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[1]孙丰华,杨阳,张茂红,等.自体富血小板血浆联合负压封闭引流技术治疗压疮的临床疗效分析[J].医学研究与战创伤救治(原医学研究生学报),2021,23(6):576-581.[doi:10.3969/j.issn.1672-271X.2021.06.004]
　SUN Feng-hua,YANG Yang,ZHANG Mao-hong,et al.Clinical efficacy of autologous platelet-rich plasma combined with vacuum sealing drainage in treating pressure ulcers[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(6):576-581.[doi:10.3969/j.issn.1672-271X.2021.06.004]
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自体富血小板血浆联合负压封闭引流技术治疗压疮的临床疗效分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年6期
页码:
576-581
栏目:
临床研究
出版日期:
2021-12-15

文章信息/Info

Title:
Clinical efficacy of autologous platelet-rich plasma combined with vacuum sealing drainage in treating pressure ulcers
作者:
孙丰华; 杨阳; 张茂红; 胡云健; 孙诚; 黄玉萍; 陈建民; 刘国印
作者单位：210002南京，东部战区总医院秦淮医疗区烧伤整形科（孙丰华、杨阳、张茂红、胡云健、孙诚、黄玉萍），骨科（陈建民、刘国印）
Author(s):
SUN Feng-hua;  YANG Yang;  ZHANG Mao-hong;  HU Yun-jian;  SUN Cheng;  HUANG Yu-ping;  CHEN Jian-min;  LIU Guo-yin
(1. Department of Burns and Plastic Surgery, 2. Department of Orthopaedics,Qinhuai Medical District，General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
富血小板血浆; 负压封闭引流; 压疮; 创面修复
Keywords:
platelet-rich plasma (PRP);  vacuum sealing drainage (VSD);  pressure ulcers;  wound repair
分类号:
R641
DOI:
10.3969/j.issn.1672-271X.2021.06.004
文献标志码:
A
摘要:
目的探讨自体富血小板血浆（PRP）联合负压封闭引流（VSD）技术在压疮创面修复中的临床疗效。方法回顾性分析2018 年1月至2020年12月间东部战区总医院秦淮医疗区收治的38例压疮患者的临床资料。根据治疗方式不同，分为PRP+VSD组（18例，25处压疮创面）和VSD组（20例，26处压疮创面）。VSD组采用清创+VSD治疗，待VSD彻底清创治疗后行换药治疗处理。PRP+VSD组是在VSD组治疗基础上联合应用PRP治疗。所有患者在入院时，彻底清创后，治疗后7 d、14 d和21 d时，行分泌物细菌培养，采用创面炎症反应症状评分量表评估创面炎症反应的严重程度，压疮愈合计量表（PUSH）评分评估压疮创面愈合情况；彻底清创治疗后3个月时，根据临床疗效评估压疮治疗的有效率；创面完全愈合后1个月和2个月时，采用温哥华瘢痕量表（VSS）评价创面瘢痕增生情况。结果治疗7 d、14 d和21 d后，PRP+VSD组创面分泌物细菌培养阳性数分别为3处、1处和1处，明显少于VSD组的10处、8处和6处 （P<0.05）。PRP+VSD组和VSD组彻底清创后创面炎症反应症状评分分别为（8.3±2.0）分和（8.0±1.9）分，明显优于入院时的（15.3±3.9）分和（14.8±4.5）分（P<0.05）。治疗后7 d、14 d和21 d，2组患者创面炎症反应症状与入院时和VSD治疗后比较，差异有统计学意义（P<0.05），同时PRP+VSD组的创面炎症反应症状评分明显低于VSD组（P<0.05）。2组患者彻底清创后的PUSH评分与入院时比较，差异有统计学意义（P<0.05）；PRP+VSD组治疗后7 d、14 d和21 d时，PUSH评分均明显优于彻底清创后（P<0.05），而VSD组仅在治疗后21 d时优于彻底清创后（P<0.05）；此外，PRP+VSD组治疗后14 d和21 d时，PUSH评分均明显优于VSD组（P<0.05）。彻底清创治疗3个月后，PRP+VSD组治疗有效率为96.0%，明显高于VSD组的76.9%（P<0.05）。对完全愈合后的创面进行随访发现，完全愈合后1个月和2个月时，PRP+VSD组的VSS评分均优于VSD组[（8.1±2.0） vs (10.2±2.2)，(4.1±1.5) vs (6.0±1.7)，P<0.05]。结论PRP联合VSD技术修复压疮创面能够有效抑制细菌生长，促进新鲜肉芽组织生长，抑制创面炎症反应，提高创面愈合率，且对瘢痕增生有明显的抑制作用。
Abstract:
ObjectiveTo investigate the clinical efficacy of autologous platelet-rich plasma (PRP) combined with vacuum sealing drainage (VSD) in treating pressure ulcers.Methods38 patients with pressure ulcers who were admitted to the Jin Ling Hospital from January 2018 to December 2020. They were divided into two groups: the PRP+VSD group (18 cases, 25 wounds) and the VSD group (20 cases, 26 wounds).Debridement combined with VSD was conducted on these patients, and dressing change was performed after VSD. PRP sequential therapy was conducted after the same treatment as the VSD group received. The secretions