封闭负压引流技术对猪皮肤软组织海水浸泡爆炸伤创面愈合的病理学影响研究

Effect of vacuum sealing drainage on the healing of seawater immersed explosion wounds in swine

目的 通过动态对比观察封闭负压引流（vacuum sealing drainage,VSD）技术对猪皮肤软组织海水浸泡爆炸伤创面愈合及病理学变化的影响,初步探索治疗的最适压力范围.方法 用雷管在5头实验小型猪的双侧肩胛部、臀部制造4个损伤程度相当的海水浸泡爆炸创面,清创后随机分为对照组和实验组（VSD-120 mmHg负压组、VSD-180 mmHg负压组、VSD-240 mmHg负压组）.每组5个创面,对照组每天常规换药,实验组隔1天换1次VSD敷料,共治疗9d,并动态观察至所有创面愈合（即治疗后58 d）.分别于治疗前和治疗后9、30、58 d,取各组创缘组织行HE染色,并对比观察.结果 实验组与对照组相比,创周细胞增殖活跃,上皮爬行较快,肉芽增生迅速;以VSD-120 mmHg负压组最为明显,其次是VSD-180 mmHg负压组.结论 在治疗海水浸泡爆炸创面时,VSD技术较常规换药法具有明显的优势,-120 mmHg是比较理想的压力.

Objective To dynamically contrast observe the effect of vacuum sealing dainage （VSD） at different negative pressures on pathological changes and wound healing of seawater immersed blast injury,exploring the optimum pressure of VSD.Methods The models of seawater immersed explosion wound were established at bilateral shoulders and hips （4 wounds of each） of 5 experimental miniature swine.After debridement,20 wounds were divided equably and randomly into the control group and the experimental groups （the VSD-120 mmHg group,the VSD-180 mmHg group and the VSD-240 mmHg group）.All the wounds in the control group and the experimental group were treated with routine change dressings everyday and with VSD at different pressure for 5 times with 1 day interval,respectively.The wound healing were observed to the 58th day and the wound magin tissues were havested and stained by HE staining at 9,30 and 58 days and then the contrast observation were also performed.Results Compared with the control group,cell proliferation around the wound was active,epithelium creeping was faster and granulation hyperplasia was rapid.The best pressure was the VSD-120 mmHg and the better one was VSD-180 mmHg.Conclusion Compared with conventional treatment,VSD shows clear benefits on the treatment of seawater immersed explosion wounds,and-120 mmHg pressure may be the ideal pressure for treatment.