使用富血小板血浆对下肢慢性创面缺损的临床研究分析

The Clinical Application Study of Platelet Rich Plasma in the Treatment of Lower Limb Skin Defect

目的:研究和探讨使用富血小板血浆(platelet-rich plasma, PRP)在人体下肢慢性创面缺损中的治疗作用,并试图寻找更佳的治疗皮肤慢性缺损的治疗方式。方法:对2016.03-2017.03一年以来在我科治疗,明确诊断为慢性创面缺损的,经纳入和排除标准筛选的共计16名患者进行分析。将其分为实验组(8人)与对照组(8人)。实验组通过对静脉血(肘部)进行抽取离心来制备富血小板血浆并加以覆盖。对照组则使用重组人表皮生长因子进行替代。两组患者均以7天为一疗程,进行换药和更换辅料。比较两组患者的创面愈合情况并比较其血液指标。结果:实验组患者在治疗后1周时观察创面,发现创面无明显渗出及感染征象,其面积缩小约1/4。对照组在1周后进行观察,发现1例有感染可能,给予再次清创并使用抗生素后辅料包扎。其余患者创面肉芽生长可,面积缩小约1/6。在治疗2周后再次进行观察,发现实验组患者创面面积缩小约2/3。而对照组患者面积缩小约1/4。在治疗后3周时,实验组所有患者创面已基本愈合85%以上。在延迟治疗1-2周后该组患者全部愈合。对照组患者在治疗3周后有两例患者愈合面积在50%以上。给予继续使用该治疗方法。剩余6例患者接受外科治疗(VSD+植皮/皮瓣)。实验组患者在各治疗观察点皮肤愈合情况较对照组均有显著改善(P<0.05)。两组所有患者均未出现严重并发症。结论:对于下肢慢性创面,使用富血小板血浆进行治疗,能够有效的促进创面愈合,减少手术及外科治疗的风险,降低治疗费用,且相对安全,具有非常重要的临床推广价值。

Objective: To study the characteristics of platelet rich plasma (PRP) in the treatment of lower limb skin defect and to find out the most suitable treatment for lower limb skin defect with no surgical indications. Methods: From 2016.03 to 2017.03, 16 patients diagnosed as lower limb skin defect were included in the research. 8 patients were treated by platelet rich plasma, while 8 patients received conservative treatment with recombinant human epidermal growth factor gel. Remove residual hemostatic gauze and dried blood every and change the new drug 7 days and observe the healing of the wound. Results: We observed that the scabby appeared in the skin defect, and there was no leakage in the wound in seventh day in all patients. The area was reduced about 1/4 in study group, 1/6 in group in 7 days in control group. The control group were observed after 1 week, 1 case with infection, give again complementary makings bandage after debridement and using antibiotics. The area was reduced about 2/3 in experimental group, 1/4 in group in 14 days in control group. 3 weeks after treatment, the experimental group patients have been healed by more than 85% of the wound. With delayed 1-2 weeks after treatment all of the patients of this group had healing. Two patients in control group patients in the treatment of three weeks had more than 50% healing area who were continued to use this treatment method. The remaining 6 patients underwent surgical treatment (VSD) + skin graft/flap whose area reduced about 1/5. Comparing to the control group, the area of group A and B was significantly reduced (P <0.05). The area of study group was significantly reduced than the control groups(P < 0.05). Conclusions: The therapy of PRP can promote wound healing, shorten hospitalization time, reduce laid-in-bed complications, reduce the economic burden in the treatment of lower limb skin defect.