兰州战区软组织爆炸伤细菌学特点及创面干预方法的实验研究
|
摘要
【目的】通过建立一种简单可控的软组织爆炸伤模型以探讨:1.兰州地区野战环境下软组织爆炸伤后感染发生的规律特点,为临床清创时限提供依据;2.爆炸伤后软组织感染的细菌谱及药物敏感性,为合理用药提供依据;3.外用中药对爆炸伤创面的促愈合作用;4.对比几种不同的创面处理方法对爆炸伤的治疗作用,以期寻找一种快速,简便,有效的创面处理方法,以备野战救治之用。
【方法】实验1:选用兰州地区健康三元品种猪5只,每只的双后臀配对,按配对设计分为自然致伤组与消毒致伤组,麻醉后固定纸质雷管致伤,于致伤后4h、7h、9h,12h、16h、24h、48h分别取创面组织,定量后匀浆,稀释不同梯度后接种换算细菌数量,进行菌种谱及药敏试验测定,同时对环境细菌进行检测。
实验2:选用兰州地区健康三元品种猪8只,麻醉后固定纸质雷管致伤双后臀肌肉丰满处,随机将16个创面分为自然致伤组,生肌玉红膏组,脱管散组于致伤后的第2、4、7、10、14天进行换药,按一定顺序取材后进行显微镜下观察、羟脯氨酸含量、创面细胞增值指数、创面面积、创面深度等测定,应用多样本间的方差分析评价出治疗效果较好的处理组。
【结果】实验1:①自然致伤组12h细菌计量达10~5cfu/g,创缘明显发红,肌肉无收缩且有腐败臭味,有感染征象,消毒组16h后达10~5cfu/g,光镜下肌纤维断裂,大量炎细胞浸润,两组均随时间变化呈上升趋势;②自然致伤组48小时内以枯草芽孢杆菌和表面菌群为主,消毒致伤组以枯草芽孢杆菌、肺炎克雷伯杆菌、奇异变形杆菌为主;革兰氏阳性菌对大部分抗生素产生耐药,仅对喹诺酮类抗生素和万古霉素敏感,革兰氏阴性菌对第三代头孢菌素,氨基苷类抗生素敏感。
实验2:与对照组相比,脱管散组、生肌玉红膏组羟脯氨酸含量、增殖指数、创面深度自第4天起,创面面积自第10天起差异有统计学意义(P＜0.05)。脱管散组与生肌玉红膏组相比,羟脯氨酸含量自第7天起,增殖指数自第4天起,创面面积自第10天起,差异有统计学意义(P＜0.05)。
【结论】实验1:①兰州地区猪肢体软组织爆炸伤的感染临界时限点为12h左右,皮肤消毒组较自然致伤组感染临界时限迟4h;兰州地区软组织爆炸伤的最佳清创时间为致伤12h内。②爆炸性软组织创面早期感染与环境细菌密切相关,应尽早清创,皮肤消毒范围应尽可能广泛彻底。早期应用抗生素应以喹诺酮类、三代头孢菌素、氨基苷类抗生素为主。
实验2:①生肌玉红膏及脱管散在控制软组织爆炸伤的感染,促进肉芽组织生长,胶原合成,创面收缩等方面与对照组相比均具一定疗效;②脱管散对爆炸性软组织创面疗效优于生肌玉红膏,该中药组方能够明显加速软组织爆炸创面的愈合,促进创面稳定。
Objective:To discuss the following things by establishing a simpleness and controled soft tissue explosive wound mold.Firstly,in order to providing local debriedement basis by probing into the specialty of infection after soft tissue explosive under field environment in Lan Zhou area.Secondly,for to providing basis of rational use of drugs via investigating the spectrum and drug sensitivity of explosive injury in soft tissue in Lan Zhou areas.Thirdly,would healing effect of external-using of traditional chinese materia.Fourly,the contrast of methods wound treatment for searching a kind of wound dealing method which is fast,convenient and effective.
Medthods:Experiment 1:5 San-yuan healthy piglets were slected,and two hindlimbs in one were paired.According to paired design,those objects were assigned to nature vulnerated group and degermed vulnerated group,muscle tissue of explosive would were removed at 4h、7h、9h、12h、16h、24h、48h after explosive injury respectively and were made into homogenate.Then,with releasing peuring platform methods bacteria were counted.The bacterial spectrum and drug sensitivity were performed.Meanwhile,the environmental bacteria were detected.
