再次妊娠剖宫产应用重组人酸性成纤维细胞生长因子的临床价值评价

摘要

Objective To evaluate the clinical value of recombinant human acidic fibroblast growth factor in cesarean section for a second time pregnancy.And to study initially its best route of administration.Methods A prospective parallel randomized controlled clinical study was conducted to compare the efficacy of recombinant human acidic fibroblast growth factor in cesarean section for a second time pregnancy. These cases were randomly prospective divided into three groups,the placebo group(treated with saline washing during operation),the spray group(treated with rh-aFGF atomizing) and rinse group(treated with rh-aFGF washing during operation).The bleeding,pain,wound healing time,in-hospital days,number of delayed healing,Scar diameter and Clinical symptoms were observed every days.Results Washing rh-aFGF during operation significantly decrease the completely healing time(6.95±3.88 vs 11.43±4.15,P=0.022),scar diameter(8.02±2.25 vs 11.83±3.17,P=0.036),incidence of pruritus(10.48%vs 42.57%,P=0.018) and incidence of incisional pain(5.71%vs 20.79%,P=0.022)comparing with placebo group.Also it can significantly decrease the completely healing time(6.95±3.88 vs 9.87±3.72,P=0.047),scar diameter(8.02±2.25 vs 9.41±2.96,P=0.025) and incidence of incisional pain(5.71%vs 15.46%,P=0.047) when comparing with atomizing.Conclusion Recombinant human acidic fibroblast growth factor can not only shorted the wound healing time of cesarean,but also decrease the scar area,the incidence of pain and itching.Washing during the operation is the best route of administration.%目的：通过对再次妊娠剖宫产妇女切口愈合的应用，评价重组人酸性成纤维细胞生长因子（rhaFGF）的临床价值，并初步探寻其最佳的给药方式。方法：采用开放性临床随机对照试验设计，随机分为喷雾治疗组、冲洗治疗组和安慰剂组，喷雾组于皮肤缝合后进行rhaFGF喷雾于切口处或纱布，冲洗组于皮肤缝合前用rhaFGF清洗创面，缝合皮肤后采用喷雾组的治疗方案；安慰剂组于皮肤缝合前用生理盐水冲洗切口。术后随访观察并记录产妇切口完全愈合时间、延迟愈合人数、住院时间、临床症状，测量产妇瘢痕直径，统计患者术后切口瘙痒、后遗疼痛发生的情况。结果：与安慰剂组相比，冲洗组完全愈合时间（6.95±3.88 d与11.43±4.15 d，P=0.022），瘢痕直径（8.02±2.25 cm与11.83±3.17 cm，P=0.036）、瘙痒发生率（10.48%与42.57%，P=0.018）、后遗疼痛发生率（5.71%与20.79%，P=0.022）等方面呈现显著性差异；与喷雾组相比，冲洗组完全愈合时间（6.95±3.88 d与9.87±3.72 d， P=0.047），瘢痕直径（8.02±2.25 cm与9.41±2.96 cm，P=0.025），后遗疼痛发生率（5.71%与15.46%，P=0.047）等方面组间比较差异有统计学意义（P＜0.05）。结论：重组人酸性成纤维细胞生长因子可缩短剖宫产切口完全愈合时间，减少瘢痕直径、瘙痒和瘙痒发生率，冲洗治疗方式效果最佳。