陈健 谢包根 黄永新 黄秀萍 翁明生 林季镶 徐志雄 党建

[摘要]目的：观察富血小板血浆联合清创术治疗难愈性创面的疗效和特点。方法：选择2015年5月-2018年1月67例难愈性创面患者为研究对象，随机分成2组，其中观察组37例，对照组30例。全部病例均给予手术彻底清创，对照组术后常规换药，观察组在常规处理基础上行自体PRP创口内注射。结果：观察组患者VAS和VSS评分均低于对照组，差异有统计学意义（P<0.05）；观察组治疗后1个月创面愈合率明显高于对照组，完全愈合时间少于对照组，差异有统计学意义（P<0.05）；两组均未出现明显不良反应。结论：应用富血小板血浆联合清创术治疗难愈性创面疗效确切，大幅度缩短了恢复疗程，降低了手术创伤，无明显不良反应，而且降低了治疗成本。

[关键词]难愈性创面；富血小板血浆；清创术；微创；自体

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2018）04-0011-04

Effect of the Platelet Rich Plasma Combined with Debridement in the Treatment of Refractory Wounds

CHEN Jian，XIE Bao-gen，HUANG Yong-xin，HUANG Xiu-ping，WENG Ming-sheng，LIN Ji-xiang，

XU Zhi-xiong，DANG Jian

（Department of Burns and Plastic Surgery，the First Hospital of Putian City，Putian 351100，Fujian，China）

Abstract： Objective To observe the effect of platelet rich plasma combined with debridement surgery in the treatment of refractory wounds. Methods 67 cases of wound patients treated in our hospital as the research object， randomly divided into two groups. 37 cases in the observation group， 30 cases in the control group. All cases were treated by thorough debridement， removal of necrotic and unhealthy granulation tissue. The control group was routinely changed after operation， and the observation group was treated by autologous PRP internal injection on the basis of routine treatment. Results The scores of VAS and VSS in the observation group were lower than those in the control group， and the differences were statistically significant（P<0.05）. The wound healing rate of the observation group was significantly higher than that of the control group at 1 month after treatment， and the total healing time was less than that of the control group（P<0.05）. There was no obvious adverse reaction in the two groups of patients. Conclusion Platelet rich plasma combined with debridement effect in treatment of refractory wounds exactly， greatly shorten the course of treatment， reduce the surgical trauma， and no obvious adverse reactions， but also reduce the cost of treatment.

Key words： refractory wound； platelet rich plasma； debridement； minimally invasive； autologous

難愈性创面，亦称难治性创面，通常定义为由各种原因引起的，经正规治疗超过4周未愈合或没有愈合趋势的创面[1]。富血小板血浆（Platelet rich plasma， PRP）是新鲜全血经离心后提取的血小板含量丰富的血浆，富含各类细胞因子，包括血小板源性生长因子（Platelet derived growth factor， PDGF）、转化生长因子（Transforming growth factor， TGF）、胰岛素样生长因子（Insulin-like growth factor， IGF）、表皮细胞生长因子（Epidermal growth factor， EGF）以及血管内皮生长因子（Vascular endothelial growth factor， VEGF）等[2-3]。本研究中，笔者采用富血小板血浆联合清创术治疗难愈性创面，取得了良好效果，现报道如下。

1 资料和方法

1.1 病例资料：选择2015年5月-2018年1月本院烧伤整形科收治的67例难愈性创面患者为研究对象，男36例，女31例，按序贯性随机分为对照组和观察组。其中观察组37例，年龄18～64岁，糖尿病性溃疡12例，创伤性溃疡13例，压迫性溃疡4例，静脉曲张性溃疡8例，溃疡面积1～4cm×2～9cm，创面不愈1～6个月，创溃疡深度0.5～3.0cm；对照组30例，年龄18～65岁，糖尿病性溃疡10例，创伤性溃疡10例，压迫性溃疡3例，静脉曲张性溃疡7例，溃疡面积1～4.5cm×2～8cm，创面不愈1～6个月，创溃疡深度0.5～2.5cm。……