负压封闭引流技术对兔创面超敏CRP和纤维连接蛋白的影响

Effect of vacuum sealing drainage on C-reactive protein and fibronectin level in rabbit model of surface wound

摘要:

目的  观察负压封闭引流（VSD）技术治疗后兔创面超敏C-反应蛋白（hs-CRP）和血浆纤维连接蛋白（Fn）水平的变化，探讨VSD促进创面愈合的作用机制。方法  复制兔创面模型16只，随机分为两组，常规组（n =8，创面每日消毒、换药及包扎治疗）和VSD组（n =8，创面行VSD敷料护创引流治疗）。在建模前（0时）及建模后7 d内各时间点（6 h、12 h、1 d、3 d、5 d和7 d），抽取外周静脉血检测hs-CRP及Fn，观察比较两检测指标的变化情况。结果  建模前两组外周静脉血hs-CRP及Fn含量差异无统计学意义（P >0.05），建模后两组指标含量均不同程度增高。自12 h时间点VSD组hs-CRP含量与常规组比较差异有统计学意义（P <0.05），VSD组hs-CRP峰值出现在第1天，为（43.81±3.15）mg/L，而常规组hs-CRP峰值出现在第3天，为（70.84±4.82）mg/L。第1天时间点VSD组Fn与常规组比较差异有统计学意义（P <0.05），两组Fn的峰值均出现在第3天，分别为（161.53±8.60）mg/L和（109.83±9.18）mg/L，但随后VSD组Fn维持在一个高浓度的平台期，下降趋势不明显。结论  VSD技术可能通过引流清除创面坏死组织和渗出液，改善创面微循环，促成纤维细胞增殖，早期降低血浆hs-CRP含量，增加Fn含量，减少炎症反应，加速创面愈合。

Abstract:

Objective To investigate changes in serum levels of hypersensitive C-reative protein (hs-CRP) and fibronectin (Fn) before and after Vacuum Sealing Drainage (VSD) applied on wound surface in a rabbit model. Methods Surface wounds were created in 16 rabbits, which were randomly assigned to control group (n = 8; normal aseptic care and regular dressing changes) and VSD group. Venous samples were obtained at baseline (0 hr) , 6 hrs, 12 hrs, 1 d, 3 d, 5 d and 7 d after the injury. Levels of hs-CRP and Fn were compared between groups. Results There was no difference of hs-CRP and Fn levels between two groups at baseline. Beginning at 12 hrs after injury, levels of hs-CRP in VSD group were consistently and significantly higher than that in  the control group (P < 0.05). The level of hs-CRP peaked at day 1 in the VSD group (43.81 ± 3.15 mg/L) compared with day 3 in the control group (70.84 ± 4.82 mg/L). Beginning from day 1, levels of Fn were significantly higher in the VSD group than that in the control group. Fn levels peaked at day 3 in both groups (161.53 ± 8.60 mg/L vs 109.83 ± 9.18 mg/L), but Fn level in the VSD group remained elevated after that and declined smoothly. Conclusions VSD technique is able to drain debris and exudates from surface wound, improve microcirculation and fibroblast proliferation, also decrease serum hs-CRP level while increasing Fn level, thereby attenuate inflammatory response, which in turn improves wound healing.