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目的:观察经紫外线预照射移植猪皮片对烧伤创面覆盖时间的影响。方法:选择2004-01/2005-12四川攀枝花钢铁有限责任公司职工总医院烧伤科收治的需要植皮的烧伤患者35例,患者均知情同意。按随机数字表法分为2组,紫外线预照射组18例,对照组17例。紫外线预照射组使用的猪皮片经过40W紫外线预照射,波长为253.7nm,灯管距猪皮30cm,照射时间2h;对照组使用的移植猪皮片未做紫外线预照射。将移植猪皮片真皮面覆盖于切削痂创面上,加压包扎,用手术刀片打洞以利引流。观察整体猪皮片的存活时间,在术后5,10,15d取0.2cm×0.3cm大小的整层猪皮制成匀浆,检测相关生化因子水平:应用双抗体夹心酶联免疫吸附法测肿瘤坏死因子α含量,应用鲎法测内毒素含量,应用黄嘌呤氧化酶法测超氧化物歧化酶活性,应用硫代戊巴比妥酸法测丙二醛含量。移植猪皮片出现外观苍白,与创面分离,融解脱落均视为失效。结果:35例烧伤患者全部进入结果分析,无脱落。①紫外线预照射组猪皮平均烧伤创面覆盖时间为(18.3±2.4)d,显著高于对照组(13.7±3.1)d(P<0.05)。覆盖猪皮术后15d,紫外线预照射组有3例移植猪皮片失效,对照组有9例移植猪皮片失效。②随时间延长,两组患者覆盖猪皮片局部组织匀浆肿瘤坏死因子α、内毒素、丙二醛含量均呈升高趋势,术后10d和15d紫外线预照射组显著低于对照组(P<0.01)。两组患者覆盖移植猪皮片局部组织匀浆超氧化物歧化酶活性随时间延长均呈下降趋势,术后10d和15d紫外线预照射组显著高于对照组(P<0.01)。结论:紫外线预照射新鲜猪皮用于覆盖烧伤创面能明显延长创面保护时间,其作用途径可能与减轻局部组织脂质过氧化反应程度及炎性因子水平有关。
OBJECTIVE: To observe the effect of transplanted pig skin slices by ultraviolet light on burn wound coverage time. Methods: Thirty - five patients with skin grafts who were admitted to the Department of Burns, General Hospital of Panzhihua Iron and Steel Co., Ltd. From January 2004 to December 2005 were selected and informed consent. According to random number table divided into 2 groups, 18 cases of UV pre-irradiation group, 17 cases of control group. The pigskin film used in the UV pre-irradiation group was pre-irradiated with 40W ultraviolet light at a wavelength of 253.7nm, the tube was 30cm away from the pigskin and the irradiation time was 2h. The pigskin slices used in the control group were not pre-irradiated with UV light. The transplanted pigskin dermis covered with cutting crust wound, pressure bandage, with a scalpel holes to facilitate drainage. The survival time of the whole pig skin was observed. The whole pig skin of 0.2cm × 0.3cm was homogenized on the 5th, 10th, 15th day after operation to detect the levels of related biochemical factors. The level of biochemical factors was measured by double antibody sandwich enzyme-linked immunosorbent assay Tumor necrosis factor-α content, the application method to detect endotoxin content, the application of xanthine oxidase method for measuring superoxide dismutase activity, the application of thiopental barbituric acid method for the determination of malondialdehyde content. Transplanted pig skin appears pale appearance, separation from the wound, melt off are regarded as failure. Results: All the 35 burn patients were involved in the result analysis without any loss. ① The average wound burn time of pigskin exposed to UV pre-irradiation was (18.3 ± 2.4) d, which was significantly higher than that of the control group (13.7 ± 3.1) days (P <0.05). 15 days after covering pigskin skin, 3 piglets transplanted in UV pre-irradiation group failed, and 9 pigs skin transplanted in control group failed. (2) With the extension of time, tumor necrosis factor alpha, endotoxin and malondialdehyde in local tissue homogenate of pigskin covered a rising trend in both groups, and were significantly lower in the pre-irradiation group than those in the control group (P <0.01). The activity of superoxide dismutase in local tissue of transplanted pigskin skin showed a decreasing trend with time prolongation in both groups, and the levels of superoxide dismutase in the tissue of transplanted pigskin at the 10th and 15th day after irradiation were significantly higher than those in the control group (P <0.01). Conclusion: The application of UV pre-irradiated fresh pig skin to burn wounds can significantly prolong the wound protection time, which may be related to the reduction of local lipid peroxidation and the level of inflammatory cytokines.