负压封闭引流对胫腓骨开放性骨折术后感染患者微循环和Th1/Th2的影响  

Effect of vacuum sealing drainage on microcirculation and Th1/Th2 in open tibia and fibula fracture patients with postoperative infection

作　　者：罗明华 杨华 吕志华 杨勇胜 于波波 LUO Ming hua;YANG Hua;LYU Zhi-hua;YANG Yong-sheng;YU Bo-bo(The Second People's Hospital of Jingdezhen,Jiangri Province,J ingdezhen,Jiangxi 3300,China)

机构地区：[1]江西省景德镇市第二人民医院骨一科,江西景德镇333000

出　　处：《中华医院感染学杂志》2020年第14期2192-2196,共5页Chinese Journal of Nosocomiology

基　　金：江西省卫生计生委科技计划基金资助项目(20161198)。

摘　　要：目的探究负压封闭引流(VSD)对胫腓骨开放性骨折术后感染患者微循环和辅助性T1(Th1)/辅助性T2(Th2)的影响。方法选取2014年2月-2019年2月江西省景德镇市第二人民医院74例胫腓骨开放性骨折患者,根据术后有无发生感染分为感染组18例和未感染组56例。未感染组采用内固定术治疗,感染组在其基础上采用VSD治疗。检测甲襞总积分、毛细血管流速与白微栓、碱性磷酸酶(ALP)、磷(P)、钙(Ca)浓度、Th1/Th2、感染组病原菌。结果与未感染组比,术后感染组甲襞总积分、白微栓降低,毛细血管流速升高,差异有统计学意义(P<0.05);感染组ALP、P、Ca浓度高于未感染组,差异有统计学意义(P<0.05)。与感染组比,术后未感染组IFN-γ、IL-2、TNF-α、IL-6水平升高(P<0.05);未感染组血清Th1及Th2亚群水平高于感染组,且未感染组Th1/Th2值较低,处于失衡状态(P<0.05)。18例感染患者分离出51株病原菌,以革兰阴性菌(60.87%)为主,革兰阳性菌占37.25%,真菌仅占1.96%。结论 VSD可明显控制感染,改善胫腓骨开放性骨折术后感染患者微循环及骨代谢,可改善Th1/Th2免疫功能。OBJECTIVE To explore the effect of vacuum sealing drainage(VSD)on microcirculation and T helper 1(Th1)/T helper 2(Th2)in open tibia and fibula fracture patients with postoperative infection.METHODS Totally 74 patients with open tibia and fibula fracture who were treated in The Second People’s Hospital of Jingdezhen,Jiangxi Province from Feb.2014 to Feb.2019 were enrolled in the study and divided into the infection group with 18 cases and the non-infection group with 56 cases according to the status of postoperative infection.The non-infection group was treated with internal fixation,while the infection group was treated with additional VSD on basis of the internal fixation.The total integral of nail fold,capillary velocity,concentrations of white micro thrombus,alkaline phosphatase(ALP),phosphorus(P),calcium(Ca),Th1/Th2 and pathogens isolated from the infection group were detected.RESULTS The total integral of nail fold and white micro thrombus of the infection group were significantly lower than those of the non-infection group,the capillary velocity of the infection group was significantly higher than that of the non-infection group(P<0.05).The levels of ALP,P and Ca of the infection group were significantly higher than those of the non-infection group(P<0.05).The levels of IFN-γ,IL-2,TNF-αand IL-6 of the non-infection group were significantly higher than those of the infection group(P<0.05).The levels of serum Th1 and Th2 of the non-infection group were significantly higher than those of the infection group,the ratio of Th1 to Th2 of the non-infection group was low and was in a an unbalanced state(P<0.05).A total of 51 strains of pathogens were isolated from 18 patients with infection,60.87%of which were gram-negative bacteria,37.25%were gram-positive bacteria,and 1.96%were fungi.CONCLUSION VSD may facilitate the control of the infection and improve the microcirculation and bone metabolism as well as the Th1/Th2 immune function of the open tibia and fibula fracture patients with postoperative infection.

关 键 词：负压封闭引流 微循环 辅助性T1细胞 辅助性T2细胞 

分 类 号：R473[医药卫生—护理学]