负压创面治疗技术对大鼠慢性溃疡创面血流及缺氧诱导因子1-α表达的影响

Effects of negative pressure wound therapy on blood perfusion and hypoxia-induce factor 1-alpha expression of rats chronic wound

：目的 通过观察负压创面治疗技术对大鼠慢性创面血流变化及缺氧诱导因子1-α（HIF1-α）表达的影响,探讨负压创面治疗技术对慢性创面治疗作用及机制.方法选取10～12周龄健康SD大鼠20只,进行慢性溃疡造模后随机分为实验组和对照组,均连续进行5 d创面治疗,实验组采用负压创面治疗技术治疗,对照组采用0.9%氯化钠溶液纱布换药治疗.采用激光多普勒血流检测系统对两组分别进行正常皮肤、治疗0 d创面及5 d治疗期间每天1次创面血流灌注量测量,进行两组正常对照和治疗0 d血流的组间、组内比较,比较治疗期间两组创面血流变化.每日大体观察两组创面愈合状况.5 d治疗期结束后对两组大鼠创面周围组织取材,免疫组化法测定缺氧诱导因子的表达,比较两组表达差异.结果 两组治疗0 d创面血流灌注量均比同组正常对照明显下降,差异有统计学意义（P＜0.01）,实验组治疗0 d创面血流灌注量、正常对照血流灌注量与对照组相比,差异无统计学意义（P＞0.05）.治疗期创面血流重复测量方差分析：处理效应与时间效应的交互作用有统计学意义（P＜0.01）,两组治疗期创面血流灌注均有随时间增加的趋势,但实验组增加的趋势比对照组更为明显,处理主效应有统计学意义（P＜0.01）,时间主效应有统计学意义（P＜0.01）,实验组各个治疗时点的创面血流灌注值均较对照组高,实验组HIF1-α表达明显少于对照组,差异有统计学意义（P〈0.01）.结论 负压创面治疗技术比常规换药能更迅速地改善创面血流及氧代谢,为慢性创面愈合提供良好的血流及氧代谢条件.

Objective To investigate the negative pressure wound therapy（ NPWT） healing mechanism on chronic wound by observing the effect on blood perfusion and hypoxia-induce factor 1-alpha（ HIF1-α） expression of rats chronic wound. Methods Twenty healthy Sprague-Dawley（ SD） rats of 10-12 weeks old were developed chronic wound and randomly divided into two groups,experiment group were received NPWT while control group were treated with wet saline gauze. Both groups were executed in series 5 days treatment. Compared 2 groups＇ wound blood perfusion by repeating measurements that once a day on series 5 days,normal control and initial wound,as well via laser doppler flow detective system. General observation of daily wound healing. To draw the wound tissue after 5 days treatment and immunohistochemical method to measure Hypoxia-induced factor1-alpha（ HIF1-α） expression of two groups. Results Both groups initial wound blood perfusion were decreased compare with normal perfusion（ P〈0. 01）. There were no difference of initial wound and normal blood perfusion between two groups（ P〈0. 01）. Results of repeated-measures ANOVA： two groups＇ effect of interaction between treatment and time were different significantly,the blood flow was increased with time in both groups,however,the trend of perfusion increasing in the experimental group was more significantly than the control group（ P〈0. 01）. There was significant difference in treatment effect between 2 groups（ P〈0. 01）,as well as time effect of 2 groups（ P〈0. 01） ： blood perfusion of wound in experimental group were increased compared with control group at each time points（ P〈0. 01）. HIF1-α expression of wound tissue in experimental group was significantly less than the control group. Conclusion Compared with the routine treatment that use wet saline gauze,NPWT were more effectively on enhance wound blood perfusion and improve oxygen to provide healthy condition for chronic wound.