高压氧对兔耳创面模型早期瘢痕组织形成的影响

摘要

目的 通过观察高压氧对兔耳创面愈合及瘢痕形成的影响,以探讨在临床中应用高压氧防治早期瘢痕的可行性.方法 选取新西兰白兔16只建立兔耳增生性瘢痕模型,每只兔左耳4个创面,右耳4个创面,共128个,随机分为高压氧组与对照组2组,每组8只,64个创面.高压氧组术后立即开始高压氧处理,2个大气压,吸氧60 min,每日1次,疗程以创面愈合为准.期间观察记录创面愈合情况以及兔耳瘢痕大小、厚度、颜色、硬度.待创面全部愈合后,切取创面进行HE染色,Masson染色和苦味酸天狼星红染色,行病理学观察、检测及分析.结果 高压氧组愈合时间为(16.7±1.8)d；对照组为(20.2±2.3)d,差异有统计学意义(P＜0.05).高压氧组瘢痕增生发生率较对照组低,实验组发生率为(38/64,59.4％),对照组发生率为(52/64,81.2％),差异有统计学意义(P＜0.05).光镜下观察,高压氧组真皮层较对照组薄,成纤维细胞数量较少,胶原较疏松,排列较整齐,胶原结节和漩涡状结构少.瘢痕增生指数,高压氧组为3.48±0.94,对照组为4.65 ±0.76,差异有统计学意义(P＜0.01).成纤维细胞密度,高压氧组为186.5±27.3,对照组为246±41.6,差异有统计学意义(P＜0.05).胶原纤维面密度,高压氧组为(31.42±5.36)％,对照组为(43.62±7.36)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原含量,高压氧组分别为(71.42±5.36)％和(28.58±5.36)％,对照组为(62.46±7.32)％和(37.54±7.32)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原比例,高压氧组为2.499,对照组为1.664,高压氧组比例更为接近正常皮肤Ⅰ型和Ⅲ型胶原约4∶1的比例.结论 高压氧可促进创面愈合,并对兔耳早期增生性瘢痕有较明显的抑制作用.%Objective To observe the effect of hyperbaric oxygen on the scar tormation at the rabbit ears at an early stage.Methods 16 New Zealand rabbits were used to estabolish the hypertrophic scar model on the ears,4 wounds on each ear.The rabbits were randomly divided into hyperbaric group(n =8) and control group(n =8).The rabbits in the hyperbaric group received hyperbaric oxygen treatment,inhaling oxygen for 1 hour daily under 2ATA circumstance until the wounds were healed.The wound healing and the scar size,thickness,color and hardness in the ears were recorded.After healing,the scar was taken for histologic study with HE staining,Masson staining and trinitrophenol siriue red staining.Results In hyperbaric oxygen group,the healing time of 64 wounds was (16.7 ± 1.8) d,while it was (20.2 ± 2.3) d in the control group,suggesting a significant difference between two groups (P ＜ 0.05).The incidence of hyperplastic scar was lower (38/64,59.4％) in hyperbaric oxygen group than that (52/64,81.2％) in control group with significant difference between them (P ＜ 0.05).Compared with the control group,the hyperbaric oxygen group had thicker corium layer and less fibroblasts,well-arranged but rare collagen and less collagen nodus and vortex-like structure under microscope.The hyperplastic index of scar was 3.48 ± 0.94 in hyperbaric oxygen group and 4.65 ± 0.76 in control group respectively (P ＜0.01).The density of fibroblast in two groups were 186.5 ± 27.3 (hyperbaric oxygen group) and 246 ±41.6 (control group) with statistically significant difference (P ＜ 0.05).Furthermore,the area density of collagen fiber were (31.42 ± 5.36) ％ in hyperbaric group and (43.62 ± 7.36) ％ in control group (P ＜0.05).The amount of collagen Ⅰ and Ⅲ was (71.42 ± 5.36)％ and (28.58 ± 5.36)％ in hyperbaric oxygen group,(62.46 ± 7.32) ％ and (37.54 ± 7.32) ％ in control group (P ＜ 0.05).The ratio of collagen Ⅰ to Ⅱ was 2.499 in hyperbaric oxygen group,which was similar to the ratio (4∶1) in normal skin,compared with the control group (1.664).Conclusions The hyperbaric oxygen can promote wound healing and effectively inhibit the early hyperplastic scar in rabbits ears.