人工真皮修复大面积烧伤复杂创面临床疗效及对炎性因子、免疫功能的影响

摘要

目的 观察人工真皮+自体刃厚皮移植术修复大面积烧伤复杂创面的临床价值及其对炎性因子、免疫功能影响.方法 选择2014年1月-2017年5月河北友爱医院收治的大面积烧伤复杂创面患者90例,将所有患者根据随机数字表法分为2组.观察组45例,先予以烧伤后复杂创面人工真皮(皮耐克)治疗后,再予以刃厚皮植皮术治疗;对照组45例,予以中厚皮片植皮术治疗.比较2组术后皮片成活情况、瘢痕形成情况及对炎性因子、免疫功能的影响.结果 观察组植皮总有效率为95.56％,高于对照组的82.22％,差异具有统计学意义(x2=4.050,P＜0.05);观察组瘢痕柔软性、血管情况、色素情况、高度评分以及总分均优于对照组,差异具有统计学意义(t=4.597、3.293、4.073、4.261、6.802,P＜0.05);观察组创面愈合时间短于对照组,差异具有统计学意义(t=9.288,P＜0.01);观察组术后3周白介素-2(IL-2)、干扰素-γ(IFN-γ)水平高于对照组,白介素-6(IL-6)水平低于对照组,差异具有统计学意义(t=20.887、1.999、3.056,P＜0.05);观察组术后CD4+、CD8+显著低于对照组,CD4+/CD8+值高于对照组,差异具有统计学意义(t =2.17、3.047、3.157,P＜0.05).结论 对大面积烧伤复杂创面患者实施人工真皮(皮耐克)修复+自体刃厚皮植皮术治疗,能提高植皮成活率,减轻瘢痕增生,缩短愈合时间,免疫排斥性较小.%Objective To explore the clinical value of artificial dermis and autologous split-skin grafting repair for complex wounds caused by extensive burns and its effects to inflammatory factors and immunologic function.Methods 90 patients with complex wounds caused by extensive burns who had been seeking treatment in the hospital between January 2014 and March 2017 were selected,and were randomly divided into two groups according to the random number table method,45 cases were set as the experimental group,first to burn skin treatment and then to give razor-thin skin graft surgery;45 cases in the control group to be medium thickness skin graft treatment.The skin grafting,scar formation,inflammatory factors and immune function were compared between the two groups.Results The total effective rate of skin grafting in the experimental group was 95.56％,higher than that in the control group,which was 82.22％,and the difference was statistically significant (x2 =4.050,P ＜ 0.05);scar limpness,blood vessel,pigment,height and total scores in the experimental group were shown to be lower than the control group,and the differences were statistically significant(t =4.597,3.293,4.073,4.261,6.802,P ＜0.05);wound healing time in the experimental group was shown to be shorter than the control group,and the difference was statistically significant (t =9.288,P ＜ 0.05);interleukin-2 (IL-2) and interferon-γ (IFN-γ) in the experimental group were higher than the control group,interleukin-6 (IL-6) level in the experimental group was shown to be lower than the control group,and the differences were statistically significant (t =20.887,1.999,3.056,P ＜ 0.05);postoperative CD4 + 、CD8 + in the experimental group were shown to be significantly lower than the control group while CD4 +/CD8 + was higher,and the difference was statistically significant (t =2.170,3.047,3.157,P ＜0.05).Conclusion For patients with complex wounds caused by extensive bums,artificial dermis and autologous split-skin grafting repair can improve the survival rate of skin grafting,reduce scar hyperplasia,shorten the healing time,and is with less immune repellency.