载纳米银海藻酸钠、丝素蛋白新型泡沫联合VSD一体化敷料的制备、性能及其对战伤感染模型的疗效

发布时间：2018-02-09 05:08

本文关键词： 战创伤纳米银负压封闭引流海藻酸钠丝素蛋白　出处：《中国人民解放军医学院》2016年博士论文　论文类型：学位论文

【摘要】：背景：战创伤伤员在火线救治和野战医院救治过程中,由于环境限制,无法采取彻底的治疗措施,战略后送的过程中医护资源有限,因此我军目前亟需一种高效、便捷的战创伤创口救护产品,能够兼具预防、治疗感染、促进创口愈合、护理成本低等多种功能；负压封闭引流技术(VSD)和含银敷料为常用创口抗感染技术,目前国内没有将这两种技术联合应用于战创伤创口的报道,其疗效、护理成本有待进一步研究；传统用于VSD的聚氨酯泡沫合成过程需加入有毒溶剂,而海藻酸钠(SA)、丝素蛋白(SF)为天然高分子化合物,是制备VSD泡沫的优良原料。目的：自主研发一种用于VSD的泡沫材料,采用SA、SF、纳米银(AgNPs)作为原料,按照VSD泡沫要求优选出力学性能、生物相容性、体外抗菌性较好的配比和浓度,而后将该泡沫与VSD技术结合,评估其治疗感染创口的疗效和护理成本。方法：1、配制SA/SF质量分数比为1/0,1/0,5/1,2/1,1/1,1/2,1/5,0/1的溶液,制得混合泡沫,同法制备比例为5：1,混合液SA浓度分别为8%、6%和4%的3组泡沫,通过力学性能检测,进行优选,并对优选组进行孔隙率、吸水性、保湿性、细胞毒性进行测定；2、选择优选比例和浓度,将AgNPs按照SA和SF溶质总和的0.25%、0.5%、1%的质量混入泡沫,通过体外抗菌实验筛选出抗菌敏感组,对这组泡沫进行细胞毒性及体外药物缓释检测；3、建立兔软组织金黄色葡萄球菌感染模型,对5组治疗方式进行治疗实验,a组为含AgNPs泡沫+VSD组,b组为含AgNP s泡沫组,c组为VSD组,d组为感染对照组,e组为非感染创口对照组,通过测量不同时间点创口细菌计数、1周内感染清除率和创口愈合时间来评估治疗效果。结果：1、SA/SF质量分数在5：1-2：1之间、SA浓度在4%-8%之间混合泡沫的力学性能符合VSD泡沫要求,选择5：1比例、8%浓度,0.5%AgNPs混合泡沫体外抗菌敏感,含0.5%AgNPs的SA/SF共混泡沫无细胞毒性,体外可缓慢释放AgNPs；2、测定创口涂菌后24h菌落数均超过105CFU/g；a、b和c组一周内感染清除率为100%、37.5%和25%,愈合时间为13.6,16.5和17.3天,a与b、c两组有统计学差异,b与c无显著差异。结论：载纳米银海藻酸钠、丝素蛋白共混泡沫符合负压封闭引流用泡沫的要求,0.5%纳米银浓度时,属于无细胞毒性的生物材料,可以缓释纳米银至所在创口,体外抗菌效果确切,该泡沫联合负压封闭引流一体化敷料对战创伤创口感染模型疗效较好,护理成本较小。
[Abstract]:Background: in the course of fire line treatment and field hospital treatment for war wounded patients, due to environmental constraints, it is impossible to take thorough treatment measures, and medical resources are limited in the process of strategic evacuation. Therefore, our army is in urgent need of a kind of high efficiency at present. Convenient wound rescue products for war trauma, can both prevent, treat infection, promote wound healing, low nursing costs, etc. Negative pressure sealing and drainage technique (VSDs) and silver dressing are commonly used wound anti-infection techniques. At present, there are no reports of the combination of these two technologies in the wound of war, its curative effect and nursing cost need to be further studied, the traditional polyurethane foam synthesis process used for VSD needs to be added toxic solvent. Sodium alginate, silk fibroin (SF), a natural polymer compound, is an excellent raw material for the preparation of VSD foam. According to the requirements of VSD foam, a better ratio and concentration of mechanical properties, biocompatibility, antibacterial property in vitro were selected, and then the foam was combined with VSD technology. To evaluate the curative effect and nursing cost of the treatment of infection wound. Methods: 1: 1, the ratio of SA/SF mass fraction was 1 / 0 / 0 / 0 / 5 / 1 / 2 / 1 / 1 / 1 / 1 / 1 / 1 / 5 / 5 / 1, and the mixed foam was prepared with the ratio of 5 to 1, the concentration of SA in the mixture was 86% and 4%, respectively, and the foam was tested by mechanical properties. The porosity, water absorption, moisture retention and cytotoxicity of the selected group were determined. The optimal selection ratio and concentration were selected, and the AgNPs was mixed into the foam at a mass of 0.25% of the sum of SA and SF solutes. The antimicrobial sensitive group was screened out by in vitro antibacterial experiment. The cytotoxicity of foam and drug release in vitro were detected to establish the rabbit soft tissue Staphylococcus aureus infection model. The treatment methods of five groups were as follows: group A with AgNPs foam VSD group, group B with AgNPs foam group, group C with AgNPs foam group, group C with VSD group with infective control group, group E with infection control group, group B with AgNPs foam group, group C with AgNPs foam group, group C with AgNPs foam group and group C with AgNPs foam group. The efficacy of the treatment was evaluated by measuring the infection clearance rate and wound healing time of wound bacteria count at different time points within one week. Results the mechanical properties of the mixed foam with SA concentration between 5: 1 and 2: 1: 1 and SA concentration between 4% and 8% met the requirements of VSD foam. The mixture foam of 5: 1 (8%) was sensitive to antimicrobial activity in vitro, and the SA/SF foam containing 0.5% AgNPs had no cytotoxicity. AgNPs2 was released slowly in vitro. The number of colonies in group C and group C exceeded 105 CFU / GG in one week, the clearance rates were 100% and 25% respectively, and the healing time was 13. 6 days 16.5 and 17. 3 days after infection, there was no significant difference between group b and c. Sodium alginate loaded with nano-silver, When silk fibroin blend foam meets the requirement of negative pressure sealing and draining foam with 0.5% nano-silver concentration, it is a non-cytotoxic biomaterial, which can release nano-silver slowly to the wound, and the antibacterial effect in vitro is definite. The foam combined with negative pressure sealing and drainage integrative dressing has better effect and less nursing cost in the wound infection model of war trauma.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R318.08;R82

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