张丽 易倩 林晓丽 倪荣苹 谭洁

[摘要]目的：探討重组牛碱性成纤维细胞生长因子（Recombinant bovine basic fibroblast growth factor，rb-bFGF）凝胶辅助治疗骶尾部Ⅲ～Ⅳ期压疮的临床疗效。方法：纳入2018年1月-2019年12月收治的102例骶尾部Ⅲ～Ⅳ期压疮患者作为研究对象，采用随机数表法分为观察组和对照组，每组各51例。对照组予以常规压疮治疗，观察组在对照组基础上增加应用rb-bFGF外用凝胶。比较两组临床疗效、恢复情况（创面治愈时间、创面肉芽生长时间、换药次数、渗液消失时间），治疗前、治疗1周、2周时均评估创面恢复情况[压疮愈合量表（Pressure ulcer scale for healing，PUSH）]、炎性因子水平[白介素-6（Interleukin-6，IL-6）、肿瘤坏死因子α（Tumor necrosis factorα，TNF-α）、白介素-8（Interleukin-8，IL-8）]，记录两组患者创面愈合满意度。结果：治疗2周后，观察组治疗总有效率高于对照组，差异有统计学意义（P<0.05）。观察组创面治愈时间、创面肉芽生长时间、换药次数、渗液消失时间均小于对照组，差异有统计学意义（P<0.05）。治疗1周、2周时，两组PUSH评分、IL-6、TNF-α、IL-8均呈持续下降趋势，观察组降幅大于对照组，不同治疗方案指标与时间存在交互效应，差异均有统计学意义（P<0.05）。观察组满意度优良率高于对照组，差异有统计学意义（P<0.05）。结论：rb-bFGF外用凝胶辅助治疗骶尾部Ⅲ～Ⅳ期压疮效果良好，有临床应用价值。

[关键词]压疮;Ⅲ～Ⅳ期;骶尾部;重组牛碱性成纤维细胞生长因子凝胶;湿性敷料;炎症因子

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0018-04

Clinical Observation of Topical rb-bFGF in the Adjuvant Treatment of Stage Ⅲ-Ⅳ Sacrococcygeal Pressure Ulcer

ZHANG Li1，YI Qian2，LIN Xiao-li1，NI Rong-ping1，TAN Jie1

（1.Department of Hepatopancreatobiliary Surgery;2.Department of Burns and Cosmetology，Deyang Peoples Hospital，Deyang 618000，Sichuan，China）

Abstract： Objective  To explore the clinical efficacy of recombinant bovine basic fibroblast growth factor （rb-bFGF） gel in the adjuvant treatment of stage Ⅲ-Ⅳ sacrococcygeal pressure ulcer. Methods  A total of 102 patients with stage Ⅲ-Ⅳ sacrococcygeal pressure ulcer admitted between January 2018 and December 2019 were included as the research subjects， and they were divided into the observation group and the control group by random number table method， with 51 cases in each group. The control group was treated with conventional pressure injury treatment， and the observation group was additionally given topical gel of rb-bFGF on the basis of control group. The clinical efficacy and recovery status （wound healing time， wound granulation growth time， frequency of dressing changes， exudation disappearance time） were compared between the two groups， and the recovery status of wounds [Pressure ulcer scale for healing （PUSH）] and inflammatory factors [Interleukin-6 （IL-6）， Tumor necrosis factor α （TNF-α）， Interleukin-8 （IL-8）] were evaluated before treatment and at one week and two weeks of treatment， and the satisfaction of wound healing was recorded in the two groups. Results  After two weeks of treatment， the total effective rate of treatment in the observation group was higher than that in the control group， the difference was statistically significant （P<0.05）. The wound healing time， wound granulation growth time， frequency of dressing changes and exudation disappearance time in the observation group were all less than those in the control group （P<0.05）. At one week and two weeks of treatment， the PUSH score and levels of IL-6， TNF-α and IL-8 in the two groups showed a continuous downward trend （P<0.05）. And the decreases in the observation group were greater than those in the control group （P<0.05）. There were interactive effects between different treatment options and time （P<0.05）. The excellent and good rate of satisfaction in  the observation group was higher than that in  the control group （P<0.05）. Conclusion  rb-bFGF topical gel has a good effect and clinical application value in the adjuvant treatment of stage Ⅲ-Ⅳ sacrococcygeal pressure ulcer.

Key words： pressure ulcer; stage Ⅲ-Ⅳ; sacrococcygeal region; recombinant bovine basic fibroblast growth factor gel（rb-bFGF）; wet dressing; inflammatory factors

压疮是由于身体局部长期受压血液循环障碍，局部组织缺血缺氧，营养缺乏致使皮肤失去正常功能而引起组织破坏[1]。Ⅲ～Ⅳ期压疮患者出现了皮肤全层缺损和组织缺损，溃疡深度因解剖位置而异[2]。目前压疮治疗以手术和外治法为主[3]，Ⅲ～Ⅳ期压疮患者病情较严重，创伤范围较大，因此应注重对压疮创处的保护。同时，有文献指出，干燥会使组织细胞损伤程度增加，湿润有助于修复创面，湿性愈合疗法可形成创面上皮细胞，有利于促进愈合[4]，因此选择合理的敷料对压疮治疗意义重大。有研究显示，重组牛碱性成纤维细胞生长因子（Recombinant bovine basic fibroblast growth factor，rb-bFGF）凝胶对促进创面愈合效果良好[5]。……