水刀技术用于感染性创面清创效果的实验研究

发布时间：2018-03-24 20:28

本文选题：创面感染　切入点：动物模型　出处：《南方医科大学》2017年硕士论文

【摘要】：目的:探讨水刀技术(WaterJet)用于感染性创面清创的效果,为水刀清创的临床应用提供实验基础及理论依据。方法:取72只Wistar大鼠随机分为2大组,无菌条件下切除各大鼠背部3cm×3cm的全层皮肤,分别将铜绿假单胞菌菌液及金黄色葡萄球菌菌液涂抹于创面制成感染模型,然后每组采用不同的清创方法(水动力清创系统、传统清创方法(手术刀+脉冲冲洗)、单纯脉冲冲洗)以及换不同冲洗液(生理盐水、洗必泰)作为冲洗介质进行清创,清创前后分别于感染创面取少量局部肌肉组织,行组织细菌学检查及组织病理学分析。结果:1.动物造模及大体外观:所有大鼠均造模成功,无动物死亡。造模后48小时打开敷料观察伤口,铜绿假单胞菌感染创面可见创面及敷料表面附有大量绿色渗出物,周围组织水肿严重,触之易出血;而金葡菌感染伤口可见创面及敷料附有黄白色脓性分泌物,周围组织水肿,触之易出血;均提示感染模型造模成功。2.组织细菌学定量检查:同种细菌各个清创组清创前组织的细菌含量相似,差异均未见统计学意义(P均0.05)。以生理盐水作为冲洗介质对铜绿假单胞菌创面进行清创时,清创后水刀清创组组织细菌量为(1.19±0.27)×108CFU/g,明显小于传统清创组(1.61±0.60)×108CFU/g(P0.05)及单纯脉冲冲洗组(6.67±4.34)×108CFU/g(P0.05);而以洗必泰作为冲洗介质对铜绿假单胞菌创面进行清创时,清创后分别为(1.29±0.24)×108CFU/g、(1.77±0.56)×108CFU/g、(5.42±3.73)×108CFU/g,水刀清创组明显小于传统清创组及单纯脉冲冲洗组(P0.05);当以生理盐水作为冲洗介质对金黄色葡萄球菌创面进行清创时,清创后水刀清创组组织细菌量为(1.61±0.50)×106CFU/g,均比传统清创组(2.59±1.35)×106CFU/g及单纯脉冲冲洗组(5.93±2.51)×106CFU/g少,差异均有统计学意义(P0.05);而以洗必泰作为冲洗介质对金黄色葡萄球菌创面进行清创时,清创后组织细菌量分别为(1.58 ± 0.57)× 106CFU/g、(2.72±1.59)× 106CFU/g、(6.87±3.68)× 106CFU/g,水刀清创组明显小于传统清创组及单纯冲洗组(P0.05)。3.HE染色光学显微镜观察结果:对铜绿假单胞菌和金葡菌创面进行清创时,无论是以生理盐水还是洗必泰作为冲洗介质,各清创方法组清创后HE染色光学显微镜观察结果示:水刀清创组见较少量炎性细胞浸润,传统清创组见部分炎性细胞浸润,单纯脉冲冲洗组见较多炎性细胞浸润,且水刀清创组组织结构破坏较传统清创组轻。结论:对不同细菌形成的感染创面进行清创时,无论是以生理盐水为冲洗介质还是以洗必泰作为冲洗介质,水刀的清创效果均优于传统清创方法及单纯冲洗,水刀作为一种新型的清创方法能更好的清除感染,促进创面愈合。
[Abstract]:Objective: to investigate the effect of water knife technique on debridement of infectious wound, and to provide experimental and theoretical basis for clinical application of water knife debridement. Methods: 72 Wistar rats were randomly divided into 2 groups. The whole skin of 3cm 脳 3cm in the back of rats was excised under aseptic condition. Pseudomonas aeruginosa solution and staphylococcus aureus solution were smeared on the wound to make infection model, and each group was treated with different debridement methods (hydrodynamic debridement system). The traditional debridement method (scalpel pulse washing, simple pulse washing) and the replacement of different washing solution (normal saline, chlorhexidine) were used as the washing medium. A small amount of local muscle tissue was taken before and after debridement. Histopathological examination and histopathological analysis. Results: 1. Animal modeling and general appearance: all rats were successfully modeled, no animals died. Dressing was opened 48 hours after making the model to observe the wound, A large number of green exudates were found on the wound surface and dressing surface of Pseudomonas aeruginosa infection. The tissue around the wound had serious edema and bleeding easily, while the wound and dressing with yellow and white purulent secretion were found in the wound of Staphylococcus aureus infection, and the surrounding tissue was edema. The results showed that the infection model was successful. 2. Quantitative examination of tissue bacteriology: the bacterial content of the tissues before debridement was similar in each group of the same kind of bacteria. There was no significant difference between the two groups (P < 0.05). When the wound of Pseudomonas aeruginosa was debrided with normal saline as the washing medium, the wound of Pseudomonas aeruginosa was debrided. After debridement, the amount of bacteria in the water knife debridement group was 1.19 卤0.27) 脳 108 CFU / g, which was significantly lower than that in the conventional debridement group (1.61 卤0.60) 脳 10 8 CFU / g P 0.05) and in the pulse washing group (6.67 卤4.34) 脳 10 8 CFU / g P 0.05.The chlorhexidine was used as the washing medium for debridement of Pseudomonas aeruginosa. After debridement, 1.29 卤0.24 脳 10 8 CFU / g were 1.77 卤0.56 脳 10 8 CFU / g respectively, 5.42 卤3.73 脳 10 8 CFU / g, respectively. The water knife debridement group was significantly lower than the traditional debridement group and the simple pulse washing group (P 0.05). After debridement, the amount of bacteria in the water knife debridement group was 1.61 卤0.50 脳 10 6 CFU / g, which was less than that in the traditional debridement group (2.59 卤1.35) 脳 106CFU/g and the pulse washing group (5.93 卤2.51) 脳 106CFU/g, the difference was statistically significant (P 0.05), but when the chlorhexidine was used as the washing medium, the wound surface of Staphylococcus aureus was debrided. The amount of bacteria in the tissue after debridement was 1.58 卤0.57) 脳 10 6 CFU / g (2.72 卤1.59) 脳 10 6 CFU / g (6.87 卤3.68) 脳 10 6 CFU / g, respectively. The results of optical microscope observation on the wound surface of Pseudomonas aeruginosa and Staphylococcus aureus were significantly lower in the water knife debridement group than in the traditional debridement group and the simple washing group. 3. The results showed that: when the wound wound was debrided by Pseudomonas aeruginosa and Staphylococcus aureus, Whether using saline or chlorhexidine as the washing medium, the results of HE staining optical microscope in each debridement group showed that a small amount of inflammatory cell infiltration was observed in the water knife debridement group, and some inflammatory cell infiltration was observed in the traditional debridement group. More inflammatory cells were infiltrated in the pure pulse washing group, and the tissue structure was damaged less in the water knife debridement group than in the traditional debridement group. Conclusion: when the infected wounds formed by different bacteria were debrided, The debridement effect of water knife is better than that of traditional debridement method and simple washing method. As a new debridement method, water knife can better remove infection and promote wound healing.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R641

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