不同负压封闭引流负压值对创面愈合的影响

Effect of VSD with different negative pressure values on the process of wound healing

目的探究不同负压封闭引流技术(VSD)负压值对创面愈合的影响。方法以Sus scrafa猪(15~18kg,雌雄不限,购买自华中农业大学畜牧科技发展研究中心)作为实验动物制备创面模型(n=9),在每头猪背部正中线两侧制备6个边长5cm的正方形全层皮肤缺损创面,采用同体自身对照,持续负压吸引组4个创面覆盖聚乙烯醇树脂(PVA)泡沫敷料分别以-125mmHg、-250mmHg、-300mmHg和-450mmHg负压持续吸引;间断负压吸引组1个创面以-125mmHg负压间断吸引;纱布组1个创面行无菌凡士林纱布换药。于创面形成后0.5h、第1、2、4、7、11、14、17、21天时间点检测创面血流灌注量;计算创面面积、创腔体积及创面上皮化率和肉芽填充率;观察创面细菌生长情况及其组织学形态变化。结果-250mmHg持续负压吸引组的创面血流量在术后第4天明显高于其他组[(208.89±5.22)PU/cm 2,P<0.01],较纱布组[(130.90±9.72)PU/cm 2]增长了60%。同时,与纱布组相比,负压吸引治疗创面面积缩小更快(P<0.01)。治疗10d后,-250mmHg负压吸引组创面上皮化率达到(60±4)%,较其他负压值组高(P<0.01),较纱布组[(40±2)%]增长50%。治疗7d时,-250mmHg负压吸引组细菌数量[(118±24.0)CFU/mL]最少,较纱布组[(780±77.3)CFU/mL]降低了85%。结论在本猪背创面模型研究中,封闭负压引流技术明显改善创面血流,减少细菌数量,提高创面上皮化率、肉芽组织填充率,促进创面愈合。其中,以-250mmHg负压持续吸引为最佳促进创面愈合的条件。

Objective To investigate the effect of vacuum sealing drainage(VSD)with different negative pressure values on the process of wound healing.Methods Sus scrafa male pigs(n=9)were used as experimental animal to prepare animal models.In each pig,six square·shaped full-thickness skin defect wounds were made on both sides of the back.Each pig served as its own control.Four wounds in the continuous negative pressure suction group were covered with PVA foam dressing and treated with continuous negative pressure drainage as-125mmHg,-250mmHg,-300mmHg,and-450mmHg,respectively.The intermittent negative pressure suction group were treated with intermittent negative pressure drainage as-125mmHg and the gauze group wounds were covered with sterile vaseline gauze only.The perfusion of blood flow of wound was detected at 0.5h,1d,2d,4d,7d,11d,14d,17d,and 21d after treatment.At the same time,the area and volume of each wound were measured,and the epithelialization of wound surface and granulation filling rate were calculated.Tissues from wound were harvested for bacteria counting.Results We found the perfusion of blood flow of wound treated continuously with VSD at-250mmHg[208.89±5.22 PU/cm 2]was significantly higher than other groups(P<0.01)at the fourth day,which increased by 60%compared with the gauze group of[130.90±9.72 PU/cm 2].Also,the wounds treated with VSD shrinked faster than the gauze group(P<0.01).After 10d of treatment,the wound epithelialization rate of the-250mmHg VSD group reached(60±4)%,which was higher than other negative pressure groups(P<0.01),and increased by 50%compared with the gauze group of(40±2)%.At the 7 th d,the number of bacteria of wounds treated with-250 mmHg VSD[(118±24.0)CFU/mL]was the lowest,which was 85%lower than that of the gauze group of[(780±77.3)CFU/mL].Conclusion In the study of the pig back wound model,the vacuum sealing drainage technique significantly improved the blood flow of the wound,reduced the number of bacteria,increased the epithelialization rate of the wound surface and the filling rate of the granulation tissue,and promoted wound healing.The continuous treatment of VSD with-250mmHg negative pressure is the best condition for promoting wound healing in this study.