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目的:探讨伤后24h 内削痂手术对深Ⅱ度烧伤创面局部释放表皮生长因子(EGF)、碱性成纤维细胞生长因子(FGF-2)、血小板衍生生长因子(PDGF-AB)及其对组织修复的影响。方法:选12例以深Ⅱ度烧伤为主的患者,每例患者均选择相对均匀的深Ⅱ度创面作为实验创面并分为3个研究区域,即手术前、手术后和未手术实验区。伤后24h 内行削痂术。术前在实验创面切取创面组织,作为手术前实验区标本,行削痂后创面均以辐照猪皮覆盖。术中部分创面保留不予手术,该保留创面作为未手术实验区。于伤后5～7d 行第2次手术,分别切取经削痂处理和未手术区的创面组织,作为手术后和未手术实验区标本。采用组织培养和 ELISA 技术测定创面组织释放 EGF、FGF-2和 PDGF-AB 的水平,并对创面组织中新生肉芽形成进行形态学观察和半定量分析。结果:伤后24h 内削痂手术后,创面组织局部释放 EGF、FGF-2和 PDGF-AB 的水平较手术前和未手术创面有显著升高(P<0.05);创面局部组织形态学观察显示,手术后创面新鲜肉芽组织形成较手术前和未手术创面显著(P<0.05)。结论:伤后24h 内削痂手术可以促进局部组织释放 EGF、FGF-2和 PDGF-AB,促进新生肉芽形成,有利于深Ⅱ度烧伤创面愈合,从而提示了伤后24h 内削痂优于常规手术。
Objective: To investigate the local release of epidermal growth factor (EGF), basic fibroblast growth factor (FGF-2), platelet-derived growth factor (PDGF-AB) The impact of tissue repair. Methods: Twelve patients with deep second degree burn were chosen. Each patient chose relatively deep second degree wounds as the experimental wounds and divided into three study areas, namely, preoperative, postoperative and non-operative experimental areas. 24h after cutting injury callus surgery. Preoperative wounds in the experimental wounds were cut, as a preoperative specimen of the experimental area, the line after excision of the wounds were irradiated pigskin coverage. Some intraoperative wounds were left without surgery, which reserved the wound as a non-operative experimental area. The second operation was performed 5-7 days after the injury, and the wound tissues with excision and non-surgical area were excised separately, which were used as specimens for the postoperative and non-operative experimental areas. The levels of EGF, FGF-2 and PDGF-AB released from wound tissue were measured by tissue culture and ELISA. Morphology and semi-quantitative analysis of granulation in wound tissue were performed. Results: The local release of EGF, FGF-2 and PDGF-AB in the wound tissue was significantly higher than that before surgery and in the non-surgical wound healing (P <0.05) after 24h operation. The local histological observation of the wound showed The fresh granulation tissue in the wounds after operation was significantly more than the preoperative and non-surgical wounds (P <0.05). Conclusion: Excision of scab surgery can promote local tissue release of EGF, FGF-2 and PDGF-AB within 24 hours after injury, promote the formation of newborn granulation and promote wound healing of deep second degree burn, suggesting that the intracutalization of scab is better than conventional surgery.