【摘要】：目的:隨著社會的發(fā)展,高能量外傷引起的開放性創(chuàng)面日益增多,對于開放性創(chuàng)面的處理除了及時(shí)的徹底清創(chuàng)外術(shù)后良好的創(chuàng)面護(hù)理至關(guān)重要,目前臨床對于創(chuàng)面護(hù)理使用的敷料基本都是利弊參半,尚無同時(shí)具有抗菌及自動清潔的敷料應(yīng)用于臨床,本實(shí)驗(yàn)設(shè)計(jì)一款抗菌自潔敷料,并通過動物實(shí)驗(yàn)驗(yàn)證其有效性。方法:首先對聚丙烯酸酯的吸液性能和保液性能進(jìn)行檢測。然后取10只新西蘭白兔,于全麻后于背部剃毛后沿脊柱兩側(cè)分別行傷口造模,均為直徑為2.0cm的4個(gè)圓形創(chuàng)面。并予以每個(gè)創(chuàng)面6×108/ml的金葡菌0.4ml均勻涂抹,然后隨機(jī)使用ε-聚賴氨酸-聚丙烯酸酯敷料(以下用ε-PL-SAP表示)、ε-聚賴氨酸紗布(以下用ε-PL紗布表示)、普通醫(yī)用紗布覆蓋四個(gè)創(chuàng)面。3天后予以隔日換藥(傷口觀察日除外)并觀察傷口情況,分別于術(shù)后7天、14天、21天觀察所有傷口創(chuàng)面面積、創(chuàng)面愈合積分PUSH積分并記錄,并于術(shù)后第三周取創(chuàng)面組織進(jìn)行石蠟包埋、切片,行組織學(xué)觀察,并于術(shù)后第三天換藥前拆除敷料,無菌棉簽取各創(chuàng)面分泌物、做細(xì)菌培養(yǎng),比較各創(chuàng)面菌落數(shù)。最終的實(shí)驗(yàn)數(shù)據(jù)采用spss22.0進(jìn)行統(tǒng)計(jì)學(xué)處理,結(jié)果中的數(shù)據(jù)采用sx?表示,采用方差分析統(tǒng)計(jì)4組試驗(yàn)數(shù)據(jù)并相互對比有無差異,P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:聚丙烯酸酯敷料在三種溶液中浸泡時(shí)在前2分鐘吸收是最迅速的,達(dá)到最大量的75%,2min過后材料吸收趨于緩慢,并于7min達(dá)到吸收最大值,基本趨于飽和,且飽和后的吸液量達(dá)到自身體重的20-30倍,并且,等量的聚丙烯酸酯材料對生理鹽水、純水、以及新鮮兔血的吸收效果無明顯差異。在創(chuàng)面造模成功并使用敷料后7、14、21天觀察所有兔子的四個(gè)創(chuàng)面面積、創(chuàng)面愈合積分,得出ε-PL-SAP敷料傷口的這兩項(xiàng)項(xiàng)指標(biāo)均值均優(yōu)于單純使用SAP敷料傷口及單純使用ε-PL紗布的傷口以及單純使用紗布組,且P0.05.術(shù)后第三天無菌棉簽取各創(chuàng)面分泌物做細(xì)菌培養(yǎng),觀察菌落數(shù),取均值比較,結(jié)果提示ε-PL-SAP組傷口金葡菌菌落數(shù)與其余三組比較有明顯統(tǒng)計(jì)學(xué)差異,且菌落數(shù)明顯低于其余三組,在造模成功后第21日取創(chuàng)面做切片HE染色,并行顯微鏡觀察,結(jié)果提示:,使用ε-PL-SAP敷料傷口較其余三組比較有明顯的肉芽組織生成,新生毛細(xì)血管及大量的成纖維細(xì)胞豐富,炎性細(xì)胞減少。結(jié)論:1.ε-聚賴氨酸-聚丙烯酸酯敷料對不同的液體均有良好的吸液性能。2.ε-聚賴氨酸-聚丙烯酸酯敷料具有良好的保液性能,能有效為創(chuàng)面提供微濕潤。3.ε-聚賴氨酸-聚丙烯酸酯敷料在動物創(chuàng)面實(shí)驗(yàn)中具有良好的促進(jìn)創(chuàng)面愈合、肉芽生長及抗菌功效。
[Abstract]:Objective: with the development of society, the open wound caused by high energy trauma is increasing day by day. It is very important for the treatment of open wound, besides timely and thorough debridement, to provide good wound care after operation. At present, the clinical dressing for wound care is mixed in both advantages and disadvantages, and there is no anti-bacterial dressing and auto-cleaning dressing in clinical application. In this experiment, an antibacterial self-cleaning dressing was designed, and its effectiveness was verified by animal experiments. Methods: firstly, the absorbency and retention of polyacrylate were tested. Then 10 New Zealand white rabbits were taken and shaved on the back after general anesthesia. The wound models were made along both sides of the spine after general anesthesia, all of which were 4 round wounds with the diameter of 2.0cm. Each wound was evenly smeared with 6 脳 108/ml staphylococcus aureus 0.4ml and then randomly used 蔚-poly-lysine-polyacrylate dressing (蔚-PL-SAP) and 蔚-poly-lysine gauze (蔚-PL gauze). Four wounds were covered with gauze. After 3 days, dressing was changed every other day (except the day of wound observation) and the wound condition was observed. All wounds were observed at 7 days, 14 days and 21 days after operation, and the PUSH integral of wound healing was recorded. At the third week after operation, the wound tissue was paraffin embedded, sliced, and histologically observed. The dressing was removed before dressing change on the third day after operation, and the exudates of each wound were taken out with sterile cotton for bacterial culture, and the number of colonies in each wound was compared. The final experimental data were statistically processed by spss22.0, and the data in the results were sx?. It was indicated that there was no difference between the 4 groups of test data by ANOVA, and the difference was statistically significant (P0.05). Results: the absorption of polyacrylate dressings in the first 2 minutes after immersion in three kinds of solutions was the fastest, reaching the maximum of 75%. After 2 minutes, the absorption of polyacrylate dressings tended to slow down, and reached the maximum absorption value at 7min, which tended to saturation. The absorbed amount of saturated polyacrylate was 20 times of its own body weight, and there was no significant difference in the absorption of normal saline, pure water and fresh rabbit blood with the same amount of polyacrylate. At 7, 14, 21 days after successful modeling of the wound and application of dressing, the four wound areas and wound healing scores of all rabbits were observed. The results showed that the average values of the two indexes of 蔚-PL-SAP dressing wound were better than those of SAP dressing wound, 蔚-PL gauze group and pure gauze group, and P0.05 was better than that of 蔚-PL dressing wound. On the third day after operation, aseptic cotton was used for bacterial culture to observe the number of bacterial colonies. The results showed that there was significant difference between 蔚-PL-SAP group and the other three groups in the number of Staphylococcus aureus colonies in wound, and the results showed that there was a significant difference between 蔚-Staphylococci group and other three groups. The colony number was significantly lower than that of the other three groups. The wound was stained with HE and observed by microscope on the 21st day after successful establishment of the model. The results showed that there was obvious granulation tissue formation in the wound with 蔚-PL-SAP dressing compared with the other three groups. New capillaries and a large number of fibroblasts are abundant and inflammatory cells decrease. 蔚-poly-lysine-polyacrylate dressings have good liquid absorption properties for different liquids. 2. 蔚-poly-lysine-polyacrylate dressings have good liquid retention properties. 3. 蔚-polylysine-polyacrylate dressing can promote wound healing, granulation growth and antibacterial effect in animal wound experiments.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R641

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