实验组与对照组组间比较差异显著。3 TP染色:TP/PD-ECGF阳性染色主要发现于实验组负压治疗后创面,实验组内部治疗前后差异显著;对照组经7天换药治疗后的组织切片中TP/PD-ECGF明显少于实验组治疗后,而且对照组内部治疗前后变化不明显。结论:从本研究结果可以看出,封闭负压吸引治疗较常规换药治疗更能促进组织细胞再生,改善创面血运,从而改善创面局部生长环境,促进组织细胞修复发生,加速创面愈合。更多还原

【Abstract】 Objective: To discuss the mechanism of V.A.C in the healing of chronic wound .Method:1 30 inpatients who have chronic wound (the date of being ill was over 1 month, including pressure sore, burn, diabetes foot and ulcer) were included in this research. They were divided into two groups, 15 patients in each group. Experiment(E) group were treated by V.A.C, and Control(C) group were treated by common dressing change. All the other treatments were similar in both groups .2 A piece of tissue measured 0.3cm×0.3cm was taken in the E group on the first day of treatment as the sample before treatment and it was put into formalin. Another same size sample was taken seven days after the V.A.C treatment was performed which was the sample after treatment.During the treatment, the pressure value was -125mmHg.Samples were taken from patients in C group in the same way on the first day when they were accepted in hospital as the sample of before treatment.Seven days after dress changing, another same size tissue was taken as the after treatment sample.Thirty samples were taken in both groups.3 Thirty examples in both groups were fixed and paraffin embedded.Slides of each sample were stained by HE, TP/PD-ECGF and CD34 immunohistochemical dyed methods. These slides were observed by microscope.MVD and TP count should be statisted. All the data were analysed by SPSS13.0,MVD counts were analysed by T-test after Test forNormality and epual variance,TP/PD-ECGF counts were analysed by Chi-Square test, and the P value less than 0.05 was taken as significant difference. Results:1 HE group: The changes of slides in E group after and before treatment were more siginifcant than in C group.Increasement of the V.A.C group changed more significant than the common group. And the V.A.C group Aizen components in E group after treatment were more than in C group.2 CD34 group: Significant difference of counts of MVD by CD34 signed before and after treatment were found in both groups.Significant difference was found between the two groups .3 TP/PD-ECGF group: Positive reaction of slides stained by TP/PD-ECGF was found mainly in E group after treatment.Less was found in C group. The change of positive reaction of TP/PD-ECGF stained in E group was significant, while there was little change in C group.Conclusion : It can be concluded that the treatment of V.A.C can play a more effective role than common dressing change in stimulating tissue regeneration,improving local circulation and promoting platelets gathering on the chronic wound which lead to the acceleration of the tissue rehabilitation and wound healing when the wound bed is filled with blood.更多还原