庆大霉素和活力碘的体外抑菌效应及其对开放性骨折术后感染的预防作用

Bacteriostasis in Vitro of Gentamycin and Povidone Iodine and Their in Vivo Prevention of Infection in Open Fracture

目的:探讨庆大霉素和活力碘体外抑菌效应及其术中冲洗对开放性骨折术后感染的预防作用。方法:体外抑菌实验检测庆大霉素和活力碘对表皮葡萄球菌和金黄色葡萄球菌的最低抑菌浓度(M IC)和最低杀菌浓度(M BC),药敏实验观察其分别对这两种细菌的抑菌圈大小。体内动物实验将家兔分为3组,均将右侧胫骨近端软组织切开,并不全离断胫骨,局部加入金黄色葡萄球菌菌液100u l后等待3 m in。模型对照组伤口不予冲洗直接关闭。另两组分别以0.1%活力碘和庆大霉素溶液冲洗创面。术后10d通过观察伤口和深部局部炎症表现、脓液性状和细菌培养来判断是否发生感染。结果:庆大霉素和活力碘均有不同程度的体外抑菌和杀菌作用,庆大霉素的M IC和M BC明显低于其他组,其抑菌圈明显大于其他组。体内动物实验模型对照组感染率100%,庆大霉素生理盐水冲洗组感染率明显低于模型对照组和活力碘冲洗组(P<0.01)。结论:庆大霉素溶液冲洗创面能明显降低开放性骨折术后感染率,体外抑菌杀菌作用明显,可较好地预防开放性骨折术后感染。

Objective： To evaluate bacteriostasis in vitro of gentamycin and povidone iodine and their in vivo prevention of infection in open fracture. Methods： In the in vitro bacteriostasis experiment, the MIC and MBC of gentamycin and povidone iodine to staphylococcus aureus or staphylococcus epidermidis were detected . Then the so bacterium to detect th groups. Had a section tibia, then followed b group, the the wound wound was lutions were instilled into the holes on the MH-agar cultured with these two kinds of e size of inhibition zone. In the in vivo experiment, 30 rabbits were divided into 3 of soft tissue on right proximate tibia in each rabbit, exposed the cavitas medullar of y the instillation of staphylococcus aureus suspension into wounds. In the control closed without any treatment. In other two groups, 3 minutes after the instillation, and cavitas medullar were irrigated respectively with 0. 1%povidone iodine and gentamycinsolution. 10 days after operation, the wounds were assessed by observing the local appearance of infection, the character of the pus and by bacterial culture. Results： In the in vitro bacteriostasis experiment, The MIC and MBC of gentamycin to staphylococcus aureus or staphylococcus epidermidis were obviously lower than povidone iodine. What＇s more, the inhibition zones on the agar of gentamycin were bigger than povidone iodine. In the in vivo experiment, every operated wound was infected in the control group with a 100% incidence of infection. In the group that had irrigation with 0. 1% povidone iodine solution, the incidence of infection was 90% and in the group irrigated with gentamycin solution, the incidence was 10%, which was significantly lower than the control and the povidone iodine group （P〈0. 01）. Conclusion. Gentamycin displays apparente bacteriostasis and sterilization to staphylococcus aureus and staphylococcus epidermidis in the in vitro bacteriostasis experiments. That＇s more, intraoperative irrigation with gentamycin solution can significantly reduce the incidence of infection in open fracture contamination by staphylococcus aureus. Thus it can effectively prevent infection in open fracture.