不同消毒剂对口腔颌面外科手术后继发感染的影响

Influence of different disinfectants on secondary infections after oral and maxillofacial surgery

目的比较不同消毒剂对口腔颌面外科手术术后继发感染的影响,为临床消毒剂的选择提供依据。方法选取120例在医院进行口腔颌面手术的患者为研究对象,按照入院顺序随机均分为A、B、C 3组,每组各40例;A组患者采用0.5%聚维酮碘进行口腔消毒,B组患者采用0.02%醋酸氯己定,C组患者采用1∶5000呋喃西林液,比较各组术前、术后2、4、6、8h伤口处组织细菌培养情况和术后感染发生率。结果 3组患者术前采样培养细菌数比较无明显差异,3组患者术后2h采样培养细菌数均低于术前,比较差异有统计学意义(P<0.05);A组患者手术后2、4、6、8h采样培养细菌数分别为(30.4±1.9)、(36.5±1.1)、(44.7±2.6)、(56.0±2.5)个/cm2,采样细菌数逐渐增加,但比较差异无统计学意义;B组患者手术后2、4、6、8h采样培养细菌数分别为(37.5±1.3)、(49.0±2.4)、(66.7±3.6)、(79.8±5.0)个/cm2,采样细菌数逐渐增加(P<0.05);C组患者手术后2、4、6、8h采样培养细菌数分别为(43.5±2.7)、(56.3±4.5)、(78.4±6.9)、(93.2±8.8)个/cm2,采样细菌数逐渐增加(P<0.05);A组术后采样细菌培养细菌数低于B组和C组(P<0.05),B组低于C组(P<0.05);A组患者术后继发感染发生率为2.5%,B组为17.5%,C组为20.0%,A组患者术后继发感染发生率低于B组和C组(P<0.05),B组低于C组,但差异无统计学意义。结论 0.5%聚维酮碘用于口腔颌面外科手术术前口腔消毒,可获得持久和有效的消毒作用,效果优于0.02%醋酸氯己定溶液和1∶5000呋喃西林液。

OBJECTIVE To compare the influence of different disinfectants on the secondary infections after the oral and maxillofacial surgery so as to provide evidence for the selection of clinical disinfectants.METHODS A total of 120cases of patients with oral and maxillofacial surgery were selected as the research objects and were randomly divided into A,B,C three groups according to the admission sequence.The patients in the group A were treated with 0.5% povidone iodine,the patients in the group B were treated with 0.02% chlorhexidine acetate,and the patients in the group C were treated by 1∶5000 nitrofurazone solution,then the bacterial culture of the wound tissue before the surgery,or at 2,4,6 and 8hours after the surgery and the incidence of the postoperative infections were compared between the three groups.RESULTS There was no significant difference in the preoperative bacterial count between the three groups;the postoperative 2hours bacterial count of the three groups were lower than that of the preoperative,the difference was significant（P0.05）.The postoperative 2,4,6,8 hours bacterial count of the group A were（30.4±1.9）,（36.5±1.1）,（44.7±2.6）,and（56.0±2.5）/cm2,the sampling bacterial count gradually increased,but the difference was not significant;the postoperative 2,4,6,8 hours bacterial count of the group B were（37.5±1.3）,（49.0±2.4）,（66.7±3.6）,and（79.8±5.0）/cm2,the sampling bacterial count gradually increased,the difference was significant（P0.05）;the postoperative 2,4,6,8hours bacterial count of the group C were（43.5±2.7）,（56.3±4.5）,（78.4±6.9）,and（93.2±8.8）/ cm2,the sampling bacterial count gradually increased,the difference was significant（P0.05）.The postoperative bacterial count of the group A was less than that of the group B（P0.05）,the postoperative bacterial count of the group B was less than that of the group C（P0.05）.The incidence of the postoperative secondary infections of the group A was 2.5%,the group B 17.5%,the group C 20.0%,the incidence of the postoperative secondary infections of the group A was lower than that of the group B or the group C（P0.05）,the group B was lower than the group C,but the difference was not significant.CONCLUSION The 0.5% povidone iodine may obtain lasting and effective disinfection effect on the preoperative oral disinfection of the oral and maxillofacial surgery,the effect is better than 0.02% chlorhexidine acetate solution and 1∶5000 nitrofurazone solution.