局部氧疗联合封闭式负压引流对豚鼠Ⅲ期压疮创面愈合的影响

摘要

Objective To investigate the effect of topical oxygen therapy combined with vacuum-assisted closure on the would healing of stage Ⅲ pressure ulcer in guinea pigs, and explore the mechanism. Methods Stage Ⅲ pressure ulcers in the left trochanter major of guinea pigs ( n = 20) were prepared, and were divided into sequential combined intervention group ( - 125 mmHg vacuum-assisted closure for 320 min and 5 L/min topical oxygen therapy for 160 min) , alternate combined intervention group ( - 125 mmHg vacuum-assisted closure for 40 min and 5 L/min topical oxygen therapy for 20 min, alternation for 8 times) , vacuum-assisted closure group ( - 125 mmHg vacuum-assisted closure for 40 min, then suspension for 20 min, and repeat for 8 times) , topical oxygen therapy group (5 L/min topical oxygen therapy for 20 min, then suspension lor 40 min, and repeal for 8 times) and blank control group ( conventional treatment for wound, and no vacuum-assisted closure and topical oxygen therapy) according to different treatment for wound. Wound areas were measured and wound shrinkage rates were calculated before wound formation and on the first, third, seventh and eleventh day after wound formation. Skin tissue specimens were collected from the wound, and tissue edema and inflammatory cell infiltration were observed with HE staining under light microscopy. The expression of vascular endothelial growth factor ( VEGF) and microvascular density ( MVD) in wound tissues was detected with irnmunohistochemical staining. Results The wound shrinkage rates in sequential combined intervention group and alternate combined intervention group were significantly higher than those in the other groups at the given time point (P < 0. 01) . Histological observation indicated that the tissue edema and inflammatory cell infiltration in wound in sequential combined intervention group and alternate combined intervention group were mild. Immunohistochemistry revealed that the expression of VEGF and MVD in wound tissues in sequential combined intervention group and alternate combined intervention group was significantly higher than that in the other groups (P<0. 01). The parameters in alternate combined intervention group were superior to those in sequential combined intervention group. Conclusion Topical oxygen therapy combined with vacuum-assisted closure can rapidly reduce wound inflammation, promote expression of VEGF and MVD in wound tissues, increase wound vascularization, and promote wound healing of stage Ⅲ pressure ulcer in guinea pigs.%目的 探讨局部氧疗与封闭负压引流联合干预对豚鼠Ⅲ期压疮创面愈合的影响及可能的作用机制.方法 于豚鼠(n=20)左侧股骨大转子处制备Ⅲ期压疮创面,根据创面处理方式的不同分为序贯联合干预组(- 125 mmHg负压治疗持续320 min,5 L/min的局部氧疗持续160 min)、交替联合干预组(- 125 mmHg负压治疗40 min,5L/min的局部氧疗20 min,交替8次)、单纯负压组(- 125 mmHg负压治疗40 min后暂停20 min,重复8次)、单纯氧疗组(5 L/min的局部氧疗20 min后暂停40 min,重复8次)和空白对照组(常规处理创面,不予负压治疗或局部氧疗).分别于创面形成第0、1、3、7、11天,测量创面面积并计算创面面积收缩率.切取创缘全层皮肤组织样本,HE染色光学显微镜观察组织水肿和炎症细胞浸润情况；免疫组织化学染色检测创缘组织中血管内皮生长因子(VEGF)和微血管密度(MVD)的表达.结果 在相同的观察时间点,联合干预贯序或交替组的创面面积收缩率均显著高于其他各组(P＜0.01)；组织学观察发现,联合干预组创缘组织的水肿和炎症细胞浸润程度轻微；免疫组织化学检测结果显示:联合干预组创缘组织中VEGF和MVD的表达均显著高于其他各组(P＜0.01).交替联合干预组各项指标均优于序贯联合干预组.结论 局部氧疗与封闭负压引流联合干预对豚鼠Ⅲ期压疮创面的愈合具有促进作用,可能与其迅速地减轻创面组织的炎症反应程度,并使创面组织中VEGF和MVD的表达增高致使创面血管化程度提高有关.