【摘要】 目的:探讨新鲜人羊膜去除绒毛膜干燥后修剪成薄厚各种的单层类型,经塑膜包装后再经γ射线辐射的辐射生物薄膜,在创伤创面修复中对创面的保护和促进愈合作用。方法:①动物实验:2001-03/2002-03在哈尔滨医科大学第一临床医学院急诊创伤实验室完成。选取Wister优质大鼠40只,麻醉后背部脱毛,浸入沸水中8s,致背部烫伤,烫伤面积相当于鼠体表面积的15%～20%,镜检相当于深Ⅱ度创面。每只大鼠的烫伤创面分别贴敷辐射生物薄膜和常规油纱,用纱布间断缝于创缘。术后3d去除敷料,暴露对比分别观察贴敷辐射生物薄膜和油纱后的创面愈合情况。于烫伤后4,6,8,10,12d活杀取材,各8只,对创面愈合情况进行组织学及电镜检查。②临床观察:选取2001-11/2004-11哈尔滨医科大学第一临床医学院急诊创伤外科的130例烫伤患者,共150个创面,其中手术供皮区创面60个,浅Ⅱ度创面50个,深Ⅱ度创面40个。手术供皮区创面:取皮厚度0.5～0.8mm,面积0.5%～4.0%。供皮区取皮后压迫止血,取皮创面对称贴敷辐射生物薄膜和油纱,15d后进行创面的检查换药处置。浅Ⅱ度创面:面积0.25%～3.0%。创面常规清创后,对称贴敷辐射生物薄膜和油纱,2d后进行创面的检查换药处置,对贴敷辐射生物薄膜侧的创面行半暴露疗法,对贴敷油纱侧的创面仍行包扎换药。深Ⅱ度创面:面积0.5%～3.0%。具体方法同浅Ⅱ度创面。如创面干燥,贴敷辐射生物薄膜侧行半暴露疗法,直至创面愈合;如创面渗液较多,给予有孔辐射生物薄膜重新包扎,待渗出停止时再行半暴露疗法。油纱侧检查换药后,仍行创面包扎疗法。结果:动物实验:中途无脱落。创面愈合情况:①大体观察:伤后4,6d贴油纱侧和辐射生物薄膜侧毛发均未长出,炎性水肿逐渐吸收。油纱侧创面伤后12d仍可见灶性小溃疡;而辐射生物薄膜侧创面伤后8d即可见大量毛发生长,伤后10,12d全部创面均愈合,皮肤具有弹性,毛发规则丛生,与正常表皮无区别。②光镜所见:贴油纱侧的创面,伤后4,6d表皮内大片凝固性坏死,真皮内大量急性炎细胞浸润,间质水肿,血管扩张充血。伤后12d创面仍有灶性溃疡,真皮层少量毛囊、毛根、毛发再生;而贴辐射生物薄膜侧的创面伤后10,12d,表皮角质层、透明层、真皮乳头层、网状层均不见炎细胞浸润,水肿细胞完全消失,纤维走形正常,属于正常皮肤组织状态。③扫描电镜观察:贴油纱侧创面伤后12d,创面中心为坏死结痂,大量炎性渗出物及白细胞存在,覆盖创面表面的为无结构状的坏死组织;而贴辐射生物薄膜侧的创面伤后12d,可见规则的角化层,毛发发育良好,毛囊数量较多,毛发成束存在。④透射电镜:贴油纱侧的创面伤后12d,细胞结构模糊不清,系创面坏死组织,其中夹杂着大量中性白细胞;而贴辐射生物薄膜侧的创面伤后12d,可见部分表皮和真皮全层,棘细胞排列整齐,颗粒层呈扁平排列,核质稀疏,角质颗粒较多,角化完全,似正常皮肤。临床观察:按实际处理分析,150个创面中,贴敷辐射生物薄膜侧脱落6个,其中浅Ⅱ度创面2个,深Ⅱ度创面4个。①不同程度创面皮肤愈合时间贴辐射生物薄膜侧比贴油纱侧平均提前时间:供皮区创面四五天犤(17±1.5),(21±1.5)d犦;浅Ⅱ度创面五六天犤(9±2),(12±2)d犦;深Ⅱ度创面七八天犤(14±1.5),(21±1.5)d犦。②深Ⅱ度创面细菌学检查结果:烫伤后8d,贴辐射生物薄膜侧的创面无细菌生长,贴油纱侧的创面细菌生长明显。结论:辐射生物薄膜制品行塑膜包装储存,拆装即用,操作简单,使用方便。经动物实验和临床治疗观察,辐射生物薄膜为手术供皮区和各种程度创伤创面的修复提供了一种良好的保护条件和环境。更多还原

【Abstract】 AIM: To prepare the radiated biological membranes with γ-ray after the fresh human amnions were divested of chorion, dried, clipped into single-layer amnions with various thickness and coated with plastic membrane sequentially so as to probe into the effect of them in preventing wounds and promoting the wound repair in the treatment of wounds. METHODS: ①Clinical experiment: The clinical experiment was conducted in the Department of Emergency and Wound Surgery, First Affiliated Hospital of Harbin Medical University from March to 2001 March 2002. Forty good-quality Wister rats were depilated on the back after anesthesia, then was dipped into boiling water for 8 seconds to induce scald of back. The scald area was 15% to 20% of rat body surface area, and the scald was deep second-degree wound by microscopic examination. The prepared biological membranes and routine oil gauzes were pressed on all the scale wounds, and the interval gauzes were sutured on the margins of wounds. Three days later, the biological membranes or oil gauzes were removed to expose the wounds, and then the wound healing was compared between the two kinds of dressings. Eight rats were sacrificed to observe wound healing histologically and by electron examination at 4, 6, 8, 10 and 12 days respectively. ②Clinical treatment: Totally 130 scalded patients were selected from the Department of Emergency and Wound Surgery, First Affiliated Hospital of Harbin Medical University between November 2001 and November 2004. There were 150 wounds in the 130 patients including 60 operated donor wounds, 50 superficial second-degree wounds and 40 deep second-degree wounds. For the operated donor wounds: the wounds 0.5 to 0.8 mm in thickness and 0.5% to 4.0% in area were taken. The donor sites were pressed to hemostasia after the skins were taken, and then the radiated biological membranes and oil gauzes matched to the wounds were applied. Fifteen days later, the wounds were examined and managed with dressing change. For the superficial second-degree wounds: The wounds were taken in the area of 0.25% to 3.0%. After routine debridement, the wounds were applied with the matched radiated biological membranes and oil gauzes. Two days later, the wounds were examined and managed with dressing change in the manner of semi-exposing the wounds applied with biological membranes and bandaging the wounds applied with oil gauzes to change dressing. For the deep second-degree wounds: The wounds were taken in the area of 0.5% to 3.0%. The managing methods