【摘要】 目的 观察不同温度悬起灸干预对大鼠压疮创面组织超微结构的影响，明确悬起灸促进压疮创面修复的最佳干预温度，以期为临床艾灸治疗压疮及慢性难愈性创面提供理论依据。方法 取133只雌性健康SD成年大鼠，随机选择3只大鼠作为空白对照组，其余130只大鼠通过缺血再灌注损伤方式建立2～3期压疮模型。将模型制备成功的125只大鼠随机分为模型对照组、水凝胶组、低温艾灸干预组、中温艾灸干预组及高温艾灸干预组，每组25只。模型对照组和空白对照组仅进行碘伏常规处理；水凝胶组用碘伏处理压疮创面后将水凝胶伤口敷料覆盖于创面处；低、中、高温艾灸干预组给予碘伏处理后分别对压疮创面中心施以38～41℃、43～46℃、48～51℃的悬起灸干预(通过红外热像仪检测创面皮肤表面温度),艾灸干预1次/d,每次持续15 min。分别于干预1,3,5,7,10 d后取各造模组大鼠压疮创面组织，透射电镜下观察压疮组织超微结构；空白对照组大鼠一并取材以观察正常皮肤组织镜下超微结构。结果 与空白对照组相比，各造模组大鼠造模后干预前均出现表皮脱落或损伤及真皮层损伤。(1)表皮修复情况：模型对照组压疮创面中基底细胞结构及功能恢复相对较慢，干预10 d后才可见大部分基底细胞基本恢复正常，但细胞器相对较少，功能较低下。低、中温艾灸干预组干预5 d后可见大部分基底细胞基本恢复正常，中温艾灸干预组可见绝大部分基底细胞基本恢复正常，绝大部分基底细胞的线粒体状态较好，结构较清晰，10 d后基底细胞线粒体数目增多，胶原纤维致密，新生表皮完整，更优于低温艾灸干预组。水凝胶组干预5 d后可见部分基底细胞线粒体肿胀；7 d后可见大部分基底细胞细胞器增多，线粒体结构逐渐恢复正常。高温艾灸干预组干预7 d后可见少部分有线粒体自噬产生，相对略差于水凝胶组。(2)真皮修复情况：模型对照组干预5 d后可见真皮层炎性细胞高度浸润，成纤维细胞变性；7 d后真皮层尚有少量炎性细胞，真皮成纤维细胞增生并有功能恢复，少部分胶原纤维相对较致密；10 d后真皮成纤维细胞增生明显，真皮有淋巴细胞，真皮损伤有恢复，部分胶原纤维相对较致密。中温艾灸干预组干预1 d后真皮层出现大量的炎性细胞浸润；5 d后可见真皮层不新鲜的粒细胞浸润，大量的成纤维细胞增生活跃，大部分胶原纤维较致密；7 d后绝大部分真皮成纤维细胞数目增多，功能活跃，且胶原纤维较致密；10 d后真皮成纤维细胞功能旺盛，胶原纤维致密。低温艾灸干预组可见上述类似大体趋势；水凝胶组及高温艾灸干预组干预5,7,10 d后亦可见真皮成纤维细胞不同程度的增生，其功能亦逐渐恢复，胶原纤维排列逐渐致密，但修复情况均较中温艾灸干预组差。结论 不同温度悬起灸干预及水凝胶处理能够整体上提前压疮创面急性炎症浸润的高峰，促进压疮创面由炎症损伤阶段向增殖修复阶段的顺利转变，继而加快压疮创面修复进程。不同温度悬起灸干预后压疮创面修复存在一定差异，其中38～41℃、43～46℃温度下悬起灸更有利于促进压疮组织残存表皮修复、新生表皮生成及真皮浅层修复，且43～46℃温度下悬起灸更具优势。更多还原

【Abstract】 Objective It is to observe the effects of suspension moxibustion of different temperature on the ultrastructure of pressure ulcer wounds in rats, and to clarify the optimal intervention temperature of the moxibustion in promoting the repair of pressure ulcer wounds, with a view to providing theoretical evidences for the treatment of pressure ulcers and chronic refractory wounds with moxibustion in clinic. Methods A total of 133 healthy adult female SD rats were taken, in which 3 rats were randomly selected as the blank control group, while the remaining 130 rats were used to establish models of stage 2-3 pressure ulcer by ischemia-reperfusion injury. The 125 successfully model rats were randomly divided into model control group, hydrogel group, low-temperature moxibustion intervention group, medium-temperature moxibustion intervention group and high-temperature moxibustion intervention group, with 25 rats in each group. The model control group and blank control group were treated with iodophor only; the hydrogel group were treated with iodophor and then covered with hydrogel wound dressing on the wounds; the low, medium, and high temperature moxibustion intervention groups were treated with iodophor and then were respectively treated with suspended moxibustion to the center of the wounds at 38-41 ℃, 43-46 ℃, and 48-51 ℃(the surface temperature of skin wounds was detected by infrared camera), once daily, 15 min per time. After 1, 3, 5, 7, and 10 days of intervention, the ultrastructure of the pressure ulcer tissues in rats of each modeling group and the normal skin tissues of rats in the blank control group were observed undertransmission electron microscopy. Resutls Compared with the blank control group, the rats in each modeling group were suffered from epidermal detachment or damage and dermal damage after modeling.