抗弧菌抗生素在海水浸泡严重创伤中的应用  

Clinical Application of Antibiotics in Seawater Immersion of Severe Trauma Patients

作　　者：任雅瑾[1] 张贞良[1] 张柳瑛[1] 汪先兵[2] 谢培增[2] 周菲[2] 陈丽[2] 

机构地区：[1]解放军421医院药剂科,广东广州510318 [2]解放军421医院神经外科,广东广州510318

出　　处：《华南国防医学杂志》2013年第7期471-473,共3页Military Medical Journal of South China

基　　金：全军医学科学技术研究"十一五"课题(06MB174)

摘　　要：目的探讨抗生素在海水浸泡严重创伤中的有效应用。方法 50例海水浸泡严重创伤患者随机纳入抗弧菌治疗组,另从病案库中随机抽取既往采用常规治疗的病人50例作为对照组。常规组采用常规海水浸泡伤治疗方法;治疗组除常规治疗外加用抗弧菌抗生素左氧氟沙星。观察比较两组患者伤后2天、4天的伤口感染与全身感染情况、细菌培养加药敏试验和临床治疗结果。结果伤口感染率对照组为30.4%,治疗组为8.9%,治疗组的伤口感染率明显低于对照组(P<0.01)。对照组检出弧菌31株,治疗组2株,治疗组弧菌株数明显低于对照组(P<0.01)。伤后3个月,对照组优良率34%、死亡率38%,治疗组优良率62%、死亡率14%,治疗组优良率明显高于对照组(P<0.01),死亡率明显低于对照组(P<0.01)。结论海水浸泡严重创伤患者伤道或脏腔的细菌容易入血且快速繁殖,使感染时间提前且严重。对海水浸泡伤的处理应强调尽早、合理的清创和早期使用广谱加抗弧菌抗生素。Objective To study an appropriate treatment strategy of patients with severe trauma and seawater im- mersion. Methods One hundred patients with severe trauma in seawater immersion were randomly divided into two groups. Fifty cases treated with routine treatment methods of seawater immersion were as control group, and the other 50 cases were treated additionally by antibiotic resistance of vibrio using levofloxacin, 30mg/kg, 2/d for 5 days in treatment group. The gross condition was observed, the bacteriological strains in the wound were determined 2 and 4 days after the wound and the antibiotic sensitivity was determined. Wound infection rates and clinical treatment results were compared. Results The infection rate was 30. 4% in control group, and 8.9% in treatment group, which was significantly different （P〈0. 01）. A total of 31 strains of vibrio were detected in control group, and 2 strains in treatment group （P〈0. 01）. After three months, the good recovery rate was 34% and the mortality was 38% in the control group,which was 62% and 14% in the control group （P〈0. 01）. Conclusion For patients with severe trauma and seawater immersion, the bacteria can easily enter the blood in wound tracts and splanchnocoele, and breeds rapidly which results in early and serious infec- tion. Early and complete debridement of the wound and the application of broad-spectrum and anti-vibrion antibiotics should be emphasized in seawater immersion wound treatment.

关 键 词：严重创伤 海水浸泡 弧菌 抗生素 临床应用 

分 类 号：R821.1[医药卫生—临床医学]