封闭负压引流对早期处理爆炸创面的细菌和微循环的影响

Effect of vacuum sealing drainage on bacteria and microcirculation of acute explosion wounds

[目的]观察封闭负压引流(vacuum sealing drainage,VSD)对早期爆炸创面的细菌和微循环的影响。[方法]选取兰州地区健康猪6头,分别用电雷管将双侧臀部制成12个爆炸性创面,配对分成两组。致伤6 h后创面有限清创,对照组(A组)用无菌凡士林纱布和纱布覆盖。治疗组(B组)用封闭负压引流治疗,施加-20 kPa负压。治疗前、后12、24、48、72 h在创面表面不同点切取约1 g创面组织匀浆作细菌计数。治疗前、治疗后72 h彩色B超观察爆炸中心区的微循环。[结果]两组创面细菌数在治疗后各个时间点均有显着性差异(P<0.01)。A组24 h内细菌数达105,B组48 h后才达到,且随时间延长细菌数并不呈指数增加。治疗前,爆炸中心区未测到血流信号。治疗后72 h A组爆炸创面存在零星的血流信号;B组爆炸创面显示丰富的血流信号。[结论]VSD抑制爆炸创面细菌数增殖,延迟创面感染时间,改善爆炸创面微循环。

[ Objective] To observe the effect of vacuum sealing drainage （VSD） on bacteria and microcirculation of acute explosion wounds in pigs. [ Method ] Twelve blast wounds, created by explosion of a specific type of electric detonations which were fixed at 1 cm over the skin of the hips of six Lanzhou healthy pigs （30 -40 kg） ,were divided into two matched groups. Debridement was performed at 6 hours after injury. Group A was treated with conventional dressing change, and group B was treated with VSD under the pressure of -20kPa. Tissue specimens collected from different sites of the wound bed before and at 12, 24, 48, 72 hours after treatment, and experienced bacteria counting. The microcirculation of the blast wounds was examined by color B-mode ultrasonic diagnostic equipment before and 72hours after treatment. [ Result] The difference of wound bacteria loads between group A and group B was statistically signficant at different time points. Bacteria loads in group B were increased to 105cfu/g at 48 h after treatment,compared with group A at 24 h. No signal of blood flow in blast wound was found before treatment. In contract,the blast wound had plenty of signals of blood flow in group B. [ Conclusion ] VSD could reduce the bacteria loads, and delay the time of infection. Meanwhile it improved the microcircnlation of the acute blast wound.