感染对猪皮肤软组织爆炸伤继发性坏死范围的影响

Effect of infection on secondary necrosis of soft tissue blast injury in pigs

目的：观察感染对猪皮肤软组织爆炸伤创面继发性坏死范围的影响．方法：用电雷管在6只15～20kg的小自家猪双侧肩胛及双侧臀部造成24个爆炸伤创面。随机分为A组和B组，每组3只动物，12个创面．A组创面伤后前3d每日常规换药，B组创面伤后前2d不做任何处理，以造成创面感染．伤后第3d，两组均常规换药．结果：伤后6h创面平均面积为（7．34±0．99）cm^2，创面平均深度（0．85±0．126）cm，两组创面面积和深度的差异无统计学意义（P〉0．05）．伤后3d，A组创面内的细菌数（0．157±0．171）×10^5细菌形成单位／克组织（cfu／g），B组创面内的细菌数（323．417±30．631）×10^5cfu／g，两组差异有统计学意义（P〈0．01），B组创面面积和深度分别（10．81±0．32）cm^2和（1．66±0．09）cm，A组创面面积和深度分别（9．17±0．60）cm^2和（1．43±0．13）cm，B组创面面积和深度均较A组大（P〈0．01）；伤后6d和9d，B组创面深度加深至（2．42±0．22）和（2．46±0．25）cm，创面面积扩大至（13．33±0．46）和（11．38±0．39）cm^2，深度较伤后3d深约1cm，创面边缘皮肤较伤后3d扩大约0．5cm，伤后6d和9d的创面面积及深度均和B组伤后3d差异有显著统计学意义（P〈0．01）．结论：感染能加重和导致爆炸伤继发性坏死；在常规治疗的干预下，感染能造成猪皮肤软组织爆炸伤感染创面深度约1cm深部组织和伤口周围约0．5cm皮肤发生继发性坏死．

AIM： To observe the influence of infection on the secondary necrosis of soft tissue blast injury in pigs. METHODS： Twenty-four blast wounds, created by explosion of a specific type of electric detonators which were fixed at 1 cm over the skin of the shoulders and hips of 6 small white domestic pigs （15 -20） kg, were divided into 2 groups： group A which was treated with conventional dressing change, and group B which was not treaed until the 3rd clay after injury. Tissue specimens, collected from the wounds on day 3, 6, and 9 after injury, were weighed and underwent bacteria counting. Meanwhile, the wound areas and depths were measured on the corresponding time points after injury. RESULTS： Six hours after injury, the mean area and depth of all wounds were （ 7.34 ± 0.99 ） cm^2 and （ 0.85 ± 0. 126） cm, without statistical significance between group A and B in both wound area and depth （ P 〉 0.05 ）. Three days after injury, the bacteria load, area, and depth of the wounds in group A were （0. 157 ± 0. 171 ） × 10^5 colory-forming unit/g （ cfu/g）, （9.17±0.60） cm^2, and （1.43 ±0. 13） cm, while those in group B were （323.417 ±30.631） × 10^5 cfu/g, （10.81 ±0.32） cm^2, and （ 1.66 ± 0.09） cm, respectively, showing significant statistical differences between group A and B in the three definite measurements of wounds （P 〈0.01 ）. Wound areas of group B on day 6 and 9 after injury were （ 13.33 ± 0.46） and （ 11.38 ± 0.39 ） cm^2, both being significantly different from those of group B on day 3 after injury （P 〈0.01 ）. Wound depths of group B on day 6 and 9 after injury were （2.42 ±0.22） and （2.46 ± 0.25 ） era, both of which had significant statistical differences as compared with those of group B on day 3 after injury （ P 〈 0.01 ）. CONCLUSION： Infection aggravates the secondary necrosis of soft tissue blast injury, and under the treatment of conventional dressing change, infection can cause about 1 cm tissue in the wound and the about 0. 5 cm skin around the wound to necrosis.