聚维酮碘和利凡诺对糖尿病足溃疡创面细菌载量影响的对比研究

A COMPARATIVE STUDY ON EFFECT OF BACTERIAL LOAD IN DIABETIC FOOT ULCERS DEALING WITH IODOPHOR AND RIVANOL RESPECTIVELY

目的应用聚维酮碘与利凡诺对糖尿病足溃疡(diabetic foot ulcers,DFUs)创面进行干预,观察其对创口表面细菌载量的影响,评价二者在DFUs换药的效果。方法2006年3月-2007年3月,选取符合选择标准的30例患者进行试验。男18例,女12例;年龄46～78岁,平均59.8岁。创面范围3cm×2cm～15cm×10cm。病程6周～6个月,平均2.1个月。采用随机对照的方法按患者就诊次序分为3组,每组10例。创面清创生理盐水冲洗后,A组以生理盐水,B组以0.3%聚维酮碘,C组以0.1%利凡诺分别湿敷创面5min,再以生理盐水冲洗,冲洗前后及冲洗后24h取标本。将各标本以大豆胰蛋白酶肉汤10倍稀释后行细菌培养计数,对比冲洗前后各组创面细菌载量的变化,分析各组干预结果的差异性。结果各标本培养菌落形成良好,菌落清晰。各组冲洗后即刻细菌培养结果细菌载量均有明显减少,各组间比较差异无统计学意义(P>0.05)。冲洗24h后细菌培养A组和C组细菌载量变化较小,B组细菌培养菌落数量明显减少,细菌载量变化明显,B组与A、C组比较,差异有统计学意义(P<0.05),A组和C组间差异无统计学意义(P>0.05)。结论聚维酮碘和利凡诺均具有较好的组织渗透及清除细菌的作用,糖尿病足局部使用能明显减少创面生物载荷,对杀灭细菌减轻感染有明显作用,聚维酮碘较利凡诺具有更长久的抑菌或杀菌作用。

Objective To investigate the change of bacterial load applied with iodophors and rivanol of diabetic foot ulcers （DFUs）, furthermore to evaluate the effect of both in removing superficial microbes of DFUs. Methods From March 2006 to March 2007, 30 patients were randomly divided into control group （group A, n=10）, iodophor group （group B, n=10） and rivanol group （group C, n=10）. There were 18 males and 12 females with an average age of 59.8 years （range 46-78 years）. The wound size ranged from 3 cm × 2 cm to 15 cm × 10 cm. The disease course was 6 weeks to 6 months （mean 2.1 months）. Each wound was debrided and irrigated before process, then drug was compressed on the wound for 5 minutes, and irrigated again. The samples gained for three times, before, immediately and 24 hours after the process. Each sample was diluted before cultivation, the bacteria of wound were counted and compared among 3 groups. Results The cultures of specimens showed that the load decreased in every group, each cultured colony of specimen grew well, and there were no significant differences between 3 grouPs immediately after procedure （P 〉 0.05）. There were significant differences between group B and groups A, C （P 〈 0.05）, but there were no significant difference between group A and group C 24 hours after treatment （P 〉 0.05）. Conclusion Both iodophors and rivanol could remove the bacteria on the surface of wound. Topical germicide could reduced bacterial load in the wound of diabetic foot, the role of sterilizing and bacteriostasis of iodophors were better than that of rivanol.