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目的观察封闭负压引流(VAC)技术对猪爆炸伤感染创面肉芽组织毛细血管新生的影响。方法用电雷管在4只小白家猪双侧肩胛及双侧臀部各造成1个面积为(7.3±1.0)cm~2爆炸伤创面,按完全随机化方法分为对照组(8个创面)和治疗组(8个创面)。两组均在伤后2 d行创面处理。对照组:创面清创后覆盖单层油纱;治疗组:清创后用VAC治疗。各组均于处置前及处置后1、3、6 d切取2 mm×2 mm×2 mm的创面组织行病理切片。光学显微镜下观察周皮细胞的分化、Image C软件行毛细血管管腔面积计算及图像处理。结果对照组处置前及处置后1、3 d,创面毛细血管较少,且血管内皮细胞周围缺少周皮细胞包裹;处置后6 d毛细血管增多,有少量周皮细胞包裹。治疗组处置后1 d毛细血管增加,并有充足的周皮细胞包裹;此后有周皮细胞包裹的毛细血管逐渐增多。治疗组处置后1、3、6 d创面内结蛋白阳性颗粒吸光度值(2569±330、3984±377、9611±960)均高于对照组(91±54、199±85、1552±298,P<0.01)。对照组处置后1、3、6 d毛细血管管腔总面积较小,分别为[(59±36)、(250±70)、(938±287)·μm~2],均小于治疗组[(818±234)、(4518±1080)、(9058±1656)μm~2,P<0.01]。结论与常规换药相比,VAC不仅能使猪皮肤软组织爆炸伤感染创面肉芽组织内新生毛细血管形成,还能促进周皮细胞分化,增加毛细血管管腔面积。
Objective To observe the effect of closed negative pressure drainage (VAC) on capillary neovascularization in granulation tissue infected with porcine blast infection. Methods A total area of (7.3 ± 1.0) cm ~ 2 blast wounds were created on the bilateral shoulder blades and bilateral buttocks of 4 White House pigs by electric detonator. The wounds were divided into control group (8 wounds) And treatment group (8 wounds). Two groups were treated wounds 2 days after injury. Control group: wound debridement covered single layer of yarn; Treatment group: VAC after debridement. All the groups were pathologically sectioned 2 mm × 2 mm × 2 mm before and 1, 3 and 6 days after the operation. Perifocal differentiation of pericytes was observed under an optical microscope. Image C software performed capillary lumen area calculation and image processing. Results Before and 1 and 3 days after treatment, there were fewer capillaries in the wound surface and no pericyte wrapping around the vascular endothelial cells. Capillary vessels were increased on the 6th day after treatment, and a small amount of pericytes were wrapped. At 1 d after treatment, the capillaries were increased in the treatment group, and there were enough pericytes; afterwards, the capillaries wrapped by the pericytes were gradually increased. The absorbency of positive protein in the wounds at 1, 3 and 6 days after treatment in the treatment group (2569 ± 330, 3984 ± 377, 9611 ± 960) were significantly higher than those in the control group (91 ± 54, 199 ± 85, 1552 ± 298, P <0.01). The total area of capillary lumen in the control group at 1, 3 and 6 d after treatment was smaller than that in the treatment group [(59 ± 36), (250 ± 70), (938 ± 287) μm 2] (818 ± 234), (4518 ± 1080), (9058 ± 1656) μm ~ 2, P <0.01]. Conclusion Compared with the conventional dressing, VAC can not only make swine skin soft tissue explosion hurt wound granulation tissue granulation tissue formation of new capillaries, but also promote the differentiation of the pericytes and increase the capillary lumen area.