封闭负压引流早期处理软组织爆炸伤创面的实验研究

摘要

目的:观察封闭负压引流(vacuum-assisted closure,VAC)早期处理对软组织爆炸伤创面的影响,为战伤早期处理提供新的思路.方法:选取健康3月龄长白猪8头,体重(50±5)kg,雌雄不拘,用同一型号的电雷管(型号:660929F48840-55,含DDNP 0.3 g,RDX 0.7 g)紧贴双侧臀部皮肤,造成16个损伤程度相当的爆炸创面,左右创面配对分成实验组和对照组.在室外暴露3 h后进行创面的彻底清创,实验组用封闭负压引流处理,负压值维持在(-50±5)Kpa;对照组用无菌干纱布覆盖.分别于治疗前后进行大体观察、细菌学计数和革兰氏阳性(G+)细菌比例分析,以及采集病理学标本进行HE染色和Masson染色.结果:治疗3 d后实验组创面细菌数为[(7.82±0.55)×104]CFU/g,对照组为[(1.07±0.14)×106]CFU/g,两组间有统计学差异(P＜0.01);实验组G+细菌比例显著提高,对照组则没有变化;实验组创面清洁,较对照组有更丰富的新生肉芽组织、血管和胶原,坏死组织明显减少.结论:VAC能抑制创面细菌增殖,提高G+细菌的比例,促进创面愈合,可用于软组织爆炸创面的早期治疗.%Objective:To investigate the effect on early treatment with vacuum-assisted closure (VAC) to wound healing of acute explosion injury in pigs, and provide a new way for early treatment of battle wounds. Methods:Eight healthy 3-month Landrace pigs of both sexes with the body mass of (50±5) kg were selected in the study. Sixteen battle wounds were made by explosion of same type detonator (pattern number: 660929F48840-55,included DDNP 0.3 g, RDX 0.7 g) in hibateral skin of buttock of 8 pigs,which were divided into experimental group and control group(pair wounds of left and right). The raw sufaces were thorough debrided at 3 h after exposure,according to the characteristics of treatment on the battlefield,experimental group was treated with VAC under the pressure of(-50±5) Kpa after debridement and sterilization and control group was treated with routine dry sterile gauze draping. Results of bacteriology (bacterial counts and the proportion of G+ bacteria) and pathology (HE stain and Masson stain) were detected at every wound before and after treatment. Results:At the 3 days after treatment,the bacterial number in the experimental group was [ (7.82±0.55)×l04] CFU/g,in control group was [ ( 1.07±0.14)×l06] CFU/g.There was significant difference between two groups. The proportion of G+ bacteria in experimental group was significantly increased. The raw surface in experimental group was clean with affluent and neoformative granulation tissue,blood vessels and collagen, necrotic tissue decreased obviously by pathological observation. Conclusion: VAC could reduce the quantity of bacteria, improve the proportion of G+ bacteria, and promote the formation of granulation tissue and the healing of wound. The VAC for the treatment of battle wounds has a positive effect.