瑰及乳膏联合重组人表皮生长因子治疗Ⅱ～Ⅲ压疮的临床分析

摘要

目的 探讨自制瑰及乳膏联合重组人表皮生长因子治疗Ⅱ～Ⅲ期压疮的机制.方法 采用随机数字表将84例Ⅱ～Ⅲ期压疮患者编号后随机均分为对照组和观察组 (n=42), 2组均给予相同的的基础治疗, 观察组在此基础上于压疮创面涂敷自制瑰及乳膏.在治疗的1、2、3和4周分别取患者压疮脱落肉芽组织, 采用免疫组织化学法检测压疮局部换药时剔出的弃用组织中转化生长因子 (TGF)-β1及血管内皮生长因子 (VEGF) 表达水平, 统计显效时间、愈合时间, 计算压疮愈合速度及有效率, 并采用压疮愈合量表 (PUSH) 评价临床疗效.结果 观察组在治疗第2、3和4周时, PUSH评分低于对照组同期水平 (P<0.05), TGF-β1及VEGF均高于对照组同期水平 (P<0.05);观察组创面显效时间和愈合时间明显缩短、压疮愈合速度提高、有效率达95.91％、与对照组比 (P<0.05), 差异有统计学意义.结论瑰及乳膏可能通过提高TGF-β1及VEGF的合成来促进压疮创面成纤维细胞生长和血管内皮新生, 这有利于改善压疮创面微循环、促进创面肉芽组织新生而加速创面组织修复.%Objective In order to investigate the mechanism of Guiji cream combined with recombinant human epidermal growth factor in the treatment of stage Ⅱ to Ⅲ pressure sores patients. Methods All of 84 Ⅱ to Ⅲpressure ulcer patients were randomly divided into control group and treatment group (n=42). Both two groups were given the same basic treatment while the treatment group was treated with Guiji cream. Granulation tissue from pressure sores were collected at the first, second, third and fourth week, respectively. The expression level of transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) were determined by immunohistochemistry. The effective time, healing time was collected and the corresponding rates were calculated. The PUSH score (pressure ulcer scale for healing) was used to evaluate clinical efficacy. Results At the second, third and fourth week, PUSH score of the treatment group was lower than the control group (P<0.05), and the expression level of TGF-β1 and VEGF were higher than that of the control group (P<0.05). The effective time and healing time in the treatment group were significantly shortened. The healing speed of pressure sore was increased, and the effective rate was 95.91％ when compared with the control group statistically significance (P <0.05). Conclusion Guiji cream may promote the growth of fibroblasts and vascular endothelial regeneration of pressure sore wounds by improving the synthesis of TGF-β1 and VEGF. Guiji cream is conducive to improve the microcirculation of pressure sore wounds, promote the regeneration of granulation tissue and accelerate the repair of wound tissue.