VSD联合表皮生长因子治疗皮肤软组织缺损的效果研究

The Effect of VSD Combined with Epidermal Growth Factor in Treatment of Skin and Soft Tissue Defects

目的:探讨负压封闭引流(Vacuum sealing drainage,VSD)联合表皮生长因子治疗皮肤软组织缺损的效果。方法:选取2017年1月-2018年1月治疗的四肢皮肤软组织缺损患者102例,根据最终采取的治疗方案分为联合组(n=41)、VSD组(n=31)和表皮生长因子组(n=30),所有患者行手术清创并行自体皮片移植修复,联合组给予VSD联合表皮生长因子治疗,VSD组给予单纯VSD治疗,表皮生长因子组给予表皮生长因子治疗,观察各组植皮存活率、瘢痕评分及疼痛程度,同时检测治疗前后干扰素-γ(Interferon-γ,IFN-γ)、白细胞介素-6(Interleukin-6,IL-6)和C反应蛋白(C-reactiveprotein,CRP)。结果:联合组植皮存活率为95.12%(39/41),明显高于VSD组的74.19%(23/31)和表皮生长因子组的73.33%(22/30),差异有统计学意义(P<0.05)。联合组瘢痕柔软度、血管分布、厚度、色泽评分及总分明显低于VSD组和表皮生长因子组,差异有统计学意义(P<0.05)。各组治疗后7dIFN-γ、IL-6和CRP明显高于治疗前,差异有统计学意义(P<0.05);联合组治疗后7dIFN-γ、IL-6和CRP明显低于VSD组和表皮生长因子组,差异有统计学意义(P<0.05)。联合组术后1周、1个月VAS评分明显低于VSD组和表皮生长因子组,差异有统计学意义(P<0.05)。结论:VSD联合表皮生长因子治疗皮肤软组织缺损有较好的效果,值得临床应用。

Objective To investigate the effect of vacuum sealing drainage (VSD) combined with epidermal growth factor in the treatment of skin and soft tissue defects. Methods 102 patients with soft tissue defects of the extremities were treated from January 2017 to January 2018, according to the final treatment, the patients were divided into the combined group (n =41), the VSD group (n =31) and the epidermal growth factor group (n =30), all patients underwent surgical debridement and autologous skin graft repair. The combined group was treated with VSD combined with epidermal growth factor, the VSD group was treated with VSD alone, the epidermal growth factor group was treated with epidermal growth factor. The survival rate of skin graft, scar score and the degree of pain in the each groups were observed, interferon-γ(IFN-γ), interleukin-6 (IL-6) and C-reactive protein(CRP) were detected before and after treatment. Results The survival rate of skin graft in the combined group was 95.12%(39/41), which was significantly higher than those in the VSD group and the epidermal growth factor group[74.19%(23/31), 73.33%(22/30)], the differences were statistically significant (P <0.05). Scar softness, vascular distribution, thickness, color score and total score in the combined group were significantly lower than those in the VSD group and the epidermal growth factor group(P <0.05). The levels of IFN-γ, IL-6 and CRP in each group were significantly higher at 7d after treatment than those before treatment(P <0.05). The levels of IFN-γ, IL-6 and CRP in the combined group were significantly lower than those in the VSD group and the epidermal growth factor group at 7d after treatment(P <0.05). The VAS score of combined group was significantly lower than that of VSD group and epidermal growth factor group at 1 week and 1 month after operation(P <0.05). Conclusion VSD combined with epidermal growth factor is effective in treating skin and soft tissue defects, and is worthy of clinical application.