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研究生:賴建宏
研究生(外文):Chien-Hung Lai
論文名稱:比較富含血小板血漿(Platelet-Rich Plasma)與藻酸鈣敷料應用於皮膚移植的效果
論文名稱(外文):Comparison of the Effects of Platelet-Rich Plasma and Calcium Alginate Dressing on Skin Graft
指導教授:賴政宏賴政宏引用關係
指導教授(外文):Cheng-Hung Lai 賴政宏
口試委員:林永昌吳瑞得
口試日期:2016-06-15
學位類別:碩士
校院名稱:國立中興大學
系所名稱:獸醫學系暨研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:46
中文關鍵詞:富含血小板血漿藻酸鈣敷料皮膚移植
外文關鍵詞:Platelet-Rich PlasmaCalcium Alginate DressingSkin Graft
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皮膚的主要功能是保護身體免於受到病原菌的感染,當動物肢體遠端的皮膚喪失或發生其他不適合進行皮瓣移植的情況時則需要進行皮膚移植,皮膚移植是指將一部分的皮膚移到另一位置。因為動物的皮膚構造與人類有些差異,所以皮膚移植用在動物身上的成功率比人低,因此在臨床上皮膚移植的應用並不普遍。本研究的目的是希望能找到可以應用於動物身上提升皮膚移植成功率的方法,因為富含血小板血漿(Platelet-Rich Plasma;PRP)及藻酸鈣敷料都有促進傷口癒合的相關報告,因此本研究是將PRP及藻酸鈣敷料應用於皮膚移植並希望能增加皮膚移植的成功率。實驗對象為15隻雄性、七週齡之Sprague Dawley品系大鼠,將這15隻大鼠隨機分為對照組、PRP組及藻酸鈣組,在每隻老鼠背上開創3個傷口,每個傷口面積為1平方公分,當中的一個傷口以縫線固定移植皮膚,另一個皮膚移植傷口則未以縫線固定,最後一個傷口則未進行皮膚移植,傷口的護理為每天更換二次。根據實驗結果,PRP組與藻酸鈣組在與對照組的比較下有顯著的差異(P<0.05),且傷口癒合狀況良好。在第七天時,移植皮膚並未發生壞死或感染等情形,但在第14天時,移植皮膚皆已形成痂皮。雖然移植皮膚無法順利移植,但由於在傷口癒合的表現上有不錯的表現,因此對於一些需要進行皮膚移植的傷口,可以考慮以PRP或藻酸鈣敷料來做替代使用,相信以他們良好的癒合能力也許可以達到不錯的效果。

Primary function of skin is to avoid attacked by microorganism. Skin graft is used for defects that cannot be reconstructed by direct apposition or skin flaps. Skin grafts are the transfer of a segment of free dermis and epidermis to a distant recipient. The structure of skin have some different between animals and human. So the success rate of skin graft in animals is less than human, and it is not common to use in clinic. The aim of this study is want to find a way which can increase success rate of skin graft. There have a lot of papers shows that both of PRP and calcium alginate dressing has well effect in wound heal. So I will use PRP and calcium alginate dressing on skin graft and compare the effect of them. We separate 15 Sprague-Dawley rats into control group, PRP group and calcium alginate group. Created 3 wounds on each rat’s back, each wound area is 1 cm2, and dressing twice per day. One of wounds does skin graft with suture, another one wound does skin graft without suture, and last wound does not skin graft. According the results, PRP group and calcium alginate group have signification different between control group (p<0.05), and wounds in PRP group and calcium alginate group healing well. When at 7th day, the skin graft in PRP group and calcium alginate dressing group haven’t necrosis or infection, and situation of heal is well; when at 14th day, the skin graft has formed scar in both group. Although skin graft is failed on PRP group and calcium alginate, but due to their effect in heal is fine, so if some wounds need to skin grafted, maybe can substitute with PRP or calcium alginate dressing, it should has well result.

