自体富血小板血浆凝胶联合负压封闭引流技术治疗难愈性创面的临床效果

王爱; 马文国; 王成德; 张焕起; 刘飞

doi:10.3760/cma.j.cn501120-20200105-00004

自体富血小板血浆凝胶联合负压封闭引流技术治疗难愈性创面的临床效果

doi: 10.3760/cma.j.cn501120-20200105-00004

1. 潍坊市益都中心医院烧伤整形外科 262500;
2. 潍坊市益都中心医院介入治疗科 262500;
3. 德州市人民医院烧伤整形外科 253045

基金项目:

潍坊市卫生健康委员会科研项目（wfwsjk_2019_214）

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出版历程
- 收稿日期: 2020-01-05
- 网络出版日期: 2021-10-28
- 刊出日期: 2021-01-20

Clinical effects of autologous platelet rich plasma gel combined with vacuum sealing drainage techno-logy in repairing refractory wounds

1. Department of Burns and Plastic Surgery, Yidu Central Hospital of Weifang, Weifang 262500, China;
2. Department of Interventional Therapy, Yidu Central Hospital of Weifang, Weifang 262500, China;
3. Department of Burns and Plastic Surgery, Dezhou People′s Hospital, Dezhou 253045, China

摘要

摘要:
目的探讨自体富血小板血浆(PRP)凝胶联合负压封闭引流(VSD)技术修复难愈性创面的临床效果。方法将2011年3月—2015年1月潍坊市益都中心医院烧伤整形外科收治的符合入选标准、进行间歇式VSD治疗的44例难愈性创面患者纳入单纯VSD组，将2015年2月—2019年9月该单位收治的符合入选标准、进行PRP凝胶和间歇式VSD治疗的43例难愈性创面患者纳入PRP＋VSD组，进行回顾性队列研究。单纯VSD组患者中男24例、女20例，年龄(37.5±2.2)岁，PRP＋VSD组患者中男25例、女18例，年龄(37.0±2.5)岁。收集2组患者第1次治疗前和第1次治疗后7、14 d的创面分泌物进行细菌培养，并计算细菌培养阳性率。第1次治疗后7、14、21 d，观察2组患者创面愈合情况并计算创面愈合率，记录2组患者创面完全愈合时间。第1次治疗前和第1次治疗后14 d，采用视觉模拟评分法(VAS)评估2组患者创面疼痛程度。创面完全愈合后1、2个月采用温哥华瘢痕量表(VSS)评估2组患者瘢痕增生情况。观察2组患者整个治疗过程中不良反应的发生情况，并计算不良反应发生率。对数据行重复测量方差分析、
χ
²检验、配对
t
检验及Bonferroni校正。结果第1次治疗后7、14 d，PRP＋VSD组患者创面分泌物细菌培养阳性率分别为37.2%(16/43)、11.6%(5/43)，明显低于单纯VSD组的56.8%(25/44)、29.5%(13/44)，
χ
²＝4.212、4.255，
P
<0.05。PRP＋VSD组患者第1次治疗后7、14、21 d创面愈合率分别为(58±14)%、(70±13)%、(89±12)%，明显高于单纯VSD组的(41±11)%、(60±11)%、(74±12)%，
t
＝6.323、3.820、5.751，
P
<0.01。PRP＋VSD组患者创面完全愈合时间为(30±6)d，明显短于单纯VSD组的(61±8)d，
t
＝20.890，
P
<0.05。PRP＋VSD组患者第1次治疗后14 d的VAS评分较单纯VSD组明显降低(
t
＝13.904，
P
<0.01)。PRP＋VSD组患者创面愈合后1、2个月VSS评分显著低于单纯VSD组(
t
＝3.307、3.637，
P
<0.01)。PRP＋VSD组患者治疗后不良反应发生率为7.0%(3/43)，显著低于单纯VSD组的22.7%(10/44)，
χ
²＝4.245，
P
<0.05。结论自体PRP凝胶联合VSD技术修复难愈性创面，抑菌效果好，可提高创面愈合率，缩短创面愈合时间，减轻疼痛和瘢痕增生程度，且不良反应较少，值得推广。
- 伤口愈合 /
- 富血小板血浆 /
- 负压伤口疗法 /
- 难愈性创面
Abstract:
Objective To investigate the clinical effects of autologous platelet rich plasma (PRP) gel in combination with vacuum sealing drainage (VSD) technology in repairing refractory wounds. Methods From March 2011 to January 2015, 44 patients with refractory wounds meeting the inclusion criteria were recruited into VSD alone group, who were admitted to the Department of Burns and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds meeting the inclusion criteria were recruited into PRP+ VSD group, who were admitted to the same unit as above-mentioned and received PRP combined with intermittent VSD treatment. The retrospective cohort study was conducted. There were 24 males and 20 females with age of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with age of (37.0±2.5) years in PRP+ VSD group. The wound exudate of patients in the two groups before and 7 and 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated. The wound healing of patients in the two groups was observed on 7, 14, and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the Visual Analog Scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely. The occurrence of adverse reactions of patients in the two groups during the whole period of treatment was observed and the incidence of adverse reactions was calculated. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired
t
test, and Bonferroni correction. Results The positive rates of bacterial culture in wound exudate of patients in PRP+ VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group,
χ
²=4.212, 4.255,
P
<0.05. The wound healing rates of patients in PRP+ VSD group on 7 and 14, and 21 d after the first treatment were respectively (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group,
t
=6.323, 3.820, 5.751,
P
<0.01. The complete wound healing time of patients in PRP+ VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group,
t
=20.890,
P
<0.05. The VAS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group on 14 d after the first treatment (
t
=13.904,
P
<0.01). The VSS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (
t
=3.307, 3.637,
P
<0.01). The incidence of adverse reactions of patients in PRP+ VSD group during the whole period of treatment was 7.0% (3/43), which was significantly lower than 22.7% (10/44) in VSD alone group,
χ
²=4.245,
P
<0.05. Conclusions Autologous PRP gel combined with VSD technology in repairing refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, alleviate wound pain, reduce scar hyperplasia, with less adverse reaction, which is worthy of promotion.
- Wound healing /
- Platelet-rich plasma /
- Negative-pressure wound therapy /
- Refractory wound