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Received:March 24, 2022 Published Online:December 20, 2022
Received:March 24, 2022 Published Online:December 20, 2022
中文摘要: 目的 研究封闭式负压引流(VSD)联合抗菌敷料对人工真皮移植术后糖尿病足溃疡创面愈合及肉芽组织转化生长因子β1(TGF-β1)和细胞周期蛋白D1(Cyclin D1)表达的影响。 方法 选取2019年1月到2021年6月到南部战区总医院烧伤整形科治疗的60例糖尿病足患者,按照随机数字法随机分为对照组和观察组,各30例。对照组患者进行人工真皮移植手术;观察组患者在对照组的基础上进行VSD并且联用藻酸盐辅料进行处理。对两组患者的创面外观形态进行观察;对两组患者血清碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)和血管内皮生长因子(VEGF)水平,创面面积,VAS评分,以及创面组织中Cyclin D1、TGF-β1水平进行分析。对两组患者渗出液进行细菌培养。结果 随访3个月,观察组在随访期间未出现溃疡复发,对照组出现5例溃疡复发。观察组患者的瘢痕增生较轻、皮肤具有较好的弹性且较完整。经治疗,两组创面面积均减少,且观察组少于对照组(P<0.05)。经治疗,两组患者的上皮组织和肉芽组织的覆盖面积、覆盖率均较治疗前增加,且观察组优于对照组(P<0.05)。治疗后,两组患者的VAS评分均有所降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后,两组患者血清bFGF、EGF和VEGF水平均有所上升(P<0.05),且相对于对照组,各时间点观察组血清bFGF、EGF和VEGF水平较高(P<0.05)。治疗后,观察组培养出细菌5株,细菌感染率为13.33%(4/30),对照组培养出细菌9株,细菌感染率为36.67%(11/30),观察组的细菌感染率低于对照组(P<0.05)。治疗后,两组创面组织中Cyclin D1和TGF-β1水平均有升高(P<0.05),且观察组高于对照组(P<0.05)。结论 VSD联合抗菌敷料对人工真皮移植术后糖尿病足溃疡创面愈合效果显著,能够增加患者肉芽组织中Cyclin D1和TGF-β1水平,升高血清bFGF、EGF和VEGF水平。
Abstract:Objective To investigate the effect of vacuum sealing pressure drainage(VSD) combined with antibacterial dressing on wound healing and the expression of transforming growth factor β1(TGF-β1) and cyclin D1 in granulation tissue of diabetes foot ulcer after artificial dermis transplantation. Methods From January 2019 to June 2021, 60 patients with diabetes foot who were treated in the Burn and Plastic Surgery Department of General Hospital of Southern Theatre Command were selected and randomly divided into the control group and the observation group randomly(n=30, each). The patients in the control group received artificial dermis transplantation; On the basis of the control group, the patients in the observation group were treated with VSD and alginate dressing. The wound appearance of the two groups was observed. The levels of basic fibroblast growth factor(bFGF), epidermal growth factor (EGF) and vascular endothelial growth factor(VEGF) in serum, wound area, VAS score, and the levels of cyclin D1, TGF-β1 in wound tissue were measured. The exudates of the two groups were cultured for bacteria. Results The patients were followed up for 3 months. During the follow-up period, there was no ulcer recurrence in the observation group, but 5 cases in the control group. The scar hyperplasia of the patients in the observation group was light, and the skin had better elasticity and integrity. After treatment, the wound area of both groups was reduced, and that of the observation group was less than that of the control group(P<0.05). After treatment, the coverage area and coverage rates of granulation tissue in the two groups were increased compared with those before treatment, and the observation group were higher than the control group(P<0.05). After treatment, the VAS scores of patients in both groups decreased(P<0.05), and the observation group was lower than that in the control group(P<0.05). After treatment, the levels of serum bFGF, EGF and VEGF in the two groups increased(P<0.05), and those in the observation group were higher than those in the control group at each time point(P<0.05). After treatment, 5 strains of bacteria were cultured in the observation group, the bacterial infection rate was 13.33%(4/30), and 9 strains were cultured in the control group, the bacterial infection rate was 36.67%(11/30). The bacterial infection rate in the observation group was lower than that in the control group(P<0.05). After treatment, the levels of cyclin D1 and TGF-β1 in wound tissues of both groups increased, and those in the observation group waere higher than those in the control group(P<0.05). Conclusion VSD combined with antibacterial dressing has a significant effect on wound healing of diabetes foot ulcer after artificial dermis transplantation, which can increase the levels of Cyclin D1 and TGF-β1 in granulation tissue of patients, and increase the levels of bFGF, EGF and VEGF in serum.
keywords: Vacuum sealing drainage Alginate Artificial dermis transplantation Diabetes foot ulcer Transforming growth factor β1 Cyclin D1
文章编号: 中图分类号: 文献标志码:A
基金项目:中国人民解放军桂林联勤保障部队面上项目(CGZ14J002)
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