烧伤后瘢痕修复早期应用地塞米松:对自体岛状皮瓣移植存活和预后的影响

Early application of examethasone improves the survival of autogenous island flap and prognosis of patients with burn scar after transplantation

背景:烧伤瘢痕自体岛状皮瓣移植修复是主要的治疗方法,移植后皮瓣漂浮、坏死是影响移植后效果的主要原因,地塞米松具有免疫调节功能,对创伤、应激过程中的免疫失衡具有调节作用。目的:探讨地塞米松对烧伤后岛状皮瓣修复患者Th1/Th2平衡的调节作用及其对及对皮瓣存活和预后的影响。方法:选择68例烧伤后瘢痕血管蒂岛状皮瓣移植修复患者,随机分为2组,2组患者移植后均给予皮瓣下负压引流、预防感染、改善微循环等治疗;在此基础上,研究组移植后立即给予地塞米松磷酸钠0.2 mg/kg,连续3 d后逐渐减量,移植后第7天停药,观察两组患者移植前及移植后1周Th1、Th2、Th1/Th2水平,比较血清干扰素γ、白细胞介素4水平,比较两组皮瓣血运障碍、坏死、积液等并发症发生率的差异。结果与结论:两组患者皮瓣移植前静脉血Th1、Th2、Th1/Th2水平及血清干扰素γ、白细胞介素4水平差异无显著性意义,移植1周后研究组Th1、Th1/Th2水平高于对照组,Th2水平低于对照组,研究组干扰素γ、白细胞介素4水平低于对照组,研究组患者并发症发生率低于对照组。结果说明,烧伤后瘢痕岛状皮瓣修复患者移植后早期应用地塞米松治疗能够减少并发症的发生,其可能通过调整Th1/Th2免疫平衡状态发挥作用。

BACKGROUND：Autologous island flap transplantation is the main therapy for burn scars. Floating and necrosis of transplanted flaps mainly impact the therapeutic effects. Dexamethasone has immunoregulatory function during trauma and stress process. OBJECTIVE：To investigate the effect of dexamethasone on immune balance of Th1/Th2 and prognosis in patients with burn scars undergoing autologous island flap transplantation. METHODS：Sixty-eight patients with burn scars undergoing transplantation of pedicled island flap were selected and randomly divided into control group and experimental group. Patients in the two groups were treated with negative pressure drainage under skin flap, infection prevention, improvement of microcirculation. After that, dexamethasone sodium phosphate （0.2 mg/kg） was immediately given in the experimental group, and the dose gradualy decreased after 3 days until drug withdrawal at 7 days. Levels of Th1, Th2, Th1/Th2 and interferon-γ, interleukin-4 were compared between the two groups before and 1 week after transplantation. In addition, incidence rates of skin flap necrosis, hemodynamic disorder, and effusion were compared between the two groups. RESULTS AND CONCLUSION：The levels of Th1, Th2, Th1/Th2, interferon-γ and interleukin-4 had no obvious differences between the two groups before flap transplantation. At 1 week after transplantation, the levels of Th1 and Th1/Th2 were higher, while the levels of Th2, interferon-γ and interleukin-4 were lower in the experimental group than the control group. Moreover, the incidence of complications was also lower in the experimental group than the control group. In conclude, dexamethasone can decrease the incidence of complications after island flap transplantation, which is maybe the result of adjusting immune balance of Th1/Th2.