自体富血小板血浆凝胶治疗难治性压力性损伤的疗效

Effect of autologous platelet-rich plasma gel on refractory stress injury

目的探讨自体富血小板血浆凝胶(autologous platelet-rich plasma gel,APG)治疗难治性压力性损伤的效果。方法选取2019年10月—2021年10月海军军医大学第一附属医院收治的难治性压力性损伤患者80例,随机分为两组各40例,对照组采用常规治疗,观察组采用APG治疗,比较两组治疗不同时间点溃疡面积、溃疡愈合时间、压力性损伤愈合评估量表得分、生长因子水平、临床疗效及生活质量。结果观察组治疗6、9、15 d溃疡面积(11.86±3.93)cm、(10.16±2.96)cm、(8.37±2.85)cm小于对照组(14.58±3.27)cm、(13.18±3.82)cm、(11.92±3.17)cm(t=3.365,P=0.001;t=3.952,P<0.001;t=5.267,P<0.001);观察组创面愈合时间(18.26±5.22)d短于对照组(25.57±5.38)d,压力性损伤愈合评估量表评分(3.97±1.27)低于对照组(6.46±1.65)(t=6.167、7.563,均P<0.001);观察组临床有效率(95.00%)高于对照组(77.50%)(χ^(2)=5.165,P=0.023);观察组治疗6d VEGF(0.61±0.23)ng/mg、IGF-1(32.84±11.48)ng/mg、EGF(13.27±5.23)pg/mg、PDGF-BB(19.82±6.35)pg/mg、TGF-B1(0.45±0.14)ng/mg高于对照组(0.24±0.16)ng/mg、(19.24±9.76)ng/mg、(10.13±4.82)pg/mg、(13.48±5.38)pg/mg、(0.27±0.16)ng/mg(t=8.352,P<0.001;t=5.708,P<0.001;t=2.792,P=0.007;t=4.818,P<0.001;t=5.355,P<0.001);观察组治疗15 d VEGF(0.47±0.22)ng/mg、IGF-1(26.92±8.62)ng/mg、EGF(13.72±4.64)pg/mg、PDGF-BB(16.53±5.92)pg/mg、TGF-B1(0.34±0.12)ng/mg高于对照组(0.31±0.17)ng/mg、(16.26±6.83)ng/mg、(9.26±3.84pg/mg、(11.74±6.28)pg/mg、(0.21±0.15)ng/mg(t=3.640、6.130、4.683、3.510、4.280,均P<0.001);观察组治疗30d生活质量评分(78.17±6.29)高于对照组(68.21±5.93)(t=7.287,P<0.001)。结论APG治疗难治性压力性损伤能够缩短创面愈合时间、提高临床疗效与生活质量。

Objective To investigate the effect of autologous platelet-rich plasma gel(APG)on refractory stress injurys.Methods Totally 80 patients with refractory stress injury admitted from Oct 2019 to Oct 2021 were selected and assigned into 2 groups randomly(40 cases each group),The control group was treated with routine treatment,and the observation group was treated with APG,Ulcer area at different time points,ulcer healing time,pressure injury healing scale score,growth factor level,clinical efficacy and quality of life were compared between the two groups.Results The ulcer area of the observation group(11.86±3.93)cm,(10.16±2.96)cm,(8.37±2.85)cm were lower than those of the control group(14.58±3.27)cm,(13.18±3.82)cm,(11.92±3.17)cm after 6,9,15 days of treatment(t=3.365,P=0.001;t=3.952,P<0.001,t=5.267,P<0.001);ulcer healing time(18.26±5.22)d in the observation group was shorter than that in the control group(25.57±5.38)d,pressure injury healing scale score(3.97±1.27)in the observation group was lower than that in the control group(6.46±1.65)(t=6.167,7.563;both P<0.001);Clinical efficacy rate(95.00%)in the observation group was higher than that in the control group(77.50%)(χ^(2)=5.165,P=0.023),VEGF(0.61±0.23)ng/mg,IGF-1(32.84±11.48)ng/mg,EGF(13.27±5.23)pg/mg,PDGF-BB(19.82±6.35)pg/mg,TGF-B1(0.45±0.14)ng/mg in the observation group were hither than those in control group 6 d after treatment(t=8.352,P<0.001;t=5.708,P<0.001;t=2.792,P=0.007;t=4.818,P<0.001;t=5.355,P<0.001),VEGF(0.47±0.22)ng/mg,IGF-1(26.92±8.62)ng/mg),EGF(13.72±4.64)pg/mg,PDGF-BB(16.53±5.92)pg/mg,TGF-B1(0.34±0.12)ng/mg in the observation group were higher than those in the control group 15 d after treatment(0.31±0.17)ng/mg,(16.26±6.83)ng/mg,(9.26±3.84)pg/mg,(11.74±6.28)pg/mg,(0.21±0.15)ng/mg(t=3.640,6.130,4.683,3.510,4.280,all P<0.001).Conclusion APG treatment of refractory stress injury can shorten wound healing time and improve clinical efficacy and quality of life.