(1)Epidermal repair: the recovery of structure and function of the basal cells in the pressure ulcer wounds of the model control group were slower, and most of the basal cells were basically restored to normal only with fewer organelles whose function was low after 10 days of intervention. After 5 days of intervention, most of the basal cells in the low and majority of the basal cells in the medium temperature moxibustion group were basically restored to normal, furthermore, the status of mitochondria in majority of the basal cells were good with clearer structure in the medium temperature group, after 10 days of intervention, the number of mitochondria in the basal cells were increased, with dense collagen fibers and complete newborn epidermis, the repair was superior to that of the low temperature group. After 5 days of intervention in the hydrogel group, the mitochondria in some basal cells was swelling; after 7 days, the organelles in most basal cells were increased, and the mitochondrial structure gradually returned to normal. After 7 days of intervention in the high temperature moxibustion group, some mitochondrial autophagy was found, which was slightly worse than that in the hydrogel group.(2)Dermal repair: after 5 days of intervention in the model control group, the dermis was highly infiltrated with inflammatory cells with degeneration of fibroblasts; after 7 days of intervention, there were still a few inflammatory cells in the dermis, with proliferation of fibroblasts and functional recovery, and a small number of collagen fibers were relatively dense; after 10 days, dermal fibroblasts proliferated significantly, there were lymphocytes in the dermis with recovery from dermal injury, and some of the collagen fibers were relatively dense. After 1 days of intervention in the medium temperature moxibustion intervention group, a large number of inflammatory cells infiltrated the dermis; after 5 days of intervention, non-fresh granulocytes infiltrated the dermis, a large number of fibroblasts were actively proliferating, and most of the collagen fibers were relatively dense; after 7 days of intervention, most of the dermal fibroblasts were increased and active, and collagen fibers were relatively dense; and after 10 days of intervention, the dermal fibroblasts were much active, and collagen fibers were dense. A similar trend was observed in the low temperature moxibustion group, dermal fibroblasts also proliferated to different degrees, their functions were gradually restored, and collagen fibers were gradually densely arranged after 5, 7, and 10 days of intervention in the hydrogel group and the high temperature moxibustion intervention group, but the repair situation was poorer than that in the medium-temperature group. Conclusion Moxibustion intervention of different temperatures and hydrogel can overall advance the peak of acute inflammatory infiltration in pressure ulcer wounds, promote the smooth transition of pressure ulcer wounds from the inflammatory injury stage to the proliferation and repair stage, and subsequently accelerate the pressure ulcer wound repair process. There were some differences in pressure ulcer wound repair after the intervention of different temperatures, among which 38-41 ℃ and 43-46 ℃ were more favorable to promote the residual epidermal repair, neoepidermal generation and superficial dermal repair of pressure ulcer tissues, and the temperature of 43-46 ℃ was more advantageous.更多还原