Observation Of Clinical Nursing Effect And Mechanism Of Moxibustion Intervention On Ⅲ-Ⅳ Period Pressure Injury

Objectives1.Observation of clinical nursing of moxibustion on Ⅲ-Ⅳ period pressure injury.2.To explore the possible mechanism of moxibustion promoting wound healing in rats with Ⅲ-Ⅳ period pressure injury.Methods1.Select the patients with III or IV period pressure injury who were treated in the hospital of Anhui province,and randomly divide them into the control group and the test group.The same method is used to prepare the wound bed.The control group selects appropriate dressing according to the wound evaluation results,and the test group applies moxibustion treatment on the basis of the control group(15 minutes for each wound).The clinical nursing effect of moxibustion on Ⅲ-Ⅳ period pressure injury was observed by using the wound healing rate,the Pressure Ulcer Scale of Healing(PUSH),and the Visual Analogue Score(VAS)before the clinical intervention and after 1,2,3 and 4 weeks of intervention.2.Thirty-two SPF rats were randomly allocated to the blank group,the model group,the conventional treatment group and the moxibustion group,and the latter three groups replicate the III-IV period pressure injury model.After the wound bed was prepared with the same method,the model group was treated with saline gauze once a day;The conventional treatment group was treated with alginate silver ion dressing once a day;The moxibustion group was treated with moxibustion intervention,15 minutes each time,once a day.The dressing of the three groups was changed continuously for 9 days.By comparing the wound healing rate,observing the pathological changes of the wound;detecting the expression of serum inflammatory factors by ELISA;detecting the density of microvessels indicated by CD31 by IHC;detecting the protein expression of VEGF,VEGFR2,Ras and the phosphorylation level of Raf-1,ERK by Western Blot;and detecting the VEGF,VEGFR-2,RAS,RAF,ERK1 /2 m RNA expression in tissues by RTPCR,the possible mechanism of moxibustion promoting the wound healing in rats with stage Ⅲ-Ⅳ period injury was preliminarily explored.Results1.(1)Statistical analysis shows no statistical significance for genders,ages,locations of pressure injury,stage of pressure injury,admission diagnosis,the initial scores of PUSH and VAS of patients in the two groups.(2)In the third and fourth weeks,the score of the test group lower than the control group,the differences were statistically significant.There were time and interaction effects of PUSH scale scores in the two groups,but the group effect was not significant.(3)The wound healing rate of test group was higher than that of control group at the third and fourth week,the differences were statistically significant.There were time effect,group effect and interaction effect on the wound healing rate of the two groups.(4)VAS scores in the first,second,third and fourth weeks of test group were lower than those in the control group,the differences were statistically significant.There were time effect,group effect and interaction effect on the VAS scores of the two groups.2.(1)There was no statistically significant difference in the wound area and body weight of rats in each group after successful modeling.(2)On the third day,there was no significant difference in the wound healing rate among the three groups;on the fifth,seventh and ninth days,compared with the model group,the conventional treatment group and the third day of the moxibustion group,the wound healing rate of the moxibustion group was significantly improved,with significant differences.(3)In the model group,large areas of cortex necrosis and dissolution,muscle fiber necrosis,and a large number of inflammatory cells infiltrated,without other accessory organs such as hair follicles;in the conventional treatment group,a large number of inflammatory cells were infiltrated and new angiogenesis was seen;the infiltration rate of inflammatory cells in the moxibustion group was significantly lower than that in the model group,showing the formation of muscle fibers and new blood vessels.(4)Model group compared to blank group: The result of the ELISA shows the expressions of IL-1β、 TNF-α、 IL-6 of rats were significantly increased.The expressions of IL-4 and IL-10 were significantly decreased.The results of CD31 immunohistochemistry showed that the density of microvessels indicated by CD31 was significantly decreased.The result of the Western Blot shows the expression levels of RAS protein,RAF-1 and ERK phosphorylation were significantly increased,the expression levels of VEGF and VEGFR2 were significantly decreased.The result of the RT-PCR shows the m RNA expression levels of RAS,RAF and ERK1/2 were significantly increased.The m RNA expression levels of VEGF and VEGFR2 were significantly decreased.(5)The conventional treatment group and moxibustion group compared to the model group: The result of the ELISA shows the expressions of IL-1β 、 TNF-α 、 IL-6 of rats were significantly decreased.The expressions of IL-4 and IL-10 were significantly increased.The results of CD31 immunohistochemistry showed that the density of microvessels indicated by CD31 was significantly increased.The result of the Western Blot shows the expression levels of RAS protein,RAF-1 and ERK phosphorylation were significantly decreased,the expression levels of VEGF and VEGFR2 were significantly increased.The result of the RT-PCR shows the m RNA expression levels of RAS,RAF and ERK1/2 were significantly decreased.The m RNA expression levels of VEGF and VEGFR2 were significantly increased.(6)The moxibustion group compared to conventional treatment group: The result of the ELISA shows the expressions of IL-1β and IL-10 were significantly decreased,The expressions of IL-4 and IL-6 were significantly increased.The results of CD31 immunohistochemistry showed that the density of microvessels indicated by CD31 was significantly increased.The result of the Western Blot shows the expression levels of RAS protein,RAF-1 and ERK phosphorylation were significantly decreased,the expression levels of VEGF and VEGFR2 were significantly increased.The result of the RT-PCR shows the m RNA expression levels of RAS,RAF and ERK1/2 were significantly decreased.The m RNA expression levels of VEGF and VEGFR2 were significantly increased.Conclusions1.Conventional dressing change combined with moxibustion can significantly relieve pain and promote wound healing in patients with Ⅲ-Ⅳ pressure injury.2.Moxibustion intervention can inhibit excessive inflammation on the wound of rats withⅢ-Ⅳ pressure injury,promote the expression levels of VEGF and VEGFR2,and promote wound angiogenesis to promote wound healing in rat model.3.Moxibustion intervention can regulate RAS/RAF/ERK signaling pathway in rats withⅢ-Ⅳ pressure injury.