本文選題：創(chuàng)面感染　切入點：動物模型　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討水刀技術(shù)(WaterJet)用于感染性創(chuàng)面清創(chuàng)的效果,為水刀清創(chuàng)的臨床應(yīng)用提供實驗基礎(chǔ)及理論依據(jù)。方法:取72只Wistar大鼠隨機分為2大組,無菌條件下切除各大鼠背部3cm×3cm的全層皮膚,分別將銅綠假單胞菌菌液及金黃色葡萄球菌菌液涂抹于創(chuàng)面制成感染模型,然后每組采用不同的清創(chuàng)方法(水動力清創(chuàng)系統(tǒng)、傳統(tǒng)清創(chuàng)方法(手術(shù)刀+脈沖沖洗)、單純脈沖沖洗)以及換不同沖洗液(生理鹽水、洗必泰)作為沖洗介質(zhì)進行清創(chuàng),清創(chuàng)前后分別于感染創(chuàng)面取少量局部肌肉組織,行組織細菌學(xué)檢查及組織病理學(xué)分析。結(jié)果:1.動物造模及大體外觀:所有大鼠均造模成功,無動物死亡。造模后48小時打開敷料觀察傷口,銅綠假單胞菌感染創(chuàng)面可見創(chuàng)面及敷料表面附有大量綠色滲出物,周圍組織水腫嚴重,觸之易出血;而金葡菌感染傷口可見創(chuàng)面及敷料附有黃白色膿性分泌物,周圍組織水腫,觸之易出血;均提示感染模型造模成功。2.組織細菌學(xué)定量檢查:同種細菌各個清創(chuàng)組清創(chuàng)前組織的細菌含量相似,差異均未見統(tǒng)計學(xué)意義(P均0.05)。以生理鹽水作為沖洗介質(zhì)對銅綠假單胞菌創(chuàng)面進行清創(chuàng)時,清創(chuàng)后水刀清創(chuàng)組組織細菌量為(1.19±0.27)×108CFU/g,明顯小于傳統(tǒng)清創(chuàng)組(1.61±0.60)×108CFU/g(P0.05)及單純脈沖沖洗組(6.67±4.34)×108CFU/g(P0.05);而以洗必泰作為沖洗介質(zhì)對銅綠假單胞菌創(chuàng)面進行清創(chuàng)時,清創(chuàng)后分別為(1.29±0.24)×108CFU/g、(1.77±0.56)×108CFU/g、(5.42±3.73)×108CFU/g,水刀清創(chuàng)組明顯小于傳統(tǒng)清創(chuàng)組及單純脈沖沖洗組(P0.05);當(dāng)以生理鹽水作為沖洗介質(zhì)對金黃色葡萄球菌創(chuàng)面進行清創(chuàng)時,清創(chuàng)后水刀清創(chuàng)組組織細菌量為(1.61±0.50)×106CFU/g,均比傳統(tǒng)清創(chuàng)組(2.59±1.35)×106CFU/g及單純脈沖沖洗組(5.93±2.51)×106CFU/g少,差異均有統(tǒng)計學(xué)意義(P0.05);而以洗必泰作為沖洗介質(zhì)對金黃色葡萄球菌創(chuàng)面進行清創(chuàng)時,清創(chuàng)后組織細菌量分別為(1.58 ± 0.57)× 106CFU/g、(2.72±1.59)× 106CFU/g、(6.87±3.68)× 106CFU/g,水刀清創(chuàng)組明顯小于傳統(tǒng)清創(chuàng)組及單純沖洗組(P0.05)。3.HE染色光學(xué)顯微鏡觀察結(jié)果:對銅綠假單胞菌和金葡菌創(chuàng)面進行清創(chuàng)時,無論是以生理鹽水還是洗必泰作為沖洗介質(zhì),各清創(chuàng)方法組清創(chuàng)后HE染色光學(xué)顯微鏡觀察結(jié)果示:水刀清創(chuàng)組見較少量炎性細胞浸潤,傳統(tǒng)清創(chuàng)組見部分炎性細胞浸潤,單純脈沖沖洗組見較多炎性細胞浸潤,且水刀清創(chuàng)組組織結(jié)構(gòu)破壞較傳統(tǒng)清創(chuàng)組輕。結(jié)論:對不同細菌形成的感染創(chuàng)面進行清創(chuàng)時,無論是以生理鹽水為沖洗介質(zhì)還是以洗必泰作為沖洗介質(zhì),水刀的清創(chuàng)效果均優(yōu)于傳統(tǒng)清創(chuàng)方法及單純沖洗,水刀作為一種新型的清創(chuàng)方法能更好的清除感染,促進創(chuàng)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 鹵0.27) 脳 108 CFU / g, which was significantly lower than that in the conventional debridement group (1.61 鹵0.60) 脳 10 8 CFU / g P 0.05) and in the pulse washing group (6.67 鹵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 鹵0.24 脳 10 8 CFU / g were 1.77 鹵0.56 脳 10 8 CFU / g respectively, 5.42 鹵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 鹵0.50 脳 10 6 CFU / g, which was less than that in the traditional debridement group (2.59 鹵1.35) 脳 106CFU/g and the pulse washing group (5.93 鹵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 鹵0.57) 脳 10 6 CFU / g (2.72 鹵1.59) 脳 10 6 CFU / g (6.87 鹵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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R641

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