脉冲冲洗在Ⅲ度开放性骨折清创术中的应用-东南大学学报医学版

脉冲冲洗在Ⅲ度开放性骨折清创术中的应用

单位：南京大学医学院附属鼓楼医院骨科, 江苏南京 210008

分类号：R683.42

出版年·卷·期（页码）：2012·31·第六期（699-701）

摘要：

目的:探讨脉冲冲洗在Ⅲ度开放性骨折Ⅰ期清创术中清除致病菌的效果。方法:对43例Ⅲ度开放性骨折患者在Ⅰ期创面清创时,常规清洁创面后使用脉冲冲洗器冲洗创面,冲洗剂为0.9%氯化钠溶液,总量>6000ml。在清创前,脉冲冲洗前、冲洗后,术后24h、48分别取创面渗出物或组织作细菌培养。结果:在清创前43例创面标本细菌培养出3个菌株者4例,2个菌株者7例,1个菌株者32例。常规方法清创后全部病例仍能培养出致病菌;常规清创再予脉冲冲洗后细菌培养阳性率为6.9%(3例),较冲洗前明显下降(P<0.05)。术后24h 细菌培养阳性率为6.9%(3例),术后48h细菌培养阳性率为11.6%(5例),两者差异无统计学意义(P>0.05)。结论:脉冲冲洗器应用于Ⅲ度开放性骨折清创时,能有效清除创面污染的致病细菌,创面清洁状态能维持1~2d。

Objective: To investigate the effects of pulsed lavage to eradicate pathogenic bacteria in the stage one debridement of Ⅲ degree open fracture. Method: Pulsed lavage was applied to 43 patients with Ⅲ degree open fracture in the process of stage one debridement after routine wound cleaning. The 0.9% sodium chloride solution was used as pulse water, with a total volume above 6 000 ml. We compared the bacteria culture results for wound exudates or tissue before debridement, before and after pulsed lavage, 24 and 48 h after operation. Results: Before debridement, the bacteria culture results in 4 of 43 patients were positive for three strains, 7 of 43 positive for two strains and 32 of 43 positive for only one strain. After routine wound cleaning, all patients remained positive for bacteria culture. However, the positive rate of bacteria culture was significantly declined after pulsed lavage (P<0.05), which was 6.9% (3 of 43). And the positive rate of bacteria culture remained 6.9% (3 of 43) 24 h after operation while it was 11.6% (5 of 43) 48 h after operation, with no significant differences (P>0.05). Conclusion: The pulsed lavage is useful for the debridement of the Ⅲ degree open fracture. The pathogenic bacteria from the wound could be effectively removed out and sustained for 1-2 days.

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