艾灸对压力性损伤大鼠创面修复的影响

于杰 孙忠人 李洪玲

[摘要] 目的 觀察艾灸对压力性损伤大鼠创面修复的影响。 方法 采用自制模型装置通过缺血-再灌注损伤方式建立2～3期压力性损伤动物模型，将造模成功的70只SD雌性大鼠随机分为模型组与艾灸组，每组各35只。每组根据干预时间的长短再分为5个亚组，即1 d、3 d、5 d、7 d、10 d亚组，7只/亚组。将空白组35只正常健康大鼠随机分为上述5个亚组，7只/亚组，不予造模，仅对模拟造模部位处进行碘伏处理。模型组于造模后只对创面进行碘伏常规处理，艾灸组在造模成功后，先对创面予碘伏处理，继予艾灸回旋灸操作，以压力性损伤创面为中心，1 cm长度为半径，1次/d，15 min/次。依次在上述5个时间点标本采集前测定压力性损伤创面面积，通过苏木精-伊红（HE）染色法观察其创面组织的病理形态学变化。 结果 治疗1 d后，各组组间的压力性损伤创面愈合率差异无统计学意义（P > 0.05）。艾灸组在其余4个时间点创面愈合率均明显高于模型组，分别对同一时间点进行两组组间比较，差异均有高度统计学意义（P < 0.01）。与模型组比较，艾灸组创面肉芽组织分别在生长状态与出现时间方面存在明显优势，其创面面积缩小程度较为明显，收缩速度更快。HE染色发现，艾灸组大鼠创面组织中的炎细胞浸润高峰及肉芽组织出现时限均较模型组提前，成纤维细胞增生程度与数量更明显，且出现时限较早。艾灸组大鼠创面更早出现新生血管和表皮结构的恢复。 结论 艾灸能够有效促进压力性损伤创面的愈合。

[关键词] 艾灸；压力性损伤；修复；创面愈合率；病理形态学

[中图分类号] R245.81 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0004-06

[Abstract] Objective To observe the effect of moxibustion on wound repair in rats with pressure injuries. Methods The models of rats with pressure ulcers which belonged to stage 2-3 were established by using self-made devices of pressure ulcers. The models of 70 SD female rats with skin ischemia reperfusion injury were randomly divided into model group and moxibustion group. There were 35 rats in each group. Each group was divided into 5 subgroups including 1 d， 3 d， 5 d， 7 d and 10 d according to the length of intervention time. Seven experimental rats were included in each subgroup. The blank group was given shaving disinfection， tied together with other groups of rats given only conventional iodophor intervention. The model group was only given conventional iodophor intervention. The moxibustion group was given iodophor intervention at first and direct moxibustion intervention to the local tissue of pressure ulcer with cyclotron operation， with moxibustion once a day and 15 minutes each time. The wound area was measured respectively after five time-points （1 d， 3 d， 5 d， 7 d and 10 d after intervention or treatment） before drawing. HE staining was used to observe the pathological changes of the pressure ulcer. Results There were no significant differences in the wound healing rates between the groups in the 1 d after intervention（P > 0.05）. Compared with the model group， the wound healing rates of moxibustion group were significantly higher at the four time-points including 3 d， 5 d， 7 d and 10 d after treatment. At the same time-points， there were significant differences between the two groups （P < 0.01）. Compared with the model group， the granulation tissues in the wounds of rats which belonged to moxibustion group with pressure ulcers had obvious advantages both in the time-points and the growth states. There were granulation tissues at the third day after treatment in the moxibustion group， while those of model group appeared about at the seventh day after iodophor intervention. Simultaneously， the wound contraction rates of pressure ulcers were faster in the moxibustion group which had more evident area reductions. Pathological changes of pressure ulcers were observed by HE staining that the peaks of the inflammatory infiltrations which existed in the moxibustion group had appeared in advance compared with the model group. Meanwhile， fibroblasts appeared earlier， having more numbers and obvious degrees of hyperplasia. The occurrence time of granulation tissues was earlier in the moxibustion group. Hence， neovascularization which belonged to moxibustion group formed earlier than that of model group. The epidermal structures of rats in the moxibustion group recovered in advance. Conclusion Moxibustion can promote the wound healing effectively in rats with pressure injuries.

[Key words] Moxibustion； Pressure injury； Repair； Wound healing rate； Pathological morphology

压力性损伤是一种由于局部组织长期受压，继而发生持续缺血、缺氧以及营养不良，最终致使组织发生溃烂、坏死的外科疾患。本病的发病因素众多，主要包括三大类，即内源性因素、外源性因素与加剧性因素，其中多因素相互作用导致发病居多[1]。剪切力、摩擦力与垂直压力共同构成压力性损伤的外源性因素，上述三大力学因素在致病过程中或单独或合并导致本病的发生[2-3]。营……