FE复合酶防治烧伤后期肉芽创面感染的临床观察

Clinical observation of the effects of FE combined enzymes on the infection of the granulation burn wound during late postburn stage

目的观察FE复合酶控制烧伤后期肉芽创面常见耐药菌感染的作用。方法选取笔者单位烧伤患者30例,随机分为治疗组15例,将FE复合酶50 ml溶于等渗盐水0-150 ml中,使其终浓度为1-3 U/ml,用无菌纱布浸湿该液后湿敷创面,1-2次/d;对照组15例,用庆大霉素+ 等渗盐水纱布湿敷创面,1-2次/d。于用药前及用药后1-5 d取创面分泌物作细菌培养,检测两组患者创面的细菌种类及所用药物对创面细菌的敏感率;观察两组患者创面愈合时间及植皮术后3、5、 8、10、12 d的创面愈合率。结果两组患者创面细菌以铜绿假单胞菌、大肠杆菌、阴沟肠杆菌、甲氧西林耐药金黄色葡萄球菌(MRSA)为主。治疗组对MRSA、表皮葡萄球菌、腐生葡萄球菌、铜绿假单胞菌、大肠杆菌、阴沟肠杆菌的敏感率分别为93．8％、100．0％、100．0％、100．0％、100．O％、95．0％,高于对照组的17．6％、31．3％、28．6％、44．0％、33．3％、28.0％(P<0．01)。治疗组植皮术后创面愈合时间为(10．6±1．5)d,明显短于对照组[(15．3±1．7)d,P<0．01]。治疗组患者植皮术后各时相点创面愈合率均明显高于对照组(P<0．01),植皮术后10 d治疗组创面愈合率为(85．4±2．4)％,与对照组(51．3±1．5)％比较,差异有统计学意义(P<0．01)。结论 FE复合酶可以有效控制创面感染,提高烧伤后期感染创面植皮成功率。

Objective To observe the effects of combined FE enzymes on the infection of the granulation burn wound during late postburn stage in controlling burn wound infection caused by common antibiotic resistant bacteria. Methods Thirty patients in our burn ward were enrolled and were randomly divided into A [treated with combined FE enzymes（ 50 ml dissolved in 0 - 150 ml normal saline to reach the final concentration of 1 -3 U/ml） ] and B （treated with gentamicin） groups, with 15 patients in each group. Several layers of gauze, either soaked with combined FE enzyme in A or gentamicin in B group, were used to cover the burn wounds once to twice a day. Bacterial culture from the burn wound exudation before and after drug administration was done before the application of the agents. The bacteria in the burn wounds and their susceptibility to antibiotics were identified. The healing time of the burn wounds was recorded. Furthermore, the healing rate of the burn wound was recorded on the 3rd , 5^th , 8^th , 10^th and 12^th post skin grafting days （PSGD）. Results The dominating bacteria in the bum wounds in both groups were Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae and M RSA. The susceptibility rate of bacteria （ M RSA, Staphylococcus epidermidis, Staphylococcus saprophyte, Pseudomonas aeruginosa, Escherichia coli and Enterobacter cloacae） to combined FE enzyme was 93. 8% , 100. 0% , 100. 0% , 100. 0% , 100. 0% and 95.0% , respectively, which were much higher than those in B group （ 17.6% , 31.3% , 28.6% , 44.0% , 33.3% , 28.0% , respectively, P 〈 0.01 ）. The wound healing time after skin grafting in A group （ 10.6 ± 1.5 days） was significantly shorter than that in B group （15.3 ± 1.7 days, P 〈0.01 ）. The wound healing rate on 10 PSGD in A group was （85.4 ±2.4）%, and which was only （51.3 ±1.5）% in B group （ P 〈 0.01 ）. Conclusion Combined FE enzyme can effectively control burn wound infection, so that the interval between skin grafting and wound healing can be shortened and success rate of skin grafting be improved.