不同清创法对开放性创口早期感染敏感指标影响的实验研究  

Experimental study on the effect of improved debridement method on sensitive markers for early infection of open wound

作　　者：卢冰[1] 赵婵娟[2] 钟振东[1] 

机构地区：[1]四川省医学科学院.四川省人民医院骨科,四川成都610072 [2]四川大学华西第二医院,四川成都610041

出　　处：《实用医院临床杂志》2017年第6期71-75,共5页Practical Journal of Clinical Medicine

摘　　要：目的探讨不同清创法对开放性创口早期感染敏感指标的影响。方法将96只SD大鼠随机分为8组,除正常组外,各组用无菌手术法切除皮肤,去掉皮下组织和部分肌肉,造成基底凹凸不平的创面,将大肠杆菌悬浊液(细菌数>1×109个/ml)1 ml均匀涂于各伤口表面,使局部细菌数>1×107个。对照组伤口不予冲洗,其余各组分别用肥皂水和生理盐水处理。分别采集1、3、7d的标本检测,通过ELISA、QRT-PCR和Western blot技术,观察感染的发生、发展、预后与免疫因子血清降钙素原(PCT)、肿瘤坏死因子(TNF)-α和脂联素(APN)之间的动态变化,比较各组对开放性创口早期感染敏感指标的影响。结果与正常组比较,对照组PCT、TNF-α水平同时升高,APN水平降低。各高低压处理组均能不同程度降低PCT、TNF-α水平,升高APN水平(P<0.01),且高压肥皂水冲洗组和高压生理盐水冲洗组术后切口早期感染发生率低于低压肥皂水和低压生理盐水组(P<0.05)。传统冲洗方式组作用7d后PCT、TNF-α和APN的水平差异无统计学意义(P>0.05)。结论对于开放性创口早期感染敏感指标的影响,改良冲洗的清创方式预防术后感染效果优于传统倒水法的清创方式。Objective To evaluate the effect of improved debridement method on sensitive markers for early infection of open wound. Methods Ninety-six SD rats were divided into 8 groups. Except for the normal group, the skin of each group was removed by sterile operation. Moreover, the subcutaneous tissue and part of the muscle were removed to make the uneven wound surface. One ml of Escheriehia coli suspension （ bacteria count 〉1 × 10^9/ml） was evenly placed on the surface of the wound in which the local number of bacteria was larger than 1 x 107. The wounds in the control group were not washed,and the rest groups were treated with soap water and physiological saline for 1 day,3 days and 7 days. The specimens were collected respectively. The positive and negative expression of APN,TNF-α and PCT were determined in the occurrence, development,prognosis of infection by using ELISA, QRT-PCR and Western blot techniques. The effects of improved debridement method on sensitive markers for early infection of open wound were compared. Results Compared to the normal group, the levels of TNF-α and PCT in the control group were increased and the level of APN was decreased, The levds of TNF and PCT were decreased in the high and low pressure treatment group and the level of APN was increased （ P 〈0. 01 ）, Furthermore, the incidence of early postoperative irffection was lower in the high-pressure soap water washing group and the high-pressure saline group than that in the low-pressure soap water and the low-pressure physiological saline group （ P 〈 0. 05 ）. After 7 days, there was no significant difference in the level of PCT, TNF-α and APN in the traditional washing method group （P 〉 0.05 ）. Conclusion For effect of open wound infection on early sensitive index,improved washing debridement method is better than tradition- al method for prevention of postoperative infection.

关 键 词：清创 开放性创口 早期感染 PCT TNF-Α APN 

分 类 号：R641[医药卫生—外科学]