速愈乐^(TM)敷料促进小型猪感染创面愈合和抑菌作用的实验研究

Experimental research on effects of SUILE(速愈乐^(TM))wound dressing in promoting healing of infected wounds in minipigs

目的:观察速愈乐^(TM)创伤敷料对小型猪感染创面促进愈合和抑菌的作用。方法:以小型猪全层皮肤缺损创面为模型,每只动物用打孔器致伤10个创面,随机分为5组:空白对照组、种菌对照组、水凝胶组、银离子组和速愈乐^(TM)组。除空白对照组外,其余各组创面于术后30 min接种1.5×10~8 CFU/ml金黄色葡萄球菌(金葡菌)0.1 ml,3个敷料组在创面覆盖相应敷料。术后观察各组创面肉芽组织生长情况、新生上皮面积、创面闭合率、创面收缩率以及创面金葡菌量,免疫组织化学染色观察新生真皮内的毛细血管数量。结果:术后3 d各组创面肉芽组织增生不明显,但速愈乐^(TM)组和空白对照组创面明显新鲜、容易出血,提示创面已有肉芽组织生长。术后4～7 d速愈乐^(TM)组肉芽组织增生活跃,7 d肉芽组织填充量达71.0%;术后7 d创缘新生上皮生长明显,与其他组比较差异具有统计学意义(P<0.05)。术后10～14 d各组创面肉芽组织继续生长,术后10 d速愈乐^(TM)组肉芽组织填充量达99.1%,其他各组填充量为87.0～89.0%,到术后12 d所有创面基本被肉芽组织填平;在此期间速愈乐^(TM)组新生上皮生长较其他组明显。术后5～7 d速愈乐^(TM)组创面收缩比其他组小。术后10～14 d速愈乐TM组创面闭合率比其他组高,于术后10 d显著优于空白对照组(P<0.05)。速愈乐^(TM)有一定抑菌作用,在炎症反应最重期间能将创面金葡菌数量控制在10~5CFU以内,术后7 d,速愈乐^(TM)组创面金葡菌量显著高于种菌对照组和水凝胶组(P<0.05),但与银离子组比较差异无显著性(P>0.05)。速愈乐^(TM)组术后14 d上皮生长良好,比正常表皮厚,但比其他各组稍薄;新生真皮胶原较多而且致密,显示胶原束明显;新生真皮显著厚于正常皮肤真皮和空白对照组新生真皮(P<0.05);新生真皮内的毛细血管数多于其他各组,与正常皮肤真皮内血管数比较差异具有显著性(P<0.05)。结论:速愈乐^(TM)敷料有明显促进创面肉芽组织增生和创缘新生上皮生长移行的作用,有一定抑制金葡菌生长和延迟创面收缩的作用。

Objective： To observe healing promoting and anti-bacterial effects of SUILE （速愈乐TM） wound dressing for infected wounds in minipigs. Methods： Full-thickness skin defects were produced in 6 pigs. Ten full thickness wounds were made in each pig, and the wounds were randomly divided into 5 groups： the blank control group, the infection control group with inoculation of Staphylococcus aureus to the wounds, and 3 test groups in which the bacterial inoculation wounds were dressed with hydrogel, silver ion and SUILE respectively. Except the blank control group, all other wounds were inoculated with 0. 1 ml Staphylococcus aureus （1.5 × 10^8 CFU/ml） 30 minutes after the creation of wounds. The growth of granulation tissue, growth of epithelium, wound closure, wound contraction rate, and the number of Staphylococcus aureus in the wound tissue were compared postoperatively, the quantity of capillary in the newly grown dermis were counted with the method of immunohistochemistry. Results：On postoperative day 3, no obvious granulation tissue growth was observed in the wounds of either group, but wounds of the SUILE test group and the blank control group were relatively fresh and prone to bleeding, indicating that certain amount of granulation tissue had formed in wounds. On postoperative day 4 to 7, granulation tissue of the SUILE test group proliferated actively with a granulation tissue content of 71.0% on day 7. On postoperative day 7, obvious growth of epithelial tissue was observed on the edge of wounds of the SUILE test group, which was significantly different from other groups （P〈0.05）. On postoperative day 10 to 14, growth of granulation tissue in every group continued. On postoperative day 10, the granulation tissue content of the SUILE test group was 99.1%, while those of other groups were 87.0% to 89.0%, and almost all wounds were filled with granulation tissue on postoperative day 12. New epithelium in the SUILE test group showed better growth than that of other groups during the entire course. As to wound contraction and closure, on postoperative day 5 to 7, wound contraction in the SUILE test group was less than that in other groups, and the rate of wound closure in the SUILE test group was higher than that of other groups on postoperative day 10 to 14, and it was significantly better than that of the blank control group （P〈0. 05）. It was found that SUILE had certain anti-bacterial effect and the quantity of Staphylococcus aureus was limited to 10s CFU during the period of inflammation. The quantity of Staphylococcus aureus was significantly higher in SUILE test group than that of the control group and the hydrogel group on postoperative day 7, while it was close to that of the group in which silver ion was used （P〈 0. 05）. On postoperative day 14, histological observation revealed good growth of epithelium in the SUILE test group with a thickness larger than that of normal epidermis but a little thinner than that of other groups, while collagen of new endothelium was richer and denser, with thicker collagen bundles than that of normal skin and the new endothelium of the blank control group （P〈0. 05）. Immunohistochemieal staining showed more capillary formation in new endothelium in the SUILE test group than other groups, and it was more prominent than that of normal skin （P〈0. 05）. Conclusions.. SUILE wound dressing is effective in improving granulation tissue proliferation and epithelization in wounds, with inhibition of Staphylococcus aureus, and wound contraction was delayed.