复合纳米银凝胶修复烧伤创面的实验观察和临床应用

Clinical and experimental observation of a composite nanophase silver ion-gel application in the repair of burn wounds

目的观察复合纳米银修复烧伤创面的效果。方法应用兔高压电损伤模型将新西兰兔45只击伤后分为3组。组1,局部应用复合纳米银凝胶治疗7 d;组2,单用纳米银凝胶治疗;组3,单用纳米级甲壳素溶液。伤后3、7、14、21和28 d分别解剖观察,并取标本做光镜学和电镜学观察;同时进行肌动蛋白和肌钙蛋白相对定量分析。临床应用65例:实行同体对照,一侧肢体(试验组)应用含有纳米银凝胶的纱布覆盖烧伤创面,另一侧(对照组)应用磺胺嘧啶银纱布。观察创面细菌培养结果和创面愈合时间。结果实验第3、7和14天,组1和组2肌动蛋白相对定量无显著差异,但在21 d和28 d,组1和组2肌动蛋白相对定量差异有统计学意义(P<0.05),而组1和组2肌钙蛋白相对定量无显著差异。临床观察结果:在65例患者130例次细菌培养结果中,试验组创面培养均为阴性,对照组有15例次阳性;试验组创面愈合时间为(17±5.8)d,对照组为(22±6.3)d,两组差异具有统计学意义(P<0.05)。65例患者均未见不良反应。结论复合纳米银凝胶具有防止感染,促进烧伤创面修复作用。

Objective To investigate the efficacy of a composite nanophase silver ion- gel on bum wounds. Methods New Zealand rabbits of 45 with electric injury were divided into three groups. In group 1, a composite nanophase silver ion - gel was applied locally every day for 7 days. In group 2 ,only nanophase silver ion - gel was administrated. In group 3, only nanophase chitosan solution was administrated. The animals were dissected and muscle samples were taken for light microscopy and electron microscopy at 3,7,14,21 and 28 days. And 100 mg samples were harvested for α- actin cDNA and troponin cDNA assay by using RT - PCR method. Sixty - five patients with bums or electric injury were enrolled. One extremity was assigned to experimental group treated with the composite nanophase silver ion- gel,and the other extremity to control group treated with silver sulfadiazine gauze. The healing time of wounds re- epithelialization was observed. Results Histological examination results of experiment had no significant difference except the group 3 during 2 weeks. However, mainly normal structures of extensor digitorum longus muscle were seen in the group 1 at 28 days and sandwich necroses tissue in the group 2. Transmission electron microscopic studies revealed that some of cells had vigorous metabolism and proliferation in the group 1, which had multiple nuclei within a single plasma membrane, amplified mitochondria and abundant endoplasmic reticulum. At 3,7 and 14 days post- injury, the relative levels of α- actin cDNA showed no significant difference between group 1 and group 2 ,but at 21 and 28 days post- injury, there was significant difference （ P 〈 0.05 ）. There was no significant difference in troponin cDNA relative levels at different time points. The average healing time was （17 ± 5.8） days in experimental group, which was significantly shorter than that in control group （22 ± 6.3 days, P〈 0.05） .Clinically,no side - effect was observed in this study. Conclusion The composite nanophase silver ion - gel can promote the healing of burn wounds effectively.