Experiment 2:8 San-yuan healthy piglets were slected,liberality buttocks were vulnerated by paper detonator after anaesthesia and fixation,then,those 16 wounds were divided into control group and Sheng ji yu hong gao group and Tuo guan san group.Dressing change and drawing materials for observing under microscope and mensurating of proline content and mensurating of cell proliferation index of wound and wound area and depth were all done respectively.At last,by variance analysis better effect of group was slected.
Results:Experiment 1:1.Bacterial measurement in nature vulnerated group reached 10~5 cfu/g at 12h after explosive injury,while degerm vulnerated group reached 10~5 cfu/g at 16h.2.Ba-cillus subtilis and surface bacteria were found in group A and Bacillus subtilis and Klebsiella pneumoniae and Proteus mirabilis were found in group B.Gram-positive bacteria were drug resistant to most antibiotics and were only sensitive to quinoxalone antibiotics and vancomycin.Gram-negative bacteria were sensitive to third-generation cephalosporin and aminoglycoside antibiotics.
Experiment 2:Compared with control group,the difference of content of proline and proliferation index and wound depth was significant at 4,7,10,14 days respectively after vulnerating,and wound area was at 10,14days(P＜0.05).Tuo guan san group compared with Sheng ji yu hong gao group difference of proline content from seventh and proliferation index from fourth and wound from tenth were significant(P＜0.05).
Conclusions:1.Infection point of explosive injury in soft tissue in Lan Zhou area was at 12h after explosive injury.Infection point of degerm vulnerated group was later 4h than not.The best point of debridement of explosive wound in soft tissue in Lan Zhou area was in 12 hours after vulnerate.2.Early infection of explosive soft-tissue wound was closely related to environmental bacteria,therefor,debriedement should be done early and the range of skin disinfection should be extensive and thoroughly as far as possible.Early application of antibiotics should give priority to quinolones and third-generation cephalosporin and aminoglycoside antibiotics.3.To compare with the control,Yu hong sheng ji gao and tuo guan san had some effect on the controling of infection in explosive wound about soft tissue and promoting granulation growth and collagen synthesis and wound contraction.4.Curative effect of tuo guan san on explosive wound about soft tissue was superior to Sheng ji yu hong gao;Tuo guang san could accelerated would healing and stabilize wound condition.
【方法】实验1:选用兰州地区健康三元品种猪5只,每只的双后臀配对,按配对设计分为自然致伤组与消毒致伤组,麻醉后固定纸质雷管致伤,于致伤后4h、7h、9h,12h、16h、24h、48h分别取创面组织,定量后匀浆,稀释不同梯度后接种换算细菌数量,进行菌种谱及药敏试验测定,同时对环境细菌进行检测。
实验2:选用兰州地区健康三元品种猪8只,麻醉后固定纸质雷管致伤双后臀肌肉丰满处,随机将16个创面分为自然致伤组,生肌玉红膏组,脱管散组于致伤后的第2、4、7、10、14天进行换药,按一定顺序取材后进行显微镜下观察、羟脯氨酸含量、创面细胞增值指数、创面面积、创面深度等测定,应用多样本间的方差分析评价出治疗效果较好的处理组。
【结果】实验1:①自然致伤组12h细菌计量达10~5cfu/g,创缘明显发红,肌肉无收缩且有腐败臭味,有感染征象,消毒组16h后达10~5cfu/g,光镜下肌纤维断裂,大量炎细胞浸润,两组均随时间变化呈上升趋势;②自然致伤组48小时内以枯草芽孢杆菌和表面菌群为主,消毒致伤组以枯草芽孢杆菌、肺炎克雷伯杆菌、奇异变形杆菌为主;革兰氏阳性菌对大部分抗生素产生耐药,仅对喹诺酮类抗生素和万古霉素敏感,革兰氏阴性菌对第三代头孢菌素,氨基苷类抗生素敏感。
实验2:与对照组相比,脱管散组、生肌玉红膏组羟脯氨酸含量、增殖指数、创面深度自第4天起,创面面积自第10天起差异有统计学意义(P＜0.05)。脱管散组与生肌玉红膏组相比,羟脯氨酸含量自第7天起,增殖指数自第4天起,创面面积自第10天起,差异有统计学意义(P＜0.05)。
【结论】实验1:①兰州地区猪肢体软组织爆炸伤的感染临界时限点为12h左右,皮肤消毒组较自然致伤组感染临界时限迟4h;兰州地区软组织爆炸伤的最佳清创时间为致伤12h内。②爆炸性软组织创面早期感染与环境细菌密切相关,应尽早清创,皮肤消毒范围应尽可能广泛彻底。早期应用抗生素应以喹诺酮类、三代头孢菌素、氨基苷类抗生素为主。
实验2:①生肌玉红膏及脱管散在控制软组织爆炸伤的感染,促进肉芽组织生长,胶原合成,创面收缩等方面与对照组相比均具一定疗效;②脱管散对爆炸性软组织创面疗效优于生肌玉红膏,该中药组方能够明显加速软组织爆炸创面的愈合,促进创面稳定。
Objective:To discuss the following things by establishing a simpleness and controled soft tissue explosive wound mold.Firstly,in order to providing local debriedement basis by probing into the specialty of infection after soft tissue explosive under field environment in Lan Zhou area.Secondly,for to providing basis of rational use of drugs via investigating the spectrum and drug sensitivity of explosive injury in soft tissue in Lan Zhou areas.Thirdly,would healing effect of external-using of traditional chinese materia.Fourly,the contrast of methods wound treatment for searching a kind of wound dealing method which is fast,convenient and effective.
