移植培养表皮细胞片时创面局部抗生素的合理选用

Selection of Topical Application of Appropriate Antimicrobial Agents for Cultured Epidermal Allograft

目的：优选出适于移植培养表皮细胞片（ＣＥＡ）的局部抗菌用药方案。方法：将培养的人表皮细胞置于含不同浓度抗生素的培养液中培养３天后，用噻唑蓝（ＭＴＴ）法测定其细胞生长率，同时采用定量铂环法和Ｋ－Ｂ纸片扩散法分别测定其在创面上和在体外的抗菌效果；并以此分别准备烧伤或肉芽创面，观察了对ＣＥＡ早期成活的影响。结果：对培养的人表皮细胞毒性作用为：碘伏（ＰＶＰ－Ⅰ）＞磺胺嘧啶银（ＡｇＳＤ）氟哌酸银（ＡｇＮ）＞丁胺卡那霉素（ＡＫ）／ＡＫ与ＰＲ复合抗生素（ＤＡＢ）＞氧哌嗪青霉素（ＰＲ）；ＡｇＮ和ＤＡＢ在临床使用浓度时抗菌效果较好，以此分别准备烧伤或肉芽创面，显著地提高了ＣＥＡ早期成活率。结论：烧伤创面外用１％ＡｇＮ、肉芽创面外用０．１％ＡＫ和０．２％ＰＲ的ＤＡＢ液湿敷、术后局部预防性应用０．０１％ＡＫ和０．０２％ＰＲ的ＤＡＢ液，可有效地提高ＣＥＡ的早期成活率。

Aim: To select the appropriate topical antimicrobial agents for cultured epidermal grafts. Methods: The cultured epithelial cells were exposed to serial dilution of these topical antimicrobial agents for 3 days, and the growth rate was determined using tetrazolium dye (MTT) test. Then, the antimicrobial effect of the agents with different concentrations on common burn wound organisms was observed with the Kirby Bawer antimicrobial susceptibility assay. In addition, we examined the efficacy of them on the burn wounds or granulation tissue with clinical used concentration, and the early take rate of cultured epidermal allografts (CEA) on prepared burn wound. Results: The cytotoxicity of these agents was arranged in following order: polyvidone iodine (PVP Ⅰ)> silver sulfadiazine (AgSD)> silver norfloxacin (AgN)> amikacin (AK) or amilacin plus piperacillin (DAB)> piperacillin (PR). Both AgN and DAB had good antimicrobial effectiveness in clinical used concentration and obviously increased the early take rate of CEA on wound beds. Conclusion: The early take rate of CEA may be impoved when burn wound prepared with 1%AgN and the granulation tissue with 0.1%AK plus 0.2%PR or the prophylactic application with 0.01%AK plus 0.02% PR after grafting.