of all pressure ulcer wounds were collected for bacterial culture on the 7th, the 14th and the 21st day after thorough debridement. And the wound inflammation symptom scale was used to assess the severity of wound inflammation. Also, the pressure ulcer scale of healing (PUSH) scores were used to evaluate the healing of pressure ulcer wounds; clinical efficacy was used to assess the effective rate in treating pressure ulcer 3 months after thorough debridement; and Vancouver Scar Scale (VSS) was used to evaluate the hyperplasia of pressure ulcer wounds respectively 1 month and 2 months after the pressure ulcer wounds were completely healed.ResultsThe number of positive bacterial cultures of wound secretions in the PRP+VSD group were respectively 3, 1 and 1 on the 7th, the 14th, and the 21st day after treatment, which were significantly less than the 10, 8, and 6 in the VSD group, showing a statistically significant difference (P<0.05). After thorough debridement, the wound inflammation symptom scores of the PRP+VSD group and the VSD group were (8.3±2.0) and (8.0±1.9) points, which were obviously better than (15.3±3.9) and (14.8±4.5) points on admission, indicating statistically significant difference (P<0.05). The wound inflammation symptoms on the 7th, the 14th, and the 21st day after treatment in both groups showed significant differences when compared with those on admission and after VSD thorough debridement (P<0.05). At the same time, the wound inflammation symptom score of the PRP+VSD group was significantly lower than that of the VSD group, showing statistically significant difference (P<0.05). In both groups, the PUSH scores after thorough debridement showed significant difference when compared with those on admission (P<0.05); in the PRP+VSD group, the PUSH scores on the 7th, the 14th and the 21st day after treatment were significantly better than those after thorough debridement (P<0.05); however, in the VSD group, the PUSH score was better than those after thorough debridement only on the 21st day after treatment (P<0.05); in addition, the PUSH scores in the PRP+VSD group were significantly better than those in the VSD group on the 14th and the 21st day after treatment (P<0.05). Among 25 wounds in the PRP+VSD group, the effective rate of 96.0%, while the VSD group was 76.9%, and this showed significant difference (P<0.05). During follow-up, we discovered that the VSS scores in the PRP+VSD group were all better than those in the VSD group respectively 1 month and 2 months after complete healing [(8.1±2.0) points vs (10.2±2.2) points, (4.1±1.5) points vs (6.0±1.7) points, P<0.05].ConclusionPRP combined with VSD could effectively inhibit bacterial growth, promote the growth of fresh granulation tissue and inhibit wound inflammation, so as to improve wound healing rate. Also, it has a significant inhibitory effect on scar hyperplasia.

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备注/Memo

备注/Memo:
基金项目：江苏省自然科学基金(BK20181113)
更新日期/Last Update: 2021-12-15