Medthods:Experiment 1:5 San-yuan healthy piglets were slected,and two hindlimbs in one were paired.According to paired design,those objects were assigned to nature vulnerated group and degermed vulnerated group,muscle tissue of explosive would were removed at 4h、7h、9h、12h、16h、24h、48h after explosive injury respectively and were made into homogenate.Then,with releasing peuring platform methods bacteria were counted.The bacterial spectrum and drug sensitivity were performed.Meanwhile,the environmental bacteria were detected.
Experiment 2:8 San-yuan healthy piglets were slected,liberality buttocks were vulnerated by paper detonator after anaesthesia and fixation,then,those 16 wounds were divided into control group and Sheng ji yu hong gao group and Tuo guan san group.Dressing change and drawing materials for observing under microscope and mensurating of proline content and mensurating of cell proliferation index of wound and wound area and depth were all done respectively.At last,by variance analysis better effect of group was slected.
Results:Experiment 1:1.Bacterial measurement in nature vulnerated group reached 10~5 cfu/g at 12h after explosive injury,while degerm vulnerated group reached 10~5 cfu/g at 16h.2.Ba-cillus subtilis and surface bacteria were found in group A and Bacillus subtilis and Klebsiella pneumoniae and Proteus mirabilis were found in group B.Gram-positive bacteria were drug resistant to most antibiotics and were only sensitive to quinoxalone antibiotics and vancomycin.Gram-negative bacteria were sensitive to third-generation cephalosporin and aminoglycoside antibiotics.
Experiment 2:Compared with control group,the difference of content of proline and proliferation index and wound depth was significant at 4,7,10,14 days respectively after vulnerating,and wound area was at 10,14days(P＜0.05).Tuo guan san group compared with Sheng ji yu hong gao group difference of proline content from seventh and proliferation index from fourth and wound from tenth were significant(P＜0.05).
Conclusions:1.Infection point of explosive injury in soft tissue in Lan Zhou area was at 12h after explosive injury.Infection point of degerm vulnerated group was later 4h than not.The best point of debridement of explosive wound in soft tissue in Lan Zhou area was in 12 hours after vulnerate.2.Early infection of explosive soft-tissue wound was closely related to environmental bacteria,therefor,debriedement should be done early and the range of skin disinfection should be extensive and thoroughly as far as possible.Early application of antibiotics should give priority to quinolones and third-generation cephalosporin and aminoglycoside antibiotics.3.To compare with the control,Yu hong sheng ji gao and tuo guan san had some effect on the controling of infection in explosive wound about soft tissue and promoting granulation growth and collagen synthesis and wound contraction.4.Curative effect of tuo guan san on explosive wound about soft tissue was superior to Sheng ji yu hong gao;Tuo guang san could accelerated would healing and stabilize wound condition.
引文
[1]陆增祺.军事医学辞典[M].上海:上海辞书出版社,1997:206.
[2]周继红,朱佩芳,王正国,等.战伤定义与分类[J]人民军医,2008,51(1):1.
[3]Parker PJ.Kosovo 1999-A surgical template for morden conflict[J].J R Army Med Corps,2000,146(3):199-203.
[4]Stanec Z,Skrbic S,Dapina I,et al.Surgical magnagement of war injuries involving soft tissue defects.Lijec Vjesn,1993,115(9-10):283.
