寒区野外家兔烧冻复合伤辅助高压氧治疗对植皮疗效的观察

The Observation of Therapeutical Effect of Skin Graft Plus Hyperbaric Oxygen on Compound Burn-cold Injury of Rabbit in the Wilds of Cold Area

目的 探讨烧冻复合伤后早期行植皮并辅助高压氧治疗 ,动态观察皮片生长及成活的情况 ,为临床救治提供依据。方法 将体质量 3 0 4 5kg大耳家兔在野外零下 2 0 2 2℃ ,风力 4 5级、湿度 75 %的自然环境下用混合燃料烧伤后再致冻 8 10h ,建立烧冻复合伤的模型 ,于伤后 10d行植皮治疗 ,按不同治疗方法分成两组 :(1)单纯植皮组 :创面行自体中厚皮片移植 ;(2 )复合高压氧植皮组 :行中厚自体皮片移植 ,同时辅助高压氧治疗 ,治疗给氧压为 0 2 5MPa一级导管给氧 ,每日 1次 ,共 15次。结果 (1)皮片生长数的变化 :复合组皮片 2d后开始生长 [(0 10 +0 10 6 )mm],4d后 80 %生长 ,8d后 10 0 %生长 ,10d后植皮区创面愈合 ;而单纯组 4d后皮片生长 [(0 0 8+0 2 10 )mm],10d后 5 0 %皮片生长 ,2周后 75 %的皮片成活 ,两组间有显著差异 (P <0 0 0 1)。 (2 )皮片组织病理观察 :复合组 4 8h后可见新生毛细血管伸至真皮与表皮之间 ,4d后有明显的毛细血管增生 ,8d后有明显的上皮增生。与单纯组 4d后皮片有新生的毛细血管建立 ,10d才可见明显的毛细血管增生 ,上皮有部分增生的现象比较 ,有显著差异。 (3)创面愈合情况 :单纯植皮组 2 0例 ,愈合 12例 ,感染 8例 ,感染率达4 0 % ,平均愈合时间 (2 0 5± 1 5 )d 。

Objective To discuss the effect of early skin graft plus hyperbaric oxygen on compound burn cold imjury through observing the growth of the flaps so as to put forward the evidence for its therapy.Methods The burn cold injury models were made by mixed fuel on the backs or buttocks of the experimental rabbits under the natural condition of -22 to -20℃ of temperature,4 to 5 degrees of wind power and 75% of humidity, and then exposed to the cold for 8 to 10 hours. Skin graft was carried out 10 days later.All the 40 models were divided into 2 grops at random (20/group):Group 1(skin graft alone)and Group 2 (skin graft plus hyperbaric oxygen).Results (1) Flap's growth.In Group 2,the flaps began to grow in 2 days’ time,and the wound was covered in 10 days time.In Group 1, the flaps began to grow in 4 days’time, and only 50% of the flaps survived. There was significant difference in the flap’s growing length at the same time( P <0 001).(2) Histopathology.In Group 2,regenerative capillaries reached the junction of epidermis and dermis in 48 hours,and capillary and epidermis proliferation clearly appeared respectively in 4 and 8 days’ time,while in Group 1,neither the regenerative capillaries nor epidermis proliferation were as good as those found in Group 1.(3) Healing of the wounds. In Group 1, 12 of 20 healed up with a mean time of 20.5 days clearly longer than that in Group 1 ( 10 5 days ), and 8 suffered from infection.No infection was found in Group 2.Conclusion It is suggested that skin graft plus hyperbaric oxygen have an ideal therapeutical effect on compound burn cold injury,such as good growth of the flaps, fast heal of the wounds and low infection rate.