脉冲冲洗术对急性骨与软组织感染创面致病菌的清除作用-东南大学学报医学版

脉冲冲洗术对急性骨与软组织感染创面致病菌的清除作用

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：R658.2;R658.3

出版年·卷·期（页码）：2014·33·第一期（17-20）

摘要：

目的：探讨脉冲冲洗术对急性骨与软组织感染创面致病菌的清除作用。方法：选取外伤后出现急性骨或软组织感染的病例37例，在常规清创后加用脉冲冲洗，分别于术前、常规方法清创后、使用脉冲冲洗后取创面渗出液进行培养。结果：术前全部37例标本中培养出球菌属28株、杆菌属26株；常规方法清创后即应用脉冲冲洗前培养出球菌属7株、杆菌属16株，杆菌属的培养阳性率高于球菌属（P<0.05）；脉冲冲洗后培养出致病菌3株，其中球菌属1株、杆菌属2株，两者比较，P >0.05；不论何种细菌，冲洗后较冲洗前培养阳性率都明显下降（P<0.05）。结论：对开放性创伤导致的急性骨与软组织感染，使用脉冲冲洗可有效清除致病细菌，尤其对使用常规方法清创较难清除的杆菌有较好的清除效果。

Objective: To assess the clearance of wound bacteria resulted in acute bone and soft tissue infection by using of pulsed lavage. Methods: 37 cases with acute bone or soft tissue infections after open injury were included in our study. Additional 6 000 ml of 0.9% sodium chloride solution was irrigated in pulses after routine debridement.We compared the bacteria culture results of wound exudates before operation, after routine debridement and after pulsed lavage. Results: Before operation,54 strains of pathogenic bacteria were found in 37 patients, 28 cocci strains and 26 bacilli strains. After routine debridement(before pulsed irrigation), there were 23 strains(7 cocci strains and 16 bacilli strains) of pathogenic bacteria left. Therefore, the strains of bacilli were significantly more than that of cocci(P<0.05). However, the strains of pathogenic bacteria decreased to 3(1 cocci strain and 2 bacilli strains) after pulsed lavage, with no significant difference between the two types of strains(P >0.05).Anyway,pulsed lavage could significantly reduce the strains of pathogenic bacteria no matter which type the bacterium was(P<0.05). Conclusion: The pulsed lavage could effectively clear pathogenic bacteria resulted in acute bone and soft tissue infection caused by open trauma, especially the bacilli, for which routine debridement was limited.

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