Effects and mechanism of pressure treatment on hemodynamic changes in patients with hypertrophic scar secondary to extensive burns
-
摘要:
目的 探讨对大面积烧伤继发增生性瘢痕患者行压力治疗后，患者肢体主要动静脉及心脏血流动力学变化，并分析其相关机制。 方法 采用回顾性自身前后对照研究方法。2017年1月—2022年2月，广东省工伤康复医院烧伤康复科收治37例符合入选标准的大面积烧伤继发增生性瘢痕患者，其中男25例、女12例，年龄23~52岁。患者创面愈合后12周内入院，于入院后1周内由康复治疗师、作业治疗师及裁缝师量身定做全身弹力衣、弹力长裤、背心及分指手套和分指袜、头罩及塑料颈圈等压力用品，穿着压力用品时将各部位压力维持在2.67~4.00 kPa。于首次穿着压力用品治疗前（以下简称压力治疗前）及首次穿着压力用品治疗1 h后（以下简称压力治疗1 h后），用彩色多普勒超声诊断仪检查左侧腋动脉脉率，腋动脉与股动脉血管腔直径、收缩期峰值流速（PSV）、阻力指数，腋静脉与股静脉血管腔直径、横截面面积、平均血流速度，心脏二尖瓣E峰值、二尖瓣A峰值、三尖瓣E峰值、主动脉瓣PSV、肺动脉瓣PSV；用光学色谱皮肤检测仪检测手背瘢痕的色泽中红色、红色素及表面明亮度，以反映瘢痕微血管的充盈与分布情况。对数据行配对样本t检验。 结果 与压力治疗前比较，患者压力治疗1 h后腋动脉PSV明显减慢（t=55.42，P<0.01），腋静脉平均血流速度明显加快（t=-60.50，P<0.01），腋动脉脉率、血管腔直径与阻力指数以及腋静脉血管腔直径、横截面面积均无明显变化（P>0.05），股静脉平均血流速度明显加快（t=-80.52，P<0.01），股动脉血管腔直径、PSV与阻力指数以及股静脉血管腔直径、横截面面积均无明显变化（P>0.05），心脏二尖瓣E峰值、二尖瓣A峰值均明显下降（t值分别为10.71、21.96，P<0.01），心脏三尖瓣E峰值明显升高（t=7.57，P<0.01），心脏主动脉瓣PSV、肺动脉瓣PSV均无明显变化（P>0.05）。患者压力治疗1 h后手背瘢痕的色泽中红色与红色素值分别为15.3±1.1、16.8±1.2，均明显低于压力治疗前的24.5±1.3、23.8±1.2（t值分别为8.32、8.04，P<0.01）；患者压力治疗1 h后手背瘢痕表面明亮度值与压力治疗前相近（P>0.05）。 结论 对大面积烧伤患者继发增生性瘢痕行压力治疗后，患者腋静脉及股静脉平均血流速度明显加快，腋动脉PSV明显减慢，心脏二尖瓣E峰值、二尖瓣A峰值均明显下降且三尖瓣E峰值明显升高，这些血流动力学变化可能与全身压力治疗减少了瘢痕局部的微血管内血流量有关。 -
关键词:
- 瘢痕 /
- 超声检查，多普勒，彩色 /
- 血流动力学 /
- 微血管 /
- 压力治疗
Abstract:Objective To investigate the hemodynamic changes of the main arteries and veins of the extremities and the heart in patients with hypertrophic scar secondary to extensive burns after pressure treatment, and to analyze the relevant mechanisms. Methods A retrospective before-after self-control study was conducted. From January 2017 to February 2022, 37 patients with hypertrophic scar secondary to extensive burns who met the inclusion criteria were hospitalized in the Burn Rehabilitation Department of Guangdong Industrial Injury Rehabilitation Hospital, including 25 males and 12 females, aged 23-52 years. The patients were admitted to the hospital within 12 weeks after wound healing, and within one week after admission, rehabilitation therapists, occupational therapists, and tailors custom-made pressure products such as full-body pressure garment, pressure pants, vests, split finger gloves, split finger socks, hoods, and plastic collars, with the pressure at each part maintained at 2.67-4.00 kPa when wearing. Before the first treatment with pressure products (hereinafter referred to as before pressure treatment) and at 1 h of the first treatment with pressure products (hereinafter referred to as 1 h of pressure treatment), color Doppler ultrasonography was performed to check the pulse rate of the axillary artery, the lumen diameter, peak systolic velocity (PSV), and resistance index of the axillary artery and femoral artery on the left side, the