负压封闭引流术治疗犬胸壁全层缺损的实验研究

目的:探讨不同负压大小下的封闭负压引流术(vacuum sealing drainage,VSD)在治疗犬胸壁全层缺损创面愈合的效果。方法:25只健康成年犬的右胸壁制作3cm×4cm大小的全层缺损,随机分为5组,所有胸壁缺损处安装一次性封闭式负压吸引器,手动抽吸负压排出胸膜腔气体产生负压,致伤24小时后复查CT观察气胸情况;然后按照压力表显示调节负压至60kpa,40kpa,20kpa,10kpa,0kpa吸引胸壁,比较五组1d,3d,5d的伤口液体引流量,胸膜闭合时间;5d时伤口取材做HE染色及CD34免疫组化染色观察伤口愈合情况。结果:在60kpa和40kpa负压吸引下,1天引流液体量最多,分别为77.6±6.62 ml,77.8±4.97 ml;胸膜闭合最快,分别为3.2±1.30天,3.6±0.55天,但是60kpa组有一只犬血气分析显示为Ⅰ型呼吸衰竭;HE染色和CD34免疫组化染色显示各组均有肉芽组织增生及血管新生,且40kpa和60kpa负压组肉芽组织和血管密度明显多于其他组,二者之间无明显差异。结论:封闭负压吸引器对胸壁全层缺损创面有明显治疗作用,并且在40kpa负压下治疗效果最好而且安全。

Research of Full-Thickness Chest Wall Defects in Dogs Treated by Vacuum Sealing Drainage

Objective: To investigate the application of vacuum sealing drainage(VSD) on the full-thickness chest wall defects of dogs.Methods: 25 dogs with 3cm×4cm chest wall defected were randomly divided into 5 groups.All the defects were connected to the disposable-VSD devices.Gas was pumped out of pleural cavity by VSD with the help of vacuum gauge.24 hours later,CT scan were ap-plied to check the pneumothorax existed.The groups were divided by different subpressure: 60kpa,40kpa,20kpa,10kpa,0kpa.In each group,the drainage of the wound and time of pleura closing were measured at 1st,3rd and 5th day after surgery.At 5th day,tissues were drawn to observe by HE and immunohistology staining.Results: The drainage of subpressure 60kpa(77.6±6.62ml) and 40kpa(77.8±4.97ml) group were more than others at the first day,and the closing time of pleura of 60kpa(3.2±1.30days) and 40kpa(3.6±0.55days) group were faster.However,blood gas analysis manifested typeⅠrespiratory failure in group 60kpa.HE staining showed there was gran-ulation tissue and immunohistology staining showed CD34positive.No difference existed between group 60kpa and 40kpa,but neovascu-larization in the two groups is much more than that in the other three groups.Conclusion: VSD is effective to treat chest wall defects,and the drainage of 60kpa and 40kpa group are much more than others,and 40kpa group can achieve the best result and be safer.