高压氧联合磨削痂术对早期大鼠深Ⅱ度烧伤局部炎症反应的影响

Effects of hyperbaric oxygen combined with tangential excision surgery on local inflammatory responsein early stage of degree Ⅱ burns in rats

目的探讨大鼠烧伤后应用不同方法处理深Ⅱ度创面对早期局部炎症反应、组织损害的影响。方法取健康Wistar大鼠60只，制成30％深Ⅱ度烧伤模型，伤后23h实施手术。按照数字表法分为：烧伤组（20只）、削痂组（20只）、磨削痂联合高压氧组（联合组，20只）。分别取术后12、24、48、72h、21d的皮肤标本，HE染色观察早期组织炎症反应、检测创面组织中丙二醛（MDA）、一氧化氮（NO）含量。结果（1）烧伤组皮肤表层细胞脱水、凝固性坏死，伤后12h炎性反应不明显，24h有炎性反应，48h该反应进一步加重且范围扩大。（2）创面削痂组24h组织损伤达真皮深层，可见炎性细胞浸润带，48h后逐渐减轻，21d愈后无毛发。（3）联合组：24h组织损伤达真皮浅层，炎细胞浸润带明显减轻：48h后该反应带消失；21d毛发生长均匀，但略稀疏。联合组NO、MDA含量较烧伤组及削痂组均低（P〈0．01或P〈0．05），且能较早地趋向于伤前水平。结论削痂及高压氧联合磨削痂均能防止创面进行性加深，但高压氧联合磨削术更能明显减轻深Ⅱ度烧伤创面局部的炎症反应，有利于创面及早愈合。

Objective To investigate the effect of different methods for the treatment of degree Ⅱburns surface in early stage of local inflammation and tissue damage following bums in rats. Methods Sixty healthy Wistar rats were chosen for the development of the 30% degreeⅡ burns model. Surgery was performed 23 hours after injury. The animals were randomly divided into the burns group （n = 20）, the tangential excision group （ n = 20 ） and the tangential excision combined with hyperbaric oxygen （ HBO ） treatment group （ or the combined therapy group, n = 20）. Skin samples were collected at h 12, 24, 48, 72 and d 21 after surgery. HE staining was performed to observe early tissue inflammatory response and to detect levels of malonylaldehyde （MDA） and nitric oxide （NO） in the burn surface. Results （1） Skin surface cell dehydration and coagulation necrosis were noted in the animals of the burns group. Inflammatory response was not obvious 12 hours after injury. Twenty-four hours later, inflammatory response occurred, which became more serious and expanded further 48 hours later. （2） Twenty-four hours after injury, tissue damage in the animals of the tangential excision group reached the deep dermal layer and inflammatory eel1 infiltration could clearly be seen, with gradual relief 48 hours later. Bums injury healed 21 days later, but airs were seen. （3） For the combined therapy group, tissue damage reached the shallow dermal layer and inflammatory cell infiltration was obviously alleviated 24 hours later. Forty-eight hours later, the response band disappeared, and 21 days later, uniform but slightly sparse hair growth could be seen. The levels of NO and MDA were all lower than those of the burns group and the tangential excision group （ P 〈 0.01 or P 〈 0.05 ）, and returned to pre-injury levels earlier.Conclusions Tangential excision and HBO combined with tangential excision could prevent the wound surface from further infihrating. It was shown that HBO combined with tangential excision could alleviate local inflammatory response in degree II burns surface more significantly, and would promote healing of the wound surface.