富血小板血浆联合负压封闭引流技术治疗慢性难愈性创面的研究

朱思文; 张莉; 蒋邦红; 逯瑶; 张逸文

doi:10.16766/j.cnki.issn.1674-4152.001768

富血小板血浆联合负压封闭引流技术治疗慢性难愈性创面的研究

doi: 10.16766/j.cnki.issn.1674-4152.001768

蚌埠医学院第一附属医院整形外科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0345

详细信息

通讯作者:
张莉，E-mail：drzhangli65@163.com

中图分类号: R457.1 R634
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- 文章访问数: 327
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-11
- 网络出版日期: 2022-02-19

Platelet-rich plasma combined with vacuum-sealing drainage in treating chronic refractory wounds

Department of Plastic Surgery, the First Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究富血小板血浆(platelet rich plasma, PRP)联合负压封闭引流技术(vacuum sealing drainage, VSD)治疗慢性难愈性创面的临床效果。方法选取2019年3月—2020年6月在蚌埠医学院第一附属医院整形烧伤科收治且符合选择标准的40例慢性难愈性创面患者，按照随机数字表法分为对照组(仅使用VSD覆盖创面)和观察组(创面基底及边缘注射PRP+VSD覆盖创面)，每组各20例。比较2组住院时间、治疗显效率、术后创面疼痛评分(采用视觉模拟评分量表)以及创面HE染色下组织形态学特点。结果对照组无效2例、有效10例、显效8例；观察组无效0例、有效0例、显效20例。与对照组相比，观察组平均住院时间明显缩短[(27.10±8.63)d vs. (20.10±3.60)d，P < 0.01]，且治疗显效率明显提高(40.00% vs. 100.00%，P < 0.01)；观察组患者术后创面疼痛评分明显低于对照组；HE染色结果显示对照组创面炎症反应明显，新生肉芽组织及血管数量较少，而观察组创面炎症反应较轻，新生肉芽组织及血管数量较多，并且再上皮化率较高。结论针对慢性难愈性创面患者, 相较于传统的PRP凝胶技术，本研究采用PRP局部注射联合VSD治疗可刺激血管生成，改善创面局部血运，加快患者康复速度，减轻患者术后疼痛，缩短住院时间，降低治疗费用，取得良好的治疗效果。
- 难愈性创面 /
- 富血小板血浆 /
- 负压封闭引流技术 /
- 局部注射
Abstract: Objective To investigate the clinical effect of platelet-rich plasma (PRP) combined with vacuum-sealing drainage (VSD) in treating chronic refractory wounds. Methods From March 2019 to June 2020, 40 patients with chronic refractory wounds admitted in the Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical College, were selected and randomly divided into two groups, namely, control (only using VSD to cover the wound) and observation groups using PRP to inject the base and margin of wounds and using VSD to cover the wounds, 20 cases in each group. The length of hospital stay, effective rate of treatment, postoperative wound pain score (using visual analogue scale), and histomorphological characteristics of wound under HE staining were compared between the two groups. Results In the control group, 2 cases were ineffective, 10 cases were effective, and 8 cases were markedly effective; in the observation group, 0 cases were ineffective, 0 cases were effective, and 20 cases were markedly effective. Compared with the control group, the average length of stay in the observation group was significantly shorter [(27.10±8.63) d vs. (20.10±3.60) d, P < 0.01], and the effective rate was significantly increased (40.00% vs. 100.00%, P < 0.01). Results of HE staining showed that the inflammatory reaction of the control group was obvious, and the number of new granulation tissue and blood vessels was less in the control group, whereas the inflammatory reaction in the observation group was lighter, the number of new granulation tissue and blood vessels was higher, and the re-epithelialisation rate was higher in the observation group. Conclusion For patients with chronic refractory wounds, compared with the traditional PRP gel technology, PRP injection combined with VSD treatment can stimulate angiogenesis, improve the local blood circulation, accelerate the recovery of patients, relieve postoperative pain, shorten the length of stay, reduce the cost of treatment, and achieve good therapeutic effect.
- Chronic refractory wounds /
- Platelet-rich plasma /
- Vacuum-sealing drainage /
- Local injection

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图 1 二次离心法制备PRP

注：A为第1次离心后；B为第2次离心后。

下载: 全尺寸图片幻灯片

图 2 2组慢性难愈性创面患者治疗前后创面HE染色组织形态学对比(×400)

注：A为对照组第1次清创；B为对照组第2次清创；C为观察组第1次清创；D为观察组第2次清创。

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图 3 患者行PRP+VSD治疗前后对比

注：A为手术清创前；B为清创后注射PRP；C为PRP联合VSD治疗后7 d；D为PRP联合VSD治疗后4个月余。

下载: 全尺寸图片幻灯片

表 1 2组慢性难愈性创面患者VAS评分比较(x ±s，分)

组别	例数	疼痛VAS评分(分)			F值	P值
组别	例数	术前	术后1周	术后2周	F值	P值
观察组	20	6.05±0.86	3.14±0.91	1.62±0.47	169.245	< 0.001
对照组	20	5.88±0.73	4.99±0.85	3.43±1.21	33.702	< 0.001
t值		0.695	-6.648	-6.209
P值		0.491	< 0.001	< 0.001

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