[5]李兵仓,杨志焕.爆炸性武器在现代战争中的应用及其致伤机制.解放军医学情报,1996,10(5):251.
[6]赵文峰,张虎威,向军,等.颌面部爆炸伤动物模型的建立和损伤特点的观察[J]现代口腔医学杂志,2006,10(2):91-93.
[7]谭颖徽,李惠增,李忠禹,等.颌面部火器伤特点及组织缺损早期修复的实验研究[J]中华口腔医学杂志,1998,33(3):139-141.
[8]史文进,李增惠,孙远,等.颌面部爆炸伤区血管的病理变化及其早期吻合的实验研究[J]第三军医大学学报,2001,23(4):378-380.
[9]张从纪,李增惠,周树夏,等.颌面部爆炸伤愈合过程中VEGF和bFGF含量变化的实验研究[J]第三军医大学学报,1999,21(11):831-833.
[10]张良潮,李曙光,凌烽,等.一种爆炸伤致伤实验模型[J]第三军医大学学报,1999,21(7):534-535.
[1]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256
[2]李金清,陈绍宗,付小兵,等.封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响[J].解放军医学杂志,2004,8(29):690
[3]王翔,何黎升.领面部爆炸性软组织伤动物模型的建立及损伤特点的实验研究[M].第四军医大学硕士论文.
[4]吴公良,赵连璧,王正国,等.野战外科学[M]上海:科学技术出版社,1981:56.
[5]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256.
[1]Parker PJ.Kosovo 1999-A surgical template for morden conflict[J].J R Army Med Corps,2000,146(3):199-203.
[2]Stanec Z,Skrbic S,Dapina I,et al.Surgical magnagement of war injuries involving soft tissue defects.Lijec Vjesn,1993,115(9-10):283.
[3]李兵仓,杨志焕.爆炸性武器在现代战争中的应用及其致伤机制.解放军医学情报,1996,10(5):251
[4]赵东升,裴国献,魏宽海,等.高温高湿环境下肢体火器伤细菌学定量观察[J].第一军医大学学报,2001,21(1):8-9.
[5]陈建长,史振满,严耘,等.寒冷干燥环境下枪弹伤细菌学定量观察[J].伤残医学杂志,2004,12(1):6-8.
[6]黎鳌,盛志勇,王正国.现代战伤外科学[M].北京:人民军医出版社,1998.
[7]陈建长,史振满,严耘,等.寒冷干燥环境下枪弹伤细菌学定量观察[J].伤残医学杂志,2004,12(1):6-8.
[8]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256.
[9]吴在德,吴肇汉,郑树,等.外科学[M]6版.北京:人民卫生出版社,2003:196.
[10]张玲,艾青,王永安,等.感染与C-反应蛋白的关系[J].吉林医学,2000,21(6):334.
[11]齐涵,王淑芬,明目,等.枯草芽孢杆菌BS_(224)菌活菌制剂(白天鹅气雾剂)治疗烧伤创面的环境细菌学检测.中国微生态学杂志,1998,3:174-176.
[12]吴公良,赵连璧,王正国,等.野战外科学[M]上海:科学技术出版社,1981:56.
[13]Chen HC,Guh JY,Tsai JH,et al.Induction of heat shock protein 70 protects mesangial cells against oxidative injury[J].kidney Int,1999,56(4):1270-1273.
[1]Mullner T,Mrkonjic L,Kwasny O,et al.The use of nega2tive pressure to promote the healing of tissue defects:aclinical trial using the vacuum seling technique[J].Br JPlast Surg,1997,38:553等的方法计算增殖指数 Proliferative lndex
[2]李金清,陈绍宗,付小兵,等.封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响[J].解放军医学杂志,2004,8(29):690
[3]赵春霖,脱管散治疗外科手术后切口感染40例[J].甘肃中医学院学报,2006,23(4):29
[4]郭红军,孔焕宇,马长华.HPLC测定生肌玉红膏中芝麻素的含量[J].中国中药杂志,2005,30(15):1212
[5]陈玉林,黄康.创面愈合的评价指标[J].中国临床康复,2002,6(8):1080
[2]周继红,朱佩芳,王正国,等.战伤定义与分类[J]人民军医,2008,51(1):1.
[3]Parker PJ.Kosovo 1999-A surgical template for morden conflict[J].J R Army Med Corps,2000,146(3):199-203.