lumen diameter, cross-sectional area, and average blood flow velocity of the axillary vein and femoral vein, and the mitral valve E peak, mitral valve A peak, tricuspid valve E peak, aortic valve PSV, and pulmonary valve PSV of the heart; an optical chromatographic skin detector was used to detect the red color, red pigment, and surface brightness of the scar on the back of the hand to reflect the filling and distribution of the scar microvessels. Data were statistically analyzed with paired sample t test. Results Compared with those before pressure treatment, the PSV of the axillary artery of patients was significantly slowed down at 1 h of pressure treatment (t=55.42, P<0.01); the average blood flow velocity of the axillary vein was significantly accelerated (t=-60.50, P<0.01); the pulse rate, lumen diameter, and resistance index of the axillary artery, as well as the lumen diameter and cross-sectional area of the axillary vein did not change obviously (P>0.05); the average blood flow velocity of the femoral vein was significantly accelerated (t=-80.52, P<0.01); the lumen diameter, PSV, and resistance index of the femoral artery, as well as the lumen diameter and cross-sectional area of the femoral vein had no significant change (P>0.05); the mitral valve E peak and mitral valve A peak of the heart decreased significantly (with t values of 10.71 and 21.96, respectively, P<0.01); the tricuspid valve E peak of the heart increased significantly (t=7.57, P<0.01); the PSV of the aortic valve and pulmonary valve of the heart did not change obviously (P>0.05). At 1 h of pressure treatment, the red color and red pigment values of the scar on the back of the hand of patients were 15.3±1.1 and 16.8±1.2, respectively, which were significantly lower than 24.5±1.3 and 23.8±1.2 before pressure treatment (with t values of 8.32 and 8.04, respectively, P<0.01). The brightness value of the scar surface on the back of the hand of patients at 1 h of pressure treatment was similar to that before pressure treatment (P>0.05). Conclusions After pressure treatment for the hypertrophic scar in patients secondary to extensive burn, the average blood flow velocity of the axillary vein and femoral vein in patients are obviously accelerated, the PSV of the axillary artery is significantly slowed down, the peak values of mitral valve E and mitral valve A of the heart are significantly decreased, and the tricuspid valve E peak is significantly increased. These hemodynamic changes may be related to the reduction of microvascular blood flow in the local area of scar after systemic pressure treatment. -
Key words:
- Cicatrix /
- Ultrasonography, Doppler, color /
- Hemodynamics /
- Microvessels /
- Pressure treatment
