摘要
目的探讨使用富血小板血浆(PRP)联合负压封闭引流(VSD)治疗深Ⅱ度烧伤的效果及对其血清炎症因子和血管生长因子水平的影响。方法前瞻性选取2021年7月至2024年6月期间鄂州市中心医院收治的深Ⅱ度烧伤患者126例作为研究对象。按照随机数字表法将患者分为观察组和对照组,每组各63例。对照组予以单一VSD治疗,观察组予以PRP联合VSD治疗。比较两组患者的疗效;比较两组患者治疗前和治疗14 d后的创面症状体征评分、疼痛程度[视觉模拟评分法(VAS)评分],治疗后1、2个月的创面瘢痕情况[温哥华瘢痕量表(VSS)评分],治疗前和治疗14 d后的血清炎症因子[细胞间黏附分子-1(ICAM-1)和肿瘤坏死因子-α(TNF-α)]、血管生长因子[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)]水平,并记录两组的并发症发生情况。结果观察组的总有效率为95.24%,显著高于对照组(82.54%),差异有统计学意义(P<0.05)。治疗后14 d,两组的创面症状体征评分均较治疗前降低,且观察组的创面症状体征评分均低于对照组,差异均有统计学意义(P<0.05)。治疗后14 d,两组的VAS评分均较治疗前降低,且观察组的VAS评分为(1.65±0.52)分,低于对照组[(2.47±0.64)分],差异均有统计学意义(P<0.05)。观察组治疗后1、2个月的VSS评分分别为(7.74±2.06)、(4.14±1.25)分,均低于对照组[(8.87±2.34)、(5.21±1.64)分],差异均有统计学意义(P<0.05)。治疗后14 d,两组血清ICAM-1、TNF-α水平均较治疗前降低,且观察组血清ICAM-1、TNF-α水平分别为(567.14±98.42)ng/mL、(75.69±9.21)μg/L,均低于对照组[(612.37±95.37)ng/mL、(87.54±10.25)μg/L],差异均有统计学意义(P<0.05)。治疗后14 d,两组VEGF和bFGF水平均较治疗前升高,且观察组VEGF和bFGF水平分别为(627.69±74.51)、(201.58±20.36)μg/L,均高于对照组[(583.41±69.32)、(178.65±18.43)μg/L],差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论PRP联合VSD治疗深Ⅱ度烧伤患者能够提高疗效,其机制可能与减少炎症因子水平、上调血管生成相关因子表达有关。
Objective To investigate the effect of platelet rich plasma(PRP)combined with vacuum sealing drainage(VSD)in the treatment of deep second degree burn and its effect on serum inflammatory factors and vascular growth factor levels.Methods A total of 126 patients with deep second degree burn admitted to Ezhou Central Hospital from July 2021 to June 2024 were prospectively selected as the study subjects.According to the random number table method,the patients were divided into the observation group and the control group,with 63 cases in each group.The control group was treated with single VSD,and the observation group was treated with PRP combined with VSD.The curative effects of the two groups were compared.The scores of wound symptoms and signs,pain degree[visual analogue scale(VAS)score],wound scar condition[Vancouver scar scale(VSS)score]at 1 and 2 months after treatment,serum inflammatory factor[intercellular adhesion molecule-1(ICAM-1)and tumor necrosis factor-α(TNF-α)],vascular growth factor[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)]levels before treatment and 14 days after treatment were compared between the two groups,and the occurrence of complications in the two groups was recorded.Results The total effective rate of the observation group was 95.24%,which was significantly higher than that of the control group(82.54%),the difference was statistically significant(P<0.05).At 14 days after treatment,the scores of wound symptoms and signs in the two groups were lower than those before treatment,and the scores of wound symptoms and signs in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).At 14 days after treatment,the VAS scores of the two groups were lower than those before treatment,and the VAS score of the observation group was(1.65±0.52)points,which was lower than that of the control group[(2.47±0.64)points],the differences were statistically significant(P<0.05).The VSS scores of the observation group at 1 and 2 months after treatment were(7.74±2.06)and(4.14±1.25)points,respectively,which were lower than those of the control group[(8.87±2.34)and(5.21±1.64)points],and the differences were statistically significant(P<0.05).At 14 days after treatment,the levels of serum ICAM-1 and TNF-αin the two groups were lower than those before treatment,and the levels of serum ICAM-1 and TNF-αin the observation group were(567.14±98.42)ng/mL and(75.69±9.21)μg/L,respectively,which were lower than those in the control group[(612.37±95.37)ng/mL,(87.54±10.25)μg/L],the differences were statistically significant(P<0.05).At 14 days after treatment,the levels of VEGF and bFGF in the two groups were higher than those before treatment,and the levels of VEGF and bFGF in the observation group were(627.69±74.51)and(201.58±20.36)μg/L,respectively,which were higher than those in the control group[(583.41±69.32)and(178.65±18.43)μg/L],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion For patients with deep second degree burn,PRP combined with VSD treatment can improve the curative effect,and its mechanism may be related to reducing the level of inflammatory factors and up-regulating the expression of angiogenesis-related factors.
作者
张炜
贺胜
黄瑛
皮利华
章强
吴海东
左志刚
ZHANG Wei;HE Sheng;HUANG Ying(Department of Burn Plastic Surgery and Slow Creation,Ezhou Central Hospital,Ezhou Hubei 436000,China)
出处
《临床和实验医学杂志》
2025年第18期1965-1969,共5页
Journal of Clinical and Experimental Medicine
基金
湖北省卫生计生委科研项目(编号:WJ2021M072)。
关键词
烧伤
富血小板血浆
负压伤口疗法
炎症反应
血管新生
Burn
Platelet-rich plasma
Negative pressure wound therapy
Inflammation
Angiogenesis
