目的 评价伤后24 h内削痂治疗大面积深Ⅱ度烧伤的安全性,探讨其减轻深Ⅱ度烧伤创面炎症反应,防止创面进行性损害,促进IL-1释放,加快创面愈合的作用.方法 12例大面积以深Ⅱ度烧伤为主的患者,每例患者均选择相对均匀的深Ⅱ度创面作为实验创面并分为3个研究区域:手术前、手术后和未手术实验区.伤后24 h内行削痂术,手术前标本取自削痂术前创面,手术后和未手术实验区标本于术后3～5 d获取.采用HE染色和Masson染色技术对创面组织处理后进行组织学观察,并观察创面的炎症反应程度;采用免疫组化染色技术观察局部组织释放IL-1的水平并进行半定量分析.记录手术中和手术前后患者的临床指标,并记录不同处理方式创面的愈合时间.结果 (1)12例患者24 h内进行削痂手术,均未出现因手术打击而发生的并发症,生命体征平稳.(2)12例患者烧伤创面组织标本的组织学检查发现,在伤后3～5 d未手术实验区创面由凝固性坏死演化成液性坏死,创面炎症反应明显加重,组织坏死范围扩大,原来残留的少量皮肤附件大部分消失;而伤后24 h内削痂治疗的创面,局部残留的皮肤附件保存良好,未见明显的组织进行性坏死.对炎症反应程度进行组织学观察结果表明手术组削痂后炎症反应程度较未手术创面明显减轻.(3)IL-1表达水平所得的半定量分析结果表明24 h内削痂手术的创面组织局部释放IL-1水平较手术前和未手术创面有显著升高,差异有统计学意义(P＜0.05).(4)采取24 h内削痂处理的创面比传统手术时间处理的创面愈合可提前7 d左右.结论 在积极并且有效的抗休克、保证患者充足血容量的情况下,对大面积深Ⅱ度烧伤创面24 h内进行削痂手术是安全的;24 h内削痂能够及时去除创面坏死组织,降低创面组织的炎症反应程度,防止烧伤创面的进行性损害,增加IL-1的释放,加快烧伤创面的愈合.%Objective To evaluate the security of tangential excision within 24 hours after burn with the massive deep Ⅱ degree wounds, in order to reduce the irflammation and prevent the wound progressive damage, promote the release evel of IL-1 to the deep Ⅱ degree burn wounds,and accelerate wound healing. Methods 12 patients with massive deep Ⅱ degree burns were studied. Each burn wound of the selected patients was divided into three regions :the preoperation area,post-operation area and non-operation area. Tangential excision was performed within 24 hours postburn. For each patient ,the samples from the pre-operation area were collected before the tangential excision,those from post-operation and non-operation area were gained on 3 -5 days postoperation. The tissue specimens were treated by histopathologically HE staining and Masson staining,and the extent of wound inflammation responds was examined. The release level of IL-1 was experimented by immunohistochemical techniques. Some of indexes were recorded during operation, preoperation and postoperation. And wound healing time was recorded. Results ( 1 )Under effective anti-shock with adequate fluid resuscitation ,there was not any complications occurrence during operation, preoperation and postoperation, and the vital signs were stable. ( 2 )Histropathologica examination of the samples showed that the wound of non-operation area after burn for 3-5 days had changed from the coagulation necrosis to solution necrosis, the wound inflammation responds had significantly increased,necrosis area had extended ,most of appendages of the skin had disappeared ;but the appendages of wound post-operation were still reserved, there was no obvious tissues necrosis. ( 3 )the outcome obtained from the expression of IL-1 semi-quantitative analysis showed that the release level of IL-1 in the partial tissue from the post-operation area has significantly increased than the non-operation area and the pre-operation area( P ＜ 0.05 ),and the difference was significant statistically. ( 4 )The wound which received the tangential excision with in 24 hours could be 7 days in advance to traditional surgical treatment. Conclusion Under effective anti-shock with adequate fluid resuscitation,tangential excision within 24 horus after burn to the massive deep Ⅱ degree wound is safe. It maybe beneficial to remove the necrotic tissue earlier,reduce the inflammation respond, prevent form the progression of tissue degenerative injury, promote the IL-1 reease and accelerate the wound healing.
展开▼
