不同温度清洗液对糖尿病足创口表面细菌清洁率和创口愈合率的影响研究  

Influence of Cleanout Fluid of Different Temperature on Epiphytic Bacteria Cleaning Rate and Healing Rate of Diabetic Foot Ulcer Wound

作　　者：仇铁英[1] 黄金[1] 周秋红[2] 杨静[1] 胡进 

机构地区：[1]中南大学湘雅二医院,湖南省长沙市410011 [2]中南大学湘雅医院 [3]湘潭市中心医院

出　　处：《中国全科医学》2016年第18期2169-2173,共5页Chinese General Practice

摘　　要：目的：观察糖尿病足创口常见感染菌的种类，探讨不同温度清洗液清洗创口后创口表面细菌数量和创口面积的变化，分析温度对创口表面细菌清洁率和创口愈合率的影响。方法选取2013年5—11月在中南大学湘雅二医院和中南大学湘雅医院内分泌科住院和创口门诊收治的符合纳入与排除标准的糖尿病足患者60例，采用随机数字表法分为常温组（22.0-24.0℃）20例、37.0℃组20例、40.0℃组20例，培养糖尿病足创口表面的细菌，查看感染菌的种类。由专业的创口治疗师对患者创口进行清洗和换药，37.0℃组、40.0℃组分别用加温箱将0.9%氯化钠溶液加温到37.0、40.0 ℃ ，分别进行涡流式冲洗，对照组在室温22.0-24.0 ℃ 的空调房间内用常温0.9%氯化钠溶液进行创口冲洗。治疗第1、4天创口清洗前后记录创口表面细菌数量，计算创口表面细菌清洁率；治疗第4、7、14、21、28、35天测定创口面积，计算创口愈合率。结果糖尿病足创口表面细菌中革兰阳性菌43株（46.7%）、革兰阴性菌47株（51.1%）和真菌2株（2.2%），前3位革兰阳性菌为金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌，前3位革兰阴性菌为铜绿假单胞菌、大肠埃希菌、普通变形杆菌。治疗第1 天和第4天清洗前、清洗后3组糖尿病足患者创口表面细菌数量比较，差异均无统计学意义（P 〉0.05）。治疗第1 天 37.0℃组、40.0℃组糖尿病足患者创口表面细菌清洁率较常温组高（ P 〈0.05）；治疗第4天 3组糖尿病足患者创口表面细菌清洁率比较，差异无统计学意义（ P 〉0.05）。3组糖尿病足患者不同时间创口愈合率比较，存在交互作用（P 〈0.05）；组间比较，差异有统计学意义（P 〈0.05）；时间间比较，差异有统计学意义（P 〈0.05）。结论糖尿病足创口表面细菌以革兰阳性菌和革兰阴性菌为主。加温创口清洗液可以�Objective To investigate the types and features of common infectious bacteria on diabetic foot ulcer wound,study the changes of epiphytic bacteria count and wound area after cleaning by cleanout fluid of different temperature, and analyze the influence of temperature on bacteria cleaning rate and wound healing rate. Methods From May to December in 2013,we enrolled 60 patients with diabetic foot who accorded with inclusion and exclusion criteria from the Endocrinology Department of the Second Xiangya Hospital of Central South University and Xiangya Hospital Central South University. Using random number table method,the patients were assigned into three groups,which were normal temperature（22. 0 - 24. 0 ℃ ） group（n = 20）,37. 0 ℃ group（ n = 20）and 40. 0 ℃ group（ n = 20）. Epiphytic bacteria of diabetic foot wound were cultured to determine the species of infectious bacteria. Professional therapists cleaned wound and changed dressing for the patients. For patients of 37. 0 ℃ group and 40. 0 ℃ group,0. 9% sodium chloride solution used was heated to 37. 0 ℃ and 40. 0 ℃ respectively,and their wound were cleaned by eddy. For patient of normal temperature group,wound was cleaned by 0. 9% sodium chloride of normal temperature in a air - conditioned room with a temperature of 22. 0 - 24. 0 ℃. On day 1 and day＆amp;nbsp;4,epiphytic bacteria count was recorded before and after wound cleaning. Bacteria cleaning rate was calculated;wound area was determined on day 4,day 7,day 14,day 21,day 28 and day 35 to calculate healing rate. Results There were 43（46. 7% ） strains of gram positive bacteria,47（51. 1% ）strains of gram - negative bacteria and 2（2. 2% ）strains of fungus. The first three species of gram positive bacteria were staphylococcus aureus,staphylococcus epidermidis and enterococcus faecalis,and the first three species of gram - negative bacteria were pseudomonas aeruginosa,escherichia coli and bacillus proteus vulgaris. On day 1 and day 4,there were not significantly different

关 键 词：糖尿病足 革兰阴性菌 革兰阳性菌 伤口愈合 温度 

分 类 号：R587.2[医药卫生—内分泌]