were same as methods for the superficial second-degree wounds. In addition, if the wounds were dry, the wounds applied with biological membranes were treated by semi-exposure till the wounds healed, and if the exudates were much from the wounds, the wounds would be re-bandaged by fenestrated radiated biological membranes till the exudates stopped exuding followed by another semi-exposure. The wounds applied with oil gauzes were still bandaged after examination and dressing change. RESULTS: Animal experiment: There was no loss during experiment. Wound healing: ①Gross observation: No hair grew from the wounds applied by either oil gauzes or radiated biological membranes, and inflammatory edema was absorbed gradually 4 and 6 days after scald. The wounds applied with oil gauzes were found with small-area focal ulcer 12 days after scald. However, the wounds applied with biological membranes were found with abundant hair growth 8 days after scald, and healed 10 or 12 days after scald, in which the skin was elastic, and the hair grew regularly, similar to the normal skin. ②Observation by light microscopy: In the wounds applied with oil gauzes, there was a mass of coagulative necrosis, and lots of acute inflammatory cells infiltrating in the dermis accompanied by interstitial edema, vascular dilatation and engorgement 4 and 6 days after scald; focal ulcer were still observed in the wounds, and a small quantity of hair follicles, hair root and hair regenerated in dermal epithelia 12 days after scald. In the wounds applied with radiated biological membranes 10 and 12 days after scald, no inflammatory cells infiltrated in the stratum corneum and stratum lucidum of epidermis, and the papillar and reticular layers of dermis, the edematous cells disappeared completely and fibers were in a regular direction, which were similar to the normal skin. ③Observation by scanning electron microscopy: In the wounds applied with oil gauzes 12 days after scald, necrotic scab, a great number of inflammatory exudates and white cells were in central wounds, and necrotic tissues without any structure covered on the surface of wounds; In the wounds applied with radiated biological membranes 12 days after scald, regular stratum corneum was found, hair grew well, and many hair follicles and bundles of hair existed. ④Observation by electron microscopy: There were unclear cell structure i.e., necrotic tissues in the wounds applied with oil gauzes, among which lots of neutrophils were found 12 days after scald. Some epidermis and full-layer of dermis were observed, echinocytes arranged orderly, the granular layer arranged in a thin and flat form, nucleoplasm was sparse, corneous granules was in a great number and keratinization was thorough in the wounds applied with radiated biological membranes 12 days after scale, which was similar to the normal skin. Clinical treatment: According to the actual management, 6 of the 150 wounds were lost when they were applied with the radiated biological membranes, 2 of the superficial second-degree wounds and 4 of the deep second-degree wounds. ①The time for wound healing was advanced in the wounds applied with radiated biological membranes versus in those applied with oil gauzes: averagely by 4 to 5 days for wounds in the donors[(17±1.5) days vs (21±1.5) days], by 5 to 6 days for the superficial second-degree wounds[(9±2) days vs (12±2) days] and by 7 to 8 days for the deep second-degree wounds[(14±1.5) days vs (21±1.5) days]. ②Bacteriological examination of deep second-degree wounds: Bacteria were not found in the wounds applied with radiated biological membranes, nevertheless grew markedly in the wounds applied with oil gauzes. CONCLUSION: Having been coated with plastic membranes, the radiated biological membranes can be used simply and easily as soon as the packing was removed. Proved by clinical experiments and clinical treatment, the radiated biological membranes provide satisfactory protective condition and environment for the repair of wounds from operated donors and those of different degrees.更多还原