-
参考文献
(26) [1] ChenK,RaoZ,DongS,et al.Roles of the fibroblast growth factor signal transduction system in tissue injury repair[J/OL].Burns Trauma,2022,10:tkac005[2022-06-16].https://pubmed.ncbi.nlm.nih.gov/35350443/.DOI: 10.1093/burnst/tkac005. [2] GauglitzGG,KortingHC,PavicicT,et al.Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies[J].Mol Med,2011,17(1/2):113-125.DOI: 10.2119/molmed.2009.00153. [3] MengX,YuZ,XuW,et al.Control of fibrosis and hypertrophic scar formation via glycolysis regulation with IR780[J/OL].Burns Trauma,2022,10:tkac015[2022-08-16].https://pubmed.ncbi.nlm.nih.gov/35769829/.DOI: 10.1093/burnst/tkac015. [4] ZhangJ,LiY,BaiX,et al.Recent advances in hypertrophic scar[J].Histol Histopathol,2018,33(1):27-39.DOI: 10.14670/HH-11-908. [5] 王洪涛,韩军涛,胡大海.炎症反应在增生性瘢痕和瘢痕疙瘩形成中的作用及其机制研究进展[J].中华烧伤杂志,2021,37(5):490-494.DOI: 10.3760/cma.j.cn501120-20200310-00143. [6] 宋菲,刘英开,王西樵.增生性瘢痕发生和演变过程中微血管和氧分压动态变化的研究[J].上海交通大学学报(医学版),2016,36(11):1553-1557.DOI: 10.3969/j.issn.1674-8115.2016.11.003. [7] 周梦云,阎玉秀,金子敏,等.增生性瘢痕压力服研究与临床现状及展望[J].现代纺织技术,2021,29(5):78-87.DOI: 10.19398/j.att.202009018. [8] 李曾慧平,冯蓓蓓,李奎成.烧伤后增生性瘢痕压力治疗及相关研究[J].中华烧伤杂志,2010,26(6):411-415.DOI: 10.3760/cma.j.issn.1009-2587.2010.06.002. [9] 王达利.增生性瘢痕防治的研究进展与方向[J/CD].中华损伤与修复杂志:电子版,2017,12(4):247-253.DOI: 10.3877/cma.j.issn.1673-9450.2017.04.002. [10] 田凌云,李映兰,吴英,等.压力疗法治疗增生性瘢痕患者有效性的荟萃分析[J].中华烧伤杂志,2019,35(9):668-675.DOI: 10.3760/cma.j.issn.1009-2587.2019.09.005. [11] 赵海洋,韩军涛,刘佳琦,等.手持续被动运动系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩的效果[J].中华烧伤杂志,2021,37(4):319-326.DOI: 10.3760/cma.j.cn501120-20201020-00443. [12] 中华医学会烧伤外科学分会,中国医师协会烧伤科医师分会.烧伤康复治疗指南(2013版)[J].中华烧伤杂志,2013,29(6):497-504.DOI: 10.3760/cma.j.issn.1009-2587.2013.06.001. [13] 中国整形美容协会瘢痕医学分会.瘢痕早期治疗全国专家共识(2020版)[J].中华烧伤杂志,2021,37(2):113-125.DOI: 10.3760/cma.j.cn501120-20200609-00300. [14] HosseiniM,BrownJ,KhosrotehraniK,et al.Skin biomechanics: a potential therapeutic intervention target to reduce scarring[J/OL].Burns Trauma,2022,10:tkac036[2022-10-16].https://pubmed.ncbi.nlm.nih.gov/36017082/.DOI: 10.1093/burnst/tkac036. [15] ShirakamiE,YamakawaS,HayashidaK.Strategies to prevent hypertrophic scar formation: a review of therapeutic interventions based on molecular evidence[J/OL].Burns Trauma,2020,8:tkz003[2022-06-16].https://pubmed.ncbi.nlm.nih.gov/32341924/.DOI: 10.1093/burnst/tkz003. [16] ZhangH,WangHY,WangDL,et al.Effect of pressure therapy for treatment of hypertrophic scar[J].Medicine (Baltimore),2019,98(26):e16263.DOI: 10.1097/MD.0000000000016263. [17] ChowL,YickKL,SunY,et al.A novel bespoke hypertrophic scar treatment: actualizing hybrid pressure and silicone therapies with 3D printing and scanning[J].Int J Bioprint,2021,7(1):327.DOI: 10.18063/ijb.v7i1.327. [18] PriceK,MoiemenN,NiceL,et al.Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study[J/OL].Burns Trauma,2021,9:tkab005[2022-06-16].https://pubmed.ncbi.nlm.nih.gov/34212058/.DOI: 10.1093/burnst/tkab005. [19] KimJD,OhSJ,KimSG,et al.Ultrasonographic findings of re-epithelialized skin after partial-thickness burns[J/OL].Burns Trauma,2018,6:21[2022-06-16].https://pubmed.ncbi.nlm.nih.gov/30123801/.DOI: 10.1186/s41038-018-0122-3. [20] 宋春红. 手背瘢痕切除后移植皮片下瘢痕增生的超声检测分析[J]. 临床超声医学杂志,2016,18(1):62-64. [21] 孙正.血管内超声测量血流动力学参数的研究进展[J].中国医学影像技术,2013,29(8):1393-1396. [22] 宋春红,张玉霞,赵炜,等.56例重度烧伤患者康复期下肢动脉血流动力学超声表现[J].分子影像学杂志,2016,39(2):97-99.DOI: 10.3969/j.issn.1674-4500.2016.02.08. [23] 王雪,杨茹茜,杨雨婷,等.20MHz高频超声对不同类型皮肤瘢痕的诊断价值[J].第三军医大学学报,2020,42(3):282-287.DOI: 10.16016/j.1000-5404.201908155. [24] LipmanK,WangM,BerthiaumeE,et al.Evaluating current scar assessment methods[J].Ann Plast Surg,2020,84(2):222-231.DOI: 10.1097/SAP.0000000000002029. [25] Li-TsangCW,LauJC,LiuSK.Validation of an objective scar pigmentation measurement by using a spectrocolorimeter[J].Burns,2003,29(8):779-784.DOI: 10.1016/s0305-4179(03)00165-7. [26] LauJC,Li-TsangCW,ZhengYP.Application of tissue ultrasound palpation system (TUPS) in objective scar evaluation[J].Burns,2005,31(4):445-452.DOI: 10.1016/j.burns.2004.07.016. -
1 彩色多普勒超声诊断仪检测大面积烧伤继发增生性瘢痕患者首次穿着压力用品治疗前后全身血流动力学情况。1A、1B、1C、1D、1E与1F、1G、1H、1I、1J.分别为患者穿着压力用品治疗前与穿着压力用品治疗1 h后心脏二尖瓣E/A峰值(花彩血流信号)、左侧腋动脉PSV（红色血流信号）、左侧腋静脉平均血流速度（蓝色血流信号）、左侧股动脉PSV（蓝色血流信号）、左侧股静脉平均血流速度（红色血流信号），图1F、1G中二尖瓣E/A峰值与PSV分别较图1A、1B下降，图1H中平均血流速度较图1C加快，图1I中PSV与图1D相近，图1J中平均血流速度较图1E明显加快
注：PSV为收缩期峰值流速
表1 37例大面积烧伤继发增生性瘢痕患者压力治疗前后左侧腋动静脉血流动力学指标比较（
时间点 腋动脉 腋静脉 脉率（次/min） 血管腔直径（cm） PSV（cm/s） 阻力指数 血管腔直径（cm） 横截面面积（cm2） 平均血流速度（cm/s） 压力治疗前 79±4 0.54±0.11 56.7±1.3 0.81±0.12 0.58±0.12 0.201±0.028 12.5±1.1 压力治疗1 h后 81±6 0.52±0.12 33.6±1.5 0.84±0.14 0.61±0.11 0.273±0.011 19.3±1.7 t值 1.34 0.10 55.42 0.16 -7.98 -2.74 -60.50 P值 0.161 0.301 <0.001 0.875 0.412 0.143 <0.001 注：压力治疗指首次穿着压力用品治疗，PSV为收缩期峰值流速 
下载: 导出CSV
表2 37例大面积烧伤继发增生性瘢痕患者压力治疗前后左侧股动静脉血流动力学指标比较（
时间点 股动脉 股静脉 血管腔直径（cm） PSV（cm/s） 阻力指数 血管腔直径（cm） 横截面面积（cm2） 平均血流速度（cm/s） 压力治疗前 0.75±0.14 72.3±2.2 0.82±0.12 0.68±0.09 0.44±0.06 44.1±2.1 压力治疗1 h后 0.78±0.12 72.0±2.6 0.82±0.14 0.68±0.08 0.39±0.04 57.4±3.2 t值 0.21 1.27 0.15 -0.85 -5.33 -80.52 P值 0.372 0.212 0.875 0.404 0.272 <0.001 注：压力治疗指首次穿着压力用品治疗，PSV为收缩期峰值流速
下载: 导出CSV
表3 37例大面积烧伤继发增生性瘢痕患者压力治疗前后心脏血流动力学指标比较（cm/s，
时间点 二尖瓣E峰值 二尖瓣A峰值 三尖瓣E峰值 主动脉瓣PSV 肺动脉瓣PSV 压力治疗前 71.4±1.3 54.8±1.1 35.2±1.6 86.2±1.5 76.2±1.8 压力治疗1 h后 60.2±1.1 42.5±1.5 43.6±1.4 88.2±1.3 75.9±1.7 t值 10.71 21.96 7.57 -1.94 1.26 P值 <0.001 <0.001 <0.001 0.060 0.215 注：压力治疗指首次穿着压力用品治疗，PSV为收缩期峰值流速
下载: 导出CSV
-
图(2) / 表(3)
计量
- 文章访问数: 1165
- HTML全文浏览量: 66
- PDF下载量: 35
- 被引次数: 0