目錄
誌謝…………………………………………………………………………… i
摘要…………………………………………………………………………… ii
Abstract……………………………………………………………………… iii
目錄………………………………………………………..………………… iv
表目次………………………………………………………………………… vi
圖目次………………………………………………………………………… vii
第一章 緒言………………………………………………………………….. 1
第二章 文獻探討…………………………………………………………….. 3
第一節 皮膚移植…………………………………………………….. 3
一、 皮膚移植的介紹……………………………………….. 3
二、 皮膚移植的注意事項………………………………….. 3
三、 皮膚移植的管理……………………………………….. 4
第二節 傷口癒合…………………………………………………….. 4
一、 傷口癒合的過程……………………………………….. 4
二、 影響傷口癒合的因素………………………………….. 6
第三節 富含血小板血漿…………………………………………….. 7
一、 富含血小板血漿的介紹……………………………….. 7
二、 富含血小板血漿的功用……………………………….. 7
三、 富含血小板血漿的製作……………………………….. 9
第四節 敷料介紹…………………………………………………….. 10
一、 敷料的種類…………………………………………….. 10
二、 敷料的選擇…………………………………………….. 11
三、 藻酸鈣介紹…………………………………………….. 12
第三章 材料與方法………………………………………………………….. 13
第一節 實驗動物…………………………………………………….. 13
第二節 實驗材料…………………………………………………….. 13
一、 實驗藥物與試劑……………………………………….. 13
二、 實驗儀器與設備……………………………………….. 14
三、 其他…………………………………………………….. 14
第三節 實驗設計………….…………………………………………. 15
一、 實驗分組……………………………………………….. 15
二、 建立皮膚移植傷口模型……………………………….. 15
三、 皮膚移植之效果評估………………………………….. 16
第四節 資料分析…………………………………………………….. 17

第四章 結果………………………………………………………………….. 19
第一節 臨床狀態觀察……………………………………………….. 19
第二節 皮膚狀態觀察……………………………………………….. 19
第三節 皮膚組織切片H&E染色下皮膚厚度觀察……………….... 20
第五章 討論…………………………………………………………………... 36
第一節 皮膚移植……………………………………………………... 36
第二節 富含血小板血漿…...………………………………………… 37
第三節 藻酸鈣敷料…………………………………………………... 38
第六章 總結………………………………………………………………....... 39
參考文獻………………………………………………………………………. 40

表目次
表2-1 正常傷口癒合過程……………………………………………… 5
表2-2 影響傷口癒合因素……………………………………………… 6
表2-3 在富含血小板血漿中的生長因子功能摘要…………………… 8
表2-4 理想敷料的特點………………………………………………… 11
表4-1a 第7天時皮膚移植傷口嚴重度比較………………………...…. 25
表4-1b 第14天時皮膚移植傷口嚴重度比較………………………...... 25
表4-2 傷口癒合面積變化….……………………………………….…. 26
表4-3 傷口的癒合百分比……………………………………………... 30
表4-4 各組大鼠皮膚組織切片下之表皮厚度測量…………………... 33

圖目次
圖 2-1 富含血小板血漿的製作流程…........................................................ 9
圖 3-1 大鼠背部開創三個傷口…………………………………………... 18
圖 3-2 大鼠背部傷口皮膚移植…………………………………………... 18
圖 4-1a 大鼠接受皮膚移植之前皮膚狀況.................................................... 22
圖 4-1b 大鼠接受皮膚移植之前皮膚狀況.................................................... 23
圖 4-2a 於皮膚移植後一周之目視觀察…………………………………… 24
圖 4-2b 於皮膚移植後二周之目視觀察…………………………………… 24
圖4-3a 無縫線固定皮膚移植的傷口變化直線圖………………………… 26
圖4-3b 縫線固定皮膚移植的傷口變化直線圖…………………………… 27
圖4-3c 未進行皮膚移植的傷口變化直線圖……………………………… 27
圖4-3d 控制組的傷口變化直線圖……………………………………….... 28
圖4-3e PRP組的傷口變化直線圖………………………………………… 28
圖4-3f 藻酸鈣組的傷口變化直線………………………………………… 29
圖4-4a 控制組的傷口癒合百分比直線圖………………………………… 31
圖4-4b PRP組的傷口癒合百分比直線圖………………………………… 31圖4-4c 藻酸鈣組的傷口癒合百分比直線圖…………………………….... 32
圖4-5 皮膚組織切片下皮膚厚度觀察......................................................... 34
圖4-5(續) 皮膚組織切片下皮膚厚度觀察..................................................... 35



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