自体富血小板血浆凝胶联合脱细胞异种真皮基质治疗深Ⅱ度烧烫伤

AUTOGENOUS PLATELET-RICH PLASMA GEL WITH ACELLULAR XENOGENEIC DERMAL MATRIX FOR TREATMENT OF DEEP Ⅱ DEGREE BURNS

目的探讨自体富血小板血浆(platelet-richplasma,PRP)凝胶联合脱细胞异种真皮基质治疗深Ⅱ度烧烫伤创面的疗效。方法 2007年1月-2009年12月,收治深Ⅱ度烧烫伤患者30例。男19例,女11例;年龄32～57岁,平均42.5岁。烧烫伤面积为(10%～48%)总体表面积,部位均为双上肢和/或双下肢,创面基本对称。伤后至入院时间为30min～8h。清创后行削痂手术,一侧肢体创面覆盖自体PRP凝胶和脱细胞异种真皮基质(治疗组),另一侧肢体创面覆盖脱细胞异种真皮基质(对照组)。比较两组创面愈合率、愈合时间、感染情况、瘢痕增生情况。结果术后7d治疗组细菌检出率为6.7%(2/30),显著低于对照组的16.7%(5/30),差异有统计学意义(P<0.05)。治疗组和对照组术后创面愈合时间分别为(18±4)d和(22±4)d,比较差异有统计学意义(P<0.05)。治疗组术后14、21d创面愈合率分别为75%±7%和88%±5%,对照组分别为62%±15%和73%±7%,两组各时间点比较差异均有统计学意义(P<0.05)。治疗组创面愈合后皮肤弹性及色泽好,外观较平整,柔软度较好,无明显瘢痕,愈合质量优于对照组。结论联合应用自体PRP凝胶与脱细胞异种真皮基质对深Ⅱ度烧烫伤创面有良好疗效,可以加速创面愈合,减轻瘢痕增生。

Objective To investigate the effectiveness of autogenous platelet-rich plasma（PRP） gel with acellular xenogeneic dermal matrix in the treatment of deep Ⅱ degree burns.Methods From January 2007 to December 2009,30 cases of deep Ⅱ degree burns were treated.There were 19 males and 11 females with an average age of 42.5 years（range,32-57 years）.The burn area was 10% to 48% of total body surface area.The time from burn to hospitalization was 30 minutes to 8 hours.All patients were treated with tangential excision surgery,one side of the wounds were covered with autogenous PRP gel and acellular xenogeneic dermal matrix（PRP group）,the other side of the wounds were covered with acellular xenogeneic dermal matrix only（control group）.The healing rate,healing time,infection condition,and scar formation were observed.Results At 7 days after operation,the infection rate in PRP group（6.7%,2/30） was significantly lower than that in control group（16.7%,5/30,P 〈0.05）.The healing times were（18 ± 4） days and（22 ± 4） days respectively in PRP group and control group,showing significant difference（P〈 0.05）.The healing rates at 14 days and 21 days were 75% ± 7% and 88% ± 5% in PRP group,were 62% ± 15% and 73% ± 7% in control group,showing significant difference（P 0.05）.RPR group was superior to control group in elasticity,color,appearance,softness,scar formation,and healing quality.Conclusion Autogenous PRP gel with acellular xenogeneic dermal matrix can accelerate the wound healing of deep Ⅱ degree burns as well as alleviate the scar proliferation.