封闭负压引流干预慢性创面神经生长因子和微血管的变化

Effect of vacuum sealing drainage on nerve growth factor and microvessels in chronic wound

背景:随着老龄化程度的增加,慢性创面呈上升趋势,在治愈慢性创面方法匮乏的情况下,封闭负压引流技术开始应用于临床。目的:观察封闭负压引流技术对人慢性创面组织中神经生长因子表达及微血管数量的影响,探索促进慢性创面愈合的机制。方法:以10例慢性创面患者为观察对象,其中胸部软组织缺损、骨髓炎伴骨外露和截肢后残端大面积皮肤缺损各1例、皮肤撕脱伤后创面感染2例、胫骨骨髓炎2例、术后伤口感染3例。分别于封闭负压引流技术吸引前、吸引7 d和14 d切取创周皮肤和创面内肉芽组织,采用免疫组织化学技术检测神经生长因子表达和微血管数量变化,并观察伤口愈合情况。结果与结论:封闭负压引流技术治疗7 d和14 d后成纤维细胞及血管内皮细胞中的神经生长因子表达明显高于治疗前(P<0.001)。封闭负压引流治疗使微血管数量显著增加(P<0.05-0.01)。封闭负压引流治疗前创基内肉芽组织量少且较晦暗,存在坏死组织和较多脓性分泌物,伤口周围组织肿胀明显。经封闭负压引流治疗后,伤口内坏死组织和脓性分泌物逐渐减少,肉芽组织呈细颗粒状,鲜红色,触之易出血,伤口周围水肿消退。提示封闭负压引流技术可以提高慢性创面创周组织中神经生长因子表达和微血管数量,促进创面愈合。

BACKGROUND：With the increase of aging degree, chronic wounds are increasing. There is few method to cure chronic wounds at present, and vacuum sealing drainage has been applied to the clinic.OBJECTIVE：To investigate the effect of vacuum sealing drainage on the expression of nerve growth factor and the change of microvascular number in the human chronic wounds, and to study the mechanism of accelerating chronic wound healing.METHODS：Ten patients with chronic wounds were included in this study, including one case of soft tissue defect of chest, one case of osteomyelitis with bone exposure, one case of large area skin defect after amputation stump, two cases of wound infection after skin avulsion injury, two cases of shinbone osteomyelitis, and three cases of postoperative wound infection. The skin around the wounds and granulation tissue within the wounds were col ected before vacuum sealing drainage treatment and at 7, 14 days after vacuum sealing drainage treatment. The nerve growth factor expressions and the microvascular number in the wounds were measured by the immunohistochemical technology. The wound healing was also observed. RESULTS AND CONCLUSION：The nerve growth factor expressions in fibroblasts and vascular endothelial cel s at 7 and 14 days after vacuum sealing drainage treatment were significantly higher than that before treatment （P〈0.001）. The microvascular number was also increased after vacuum sealing drainage treatment compared with pre-treatment （P〈0.05-0.01）. The vacuum sealing drainage treatment reduced necrotic tissue and purulent secretion within the wounds, as wel as swel ing around the wounds. Simultaneously, granulation tissue gradual y became fine granules, bright red, and bleeding easily, thus it is suitable for promoting wound healing.