封闭负压引流技术对海水浸泡爆炸伤创面TNF-α表达和细菌指数的影响

Effect of Vacuum sealing drainage on tumor necrosis factor alpha expression and bacteriological index in swine seawater-immersed blast-injury wounds

目的:通过动态对比观察封闭负压引流技术(vacuum sealing drainage,VSD)对猪皮肤软组织海水浸泡爆炸创伤面TNF-α表达和细菌指数的影响,寻找最适治疗压力范围。方法:以5头小型猪为实验动物,于每头猪的双侧臀部和肩胛部制造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-120mm Hg负压组、VSD-180mm Hg负压组、VSD-240mm Hg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(即第58d),分别于治疗前、治疗后1d、3d、5d、7d、9d,取各组创面肉芽组织检测TNF-α水平和细菌指数。结果:1治疗后的前3d,实验组与对照组间细菌指数差异不明显,3d后,实验组与对照组相比细菌指数明显降低(P<0.01),但相邻不同压力组间差异不明显(P>0.05);2实验组各组创面经治疗后细菌均由海水细菌向猪皮肤寄生菌过渡、由G-菌向G+菌过渡,而对照组细菌变化较实验组相对缓慢;3各组创面在治疗过程中肉芽组织的TNF-α水平均表现为先升高后逐渐下降。与对照组相比,实验组上升、下降速度较快,峰值出现早且高,于第5天到峰值,之后快速下降(P<0.01),以VSD-120mm Hg组变化最快,其次是VSD-180mm Hg组,但相邻压力组间差异不显著(P>0.05)。结论:在治疗海水浸泡爆炸创面时,VSD技术可通过减少创面细菌指数、改变细菌构成、调节TNF-α表达等减轻创面炎症,促进创面愈合。

Objective To dynamically observe the effect of tumor necrosis factor alpha and bacteriological index at different negative pressures of Vacuum sealing drainage（VSD）on seawaterimmersed blast-injury wounds so as to grope the optimal therapeutic negative pressure range.Methods The seawater-immersed blast-injury wounds were established on 5 experimental miniature swine at two sides of shoulders and hips.Each swine has 4 wounds and divided into 4groups randomly：control group,VSD-120 mm Hg group,VSD-180 mm Hg group and VSD-240 mm Hg group.All the wounds were removal of necrotic tissue and foreign bodies before treatment.The experimental groups were treated with VSD,and the control group was treated by regular method.The treatment on each wound continued for 9 days,and the observation continued until the 58 thday.Tumor necrosis factor alpha expression and bacteriological index of wounds granulation tissue were respectively observed at 0,1,3,5,7,9 day and comparison were made among them.Results 1The bacteriological index of the experimental groups were decreased after treatment,but the control group＇s was increased in the first 3 days of treatment.The bacteriological index of the experimental groups was significantly lower than that of the control group after 3 days＇ treatment（P〈0.01）.2The bacterial composition took an obvious tendency of transition from seawater bacterium to skin fungus and from G-bacterium to G＋bacterium.Compared with the experimental groups,the control group was slower in the rate of transition.3In all groups,the TNF-α expression on wounds granulation tissue increased after trauma.Compared with the control group,the rate of increase and decrease were faster,and the summit peek value came earlier and higher significantly（P〈0.01）.The comparison among the adjacent pressure groups showed no statistical significance（P〉0.05）.Conclusions Compared with conventional therapy,VSD shows clear benefits during the treatment of seawater-immersed blastinjury wounds.The wounds inflammation was reduced by decreasing bacteriological index,changing bacterial composition,adjusting TNF-α expression and so on in experimental groups,and-120 mm Hg pressure may be relatively ideal pressure.