重组人粒细胞-巨噬细胞集落刺激因子与纳米银对深Ⅱ度烫伤创面愈合影响的比较

Comparison of effects of recombinant human granulocyte /macrophage colony stimulating factor and nano- silver on the recovery of degreed Ⅱ deep burn

目的比较重组人粒细胞-巨噬细胞集落刺激因子(rhGM-CSF)与纳米银敷料对深Ⅱ度烫伤创面愈合过程的影响。方法用Wistar大鼠建立深Ⅱ度烫伤模型,分为A、B、C 3组,A组(n=30):凡士林纱布覆盖;B组(n=30):纳米银敷料覆盖;C组(n=30):rhGM-CSF涂抹创面。分别于伤后第1、4、7、10、14、21天,观察创面炎症反应,计算愈合率,细菌培养并计数。结果 A、B、C 3组均在第10天出现明显的血管化和上皮化,A组创面伤后红肿明显,并且在第14天出现痂下积脓,向皮下潜行,切片可见大量炎性细胞浸润、聚集、迁移,血管壁通透性增加,血管化和上皮化进程较慢;B、C组创面伤后红肿,在伤后第4天炎症反应最重,切片可见炎性细胞浸润、聚集、迁移,血管壁通透性增加,血管化和上皮化进程较A组明显加快,至第14天因为创面溶痂,炎症反应较前略有加重。创面愈合率方面,C组>B组>A组,第14、21天,差异有统计学意义(P<0.05)。A组和B组、C组分别于伤后第4和10天出现细菌生长,第10、14、21天,B组、C组比A组细菌生长数量减少,差异有统计学意义(P<0.05),而B组、C组之间差异无统计学意义(P>0.05);革兰阳性菌以金黄色葡萄球菌居首位,革兰阴性菌以铜绿假单胞菌居首位。结论 rhGM-CSF和纳米银敷料外用,均能减少深Ⅱ度烫伤创面细菌生长,减轻炎症反应;促进创面愈合方面,rhGM-CSF优于纳米银敷料。

Objective To compare the effects of recombinant human granulocyte/macrophage colonystimulating factor （rhGM - CSF） and nano - silver as treatment for degreed Ⅱ deep burn. Methods The degreed Ⅱ deep burn mod- el were constructed with Wistar rats, which were randomly divided into 3 groups, petrolatum treatment （ Group A, n = 30）, nano - silver treatment （Group B, n = 30） and rhGM - CSF treatment （ Group C, n = 30）. The inflammatory reac- tion, healing rate and culture bacteria on wound were observed on the 1 st, 4th, 7th, 10th, 14th and 21st day after treatment. Results Vasculization and epithelizaiton were observed in all the 3 groups on the l0ts day. Obvious redness and swollen were observed in Group A, with abscess under scab and infiltrated subcutaneously, and mass inflammatory cells, in- creased vascular penetration and slow vasculizatoin and epitheliztion were also observed. These were suppressed in Group B and C. Significantly highest healing rates were observed in Group C, followed by Group B and Group A on the 14＇s and 21st day （P 〈0. 05）. Bacteria were found in Group A and B on the 4ts day, while on the 10th day in Group C. Significant- ly less bacteria were observed in Group B or C than those in Group A on the 10＇h, 14th and 21st day （P 〈0. 05）, while there was no significant difference between Group B and C （P 〉 0. 05）. Conclusion The rhGM - CSF and nano - silver treatment can reduce bacteria growth and alleviate inflammatory reaction. And rhGM - CSF provides better efficacy on pro- moting wound healing than nano - silver.