[4]Stanec Z,Skrbic S,Dapina I,et al.Surgical magnagement of war injuries involving soft tissue defects.Lijec Vjesn,1993,115(9-10):283.
[5]李兵仓,杨志焕.爆炸性武器在现代战争中的应用及其致伤机制.解放军医学情报,1996,10(5):251.
[6]赵文峰,张虎威,向军,等.颌面部爆炸伤动物模型的建立和损伤特点的观察[J]现代口腔医学杂志,2006,10(2):91-93.
[7]谭颖徽,李惠增,李忠禹,等.颌面部火器伤特点及组织缺损早期修复的实验研究[J]中华口腔医学杂志,1998,33(3):139-141.
[8]史文进,李增惠,孙远,等.颌面部爆炸伤区血管的病理变化及其早期吻合的实验研究[J]第三军医大学学报,2001,23(4):378-380.
[9]张从纪,李增惠,周树夏,等.颌面部爆炸伤愈合过程中VEGF和bFGF含量变化的实验研究[J]第三军医大学学报,1999,21(11):831-833.
[10]张良潮,李曙光,凌烽,等.一种爆炸伤致伤实验模型[J]第三军医大学学报,1999,21(7):534-535.
[1]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256
[2]李金清,陈绍宗,付小兵,等.封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响[J].解放军医学杂志,2004,8(29):690
[3]王翔,何黎升.领面部爆炸性软组织伤动物模型的建立及损伤特点的实验研究[M].第四军医大学硕士论文.
[4]吴公良,赵连璧,王正国,等.野战外科学[M]上海:科学技术出版社,1981:56.
[5]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256.
[1]Parker PJ.Kosovo 1999-A surgical template for morden conflict[J].J R Army Med Corps,2000,146(3):199-203.
[2]Stanec Z,Skrbic S,Dapina I,et al.Surgical magnagement of war injuries involving soft tissue defects.Lijec Vjesn,1993,115(9-10):283.
[3]李兵仓,杨志焕.爆炸性武器在现代战争中的应用及其致伤机制.解放军医学情报,1996,10(5):251
[4]赵东升,裴国献,魏宽海,等.高温高湿环境下肢体火器伤细菌学定量观察[J].第一军医大学学报,2001,21(1):8-9.
[5]陈建长,史振满,严耘,等.寒冷干燥环境下枪弹伤细菌学定量观察[J].伤残医学杂志,2004,12(1):6-8.
[6]黎鳌,盛志勇,王正国.现代战伤外科学[M].北京:人民军医出版社,1998.
[7]陈建长,史振满,严耘,等.寒冷干燥环境下枪弹伤细菌学定量观察[J].伤残医学杂志,2004,12(1):6-8.
[8]孙志刚,郭树忠,鲁开化,等.火器伤软组织缺损模型的建立[J].创伤外科杂志,2002,4(4):256.
[9]吴在德,吴肇汉,郑树,等.外科学[M]6版.北京:人民卫生出版社,2003:196.
[10]张玲,艾青,王永安,等.感染与C-反应蛋白的关系[J].吉林医学,2000,21(6):334.
[11]齐涵,王淑芬,明目,等.枯草芽孢杆菌BS_(224)菌活菌制剂(白天鹅气雾剂)治疗烧伤创面的环境细菌学检测.中国微生态学杂志,1998,3:174-176.
[12]吴公良,赵连璧,王正国,等.野战外科学[M]上海:科学技术出版社,1981:56.
[13]Chen HC,Guh JY,Tsai JH,et al.Induction of heat shock protein 70 protects mesangial cells against oxidative injury[J].kidney Int,1999,56(4):1270-1273.
[1]Mullner T,Mrkonjic L,Kwasny O,et al.The use of nega2tive pressure to promote the healing of tissue defects:aclinical trial using the vacuum seling technique[J].Br JPlast Surg,1997,38:553等的方法计算增殖指数 Proliferative lndex
[2]李金清,陈绍宗,付小兵,等.封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响[J].解放军医学杂志,2004,8(29):690
[3]赵春霖,脱管散治疗外科手术后切口感染40例[J].甘肃中医学院学报,2006,23(4):29
[4]郭红军,孔焕宇,马长华.HPLC测定生肌玉红膏中芝麻素的含量[J].中国中药杂志,2005,30(15):1212
[5]陈玉林,黄康.创面愈合的评价指标[J].中国临床康复,2002,6(8):1080
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |