高寒区肢体爆炸伤易感菌谱的测定及相关研究  

Determination of common pathogenic bacteria of blast injury to the limbs in plateau area and related research

作　　者：王正雷[1] 王涛 李阳[1] 张文进[1] 刘建辉[1] 孔军[1] 郭宁[1] 宫明[1] 孙鹏[1] 范文宪[1] 王海斌[1] 齐琦[1] 

机构地区：[1]哈尔滨解放军第211医院骨二科,150080 [2]医学检验科

出　　处：《解放军医学杂志》2015年第10期849-852,共4页Medical Journal of Chinese People's Liberation Army

基　　金：全军医学科技“十二五”科研项目(CWS11J214)~~

摘　　要：目的探讨高寒区寒冷环境下,肢体爆炸伤后易感菌的种类与药敏情况,为战创伤感染的预防及治疗提供依据。方法在中俄边界、黑龙江流域和松花江流域,用800只兔制作成高寒区寒冷环境下爆炸伤模型,于伤后1、3、6、12、24、48、72、96h进行大体观察、生命体征观察、伤道分泌物细菌培养和分类及药敏试验,同时对靶场空气、地表雪、土壤、动物皮毛进行细菌培养和分类及药敏试验。结果靶场空气、地表雪中主要为芽孢杆菌,并有部分微球菌,土壤中主要为芽孢杆菌、大肠埃希菌、铜绿假单胞菌;兔皮毛培养主要为葡萄球菌、不动杆菌、铜绿假单胞菌和大肠埃希菌。伤后兔呼吸、脉搏加快,体温下降;致伤后24h呼吸、脉搏恢复正常,但体温仍低于致伤前。伤道分泌物细菌培养主要为革兰阳性菌,伤后伤道分泌物细菌培养菌株数从高到低依次是枯草芽孢杆菌、凝固酶阴性葡萄球菌、大肠埃希菌、铜绿假单胞菌、嗜麦芽寡养单胞菌。药敏结果显示革兰阳性菌对氧氟沙星、环丙沙星、红霉素等药物敏感,耐药菌较少;革兰阴性菌对头孢他啶、米诺环素、复方新诺明等敏感。结论高寒区寒冷干燥环境下爆炸伤后伤口细菌生长繁殖慢,清创时限可适当延长2~3h,易感菌群主要为革兰阳性菌,与周围环境中菌群存在相关性,应联合使用抗生素（氧氟沙星、环丙沙星、红霉素之一联用头孢他啶、米诺环素、复方新诺明中的一种）来预防爆炸伤感染。Objective To investigate the common pathogenic bacteria and their drug susceptibility in the wounds in the limbs as a result of blast injury in plateau with a low temperature so as to provide a basis for prevention and treatment of war wound infection in such area. Methods The model of blast injury was reproduced to the hind legs of 800 rabbits in cold and dry plateau. 1, 3, 6, 12, 24, 48, 72 and 96h after injury, the general condition and vital signs of the wounded were observed, and bacterial culture, flora analysis and drug susceptibility test of excretion from wound tract, air, surface of snow, soil and animal fur were performed. Results Micrococci and Bacilli were found in air and snow. Bacillus subtilis, Escherichia coli and Pseudornonas aeruginosa were found in soil, and Staphylococcus aureus, Acinetobacters, Pseudomonas aeruginosa and Escherichia coli in rabbit fur. The respiration and pulse became faster, and body temperature lowered after injury compared with that before injury. G~ bacteria were found in most wound tract secretions, and the frequency of the bacterial strains in descending order were Bacillus subtilis, coagulase-negative Staphylococci, E. coli, Pseudomonas aeruginosa, Stenotrophomonas maltophilia strains. The sensitive antibiotics for these G＋ bacteria were ofloxacin, ciprofloxacin, erythromycin. Susceptible G- bacteria were susceptible to ceftazidime, minocycline, sulfamethoxazole etc. Conclusions The growth of bacteria in the wounds as a result of blast injury grow slower in cold and dry alpine area. The time of debridement may be delayed for 2-3h. G＋ bacteria were main susceptible flora to antibiotics, and it is related to the bacterial flora of the surrounding environment, thus it is suggested that a combination of different antibiotics （ofloxacin, ciprofloxacin or erythromycin alone combined with ceftazidime, minocycline or cotrimoxazole alone） are needed to prevent infection after blast injury.

关 键 词：高寒区 爆炸伤 细菌学技术 微生物敏感性试验 

分 类 号：R446.51[医药卫生—诊断学]