封闭负压引流技术对人慢性创面中透明质酸含量的影响

Effect of vacuum assisted closure on hyahuronic acid content in human chronic wound

目的研究人慢性创面在经封闭负压引流治疗前后,创面渗出液中透明质酸含量的变化,部分阐明封闭负压引流促进慢性创面愈合的机理。方法取8例乳癌术后第1、2、3、4天急性创面的引流液,同时收集11例慢性创面(5例压力性溃疡,6例静脉性溃疡)于封闭负压引流治疗前以及治疗后第1、3、5、7、9天的渗出液,利用放射免疫测定的方法分别测定其中透明质酸的含量,并进行动态的观察与比较。结果急性创面引流液中随时间延长透明质酸含量逐渐增高,各时间点的差异有显著意义(P<0.05)。压力性溃疡中,封闭负压引流治疗前渗出液中透明质酸含量较低,引流后随治疗时间的延长透明质酸水平升高(第1、3、5、7天差异有显著意义P<0.05),至第9天有下降趋势;而静脉性溃疡中,封闭负压引流治疗前透明质酸水平极高,治疗后透明质酸含量随时间延长呈现极明显的波动,但于第7天后呈下降趋势。结论封闭负压引流通过平衡透明质酸的代谢从而促进慢性创面的愈合,这可能是封闭负压引流促进慢性创面愈合的一个重要机制。

Objective To study the variations of hyaluronic acid content in exudate of human chronic wound before and after treatment of vacuum assisted closure so as to partly clarify the mechanisms of vacuum assisted closure in promoting chronic wound healing. Methods Collecting exudate of eight acute wound （breast cancer） at day 1, 2, 3, 4 postoperatively and 11 chronic wound （5 cases of pressure sore, 6 cases venous ulcer） pretreatment and posttreatment of vacuum assisted closure at day 1, 3, 5, 7, 9, we deter- mined Hyaluronic acid content and made comparisons between them based on RIA. Results Hyaluronic acid content became higher with time going in acute wound with significant variations between every timepoint （P 〈 0.05）. In pressure sore exudate, hyaluronic acid levels increased after vacuum assisted closure compared to that of before vacuum assisted closure （there were significamt variations at day 1, 3, 5, 7. P 〈 0.05）. But in venous ulcer exudate, there were high hyaluronic acid levels before vacuum assisteclosure. Hyaluronic acid content became unstable after vacuum assisted closure with obvious decrease at day 7. Conclusion Vacuum assisted closure can promote chronic wound healing through balancing hyaluronic acid metabolism, which may be an important mechanism of vacuum assisted closure benefiting chronic wound healing.