复合皮移植技术与富血小板血浆对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度的影响

Effect of Composite Skin Transplantation and Platelet-rich Plasma on the Level of Serum Infl ammatory Factors and Aesthetic Degree in Patients with Large Area Scar after Burn

目的:探讨复合皮移植技术与富血小板血浆(Platelet-rich plasma,PRP)对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度影响。方法:选取2016年11月-2018年11月笔者医院收治的96例烧伤后大面积瘢痕整复患者,按照随机数表法,分成对照组和研究组,每组各48例。其中对照组患者给予复合皮移植术,研究组患者采用PRP治疗,术后两组患者均定期换药。观察两组患者的创面愈合时间和临床疗效,观察两组患者炎症因子γ-干扰素(IFN-γ)、白细胞介素-2(IL-2)和白细胞介素-6(IL-6)治疗前后的变化情况,观察两组患者血管内皮生长因子(VEGF)和转化生长因子-β1(TGF-β1)的水平,采用OSAS瘢痕评价量表评价两组患者术后的美观度并比较两种方式的安全性。结果:研究组平均愈合时间明显短于对照组,且研究组总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的IFN-γ和IL-2较治疗前均有明显改善,且研究组均明显高于对照组,差异有统计学意义(P<0.05)。研究组患者治疗后IL-6水平明显低于治疗前,差异有统计学意义(P<0.05)。研究组患者术后5d和10d血清中VEGT和TGF-β1的水平均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的瘢痕平整度、瘢痕弹性程度和瘢痕颜色均有明显改善,研究组改善更明显,差异均有统计学意义(P<0.05)。研究组总不良反应发生率为4.17%明显低于对照组的18.75%,差异有统计学意义(P<0.05)。结论:PRP对烧伤后大面积瘢痕患者具有明显的临床优势,可加快创面愈合,有效降低血清炎症因子水平,减少瘢痕生长,安全性更高,值得临床推广。

Objective To study the effects of composite skin transplantation and platelet-rich plasma(PRP)on the level of serum infl ammatory factors and aesthetics in patients with large area scar after burn.Methods From November 2016 to November 2018,96 patients with large area scar after burn were treated in our hospital.According to the method of random table,the patients were divided into the control group(n=48)and the study group(n=48).The patients in the control group were treated with compound skin transplantation,the patients in the study group were treated with PRP,and both groups changed dressing regularly after operation.To observe the wound healing time and clinical effi cacy of the two groups,and to compare the changes of inflammatory factors IFN-γ,IL-2 and IL-6 before and after treatment,and to observe the levels of vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGF-β1)in the two groups.In addition,OSAS scar evaluation scale was used to evaluate the postoperative aesthetic degree of the two groups and compare the safety of the two methods.Results The average healing time of the study group was signifi cantly shorter than that of the control group,and the total effective rate of the study group was signifi cantly higher than that of the control group,the differences were statistically signifi cant(P<0.05).The IFN-γand IL-2 in the two groups were signifi cantly improved compared with those before treatment,and the IFN-γand IL-2 in the study group were signifi cantly higher than those in the control group(P<0.05).The level of IL-6 in the study group was signifi cantly lower than that before treatment(P<0.05).The serum levels of VEGT and TGF-β1 in the study group were signifi cantly higher than those in the control group(P<0.05).After treatment,the smoothness,elasticity and color of scars in the two groups were signifi cantly improved,especially in the study group(P<0.05).The total incidence of adverse reactions in the study group was 4.17%,which was signifi cantly lower than that in the control group(18.75%,P<0.05).Conclusion PRP has obvious clinical advantages and higher safety in patients with large area burn scar,it can accelerate wound healing,effectively reduce the serum levels of infl ammatory cytokines and reduce scar growth,it is worthy of clinical promotion.