rhGM-CSF和纳米银联合外用对深Ⅱ度烫伤创面病原菌的影响

Effect of recombinant human Granulocyte/macrophage colonystimulating factor combined with nano-silver for deep burn degreen Ⅱ about pathogens

目的研究重组人粒细胞-巨噬细胞集落刺激因子(rhGM-CSF)和纳米银联合外用,对深Ⅱ度烫伤创面愈合过程病原菌分布及其耐药性分析。方法用Wistar大鼠建立深Ⅱ度烫伤模型,分为A、B、C、D四组,A组(30例):凡士林纱布覆盖,B组(30例):纳米银覆盖,C组(30例):rhGM-CSF涂抹创面,D组(30例):rhGM-CSF+纳米银覆盖,伤后第1、4、7、10、14、21天,创面分泌物细菌培养并计数,细菌分离鉴定,测定细菌耐药谱。结果 A组在第4、7、10、14、21天均培养出细菌[(3.22±1.04)×104/cm2、(4.57±1.15)×104/cm2、(8.13±1.25)×104/cm2、(16.36±3.22)×104/cm2、(14.52±3.10)×104/cm2];B、C两组在第10、14、21天培养出细菌[B组:(5.67±0.77)×104/cm2、(8.14±1.21)×104/cm2、(6.86±0.96)×104/cm2;C组:(4.38±1.44)×104/cm2、(6.80±0.85)×104/cm2、(4.94±0.40)×104/cm2];D组在第14、21天培养出细菌[(4.10±0.47)×104/cm2、(2.46±0.76)×104/cm2]。第10、14、21天,A、B、C、D组细菌计数比较,差异均有统计学意义(均P<0.05)。革兰阳性菌以金黄色葡萄球菌居首位;革兰阴性菌以铜绿假单胞菌居首位。药敏试验结果显示,金黄色葡萄球菌主要对青霉素G、环丙沙星、利福平、苯唑西林、氧氟沙星、庆大霉素、四环素等耐药,铜绿假单胞菌主要对哌拉西林、奈替米星、头孢吡肟、哌拉西林他唑巴坦、庆大霉素等耐药,病原菌对抗菌药物敏感性均为D组>C组>B组>A组。结论 rhGM-CSF和纳米银联合外用,减少深Ⅱ度烫伤创面细菌生长,提高病原菌对抗菌药物的敏感性。

Objective To study the distribution and drug resistance of the pathogens, about recombinant human Granulocyte/macrophage colonystimulating factor(rhGM-CSF) combined with nano-silver as a treatment for deep burn degreen Ⅱ. Methods The burn model were done with Wistar rats. They were randomly divided into four groups, petrolatum treatment(group A, n=30), nano-silver treatment(group B, n=30), rhGM-CSF treatment(group C, n=30), and rhGM- CSF combined with nano-silver treatment(group D, n=30). Bacteria were cultured, isolated identified, and determined antibiotics spectrum, on postburn day 1, 4, 7, 10, 14, 21 in all groups. Results There were bacterias in group A on postburn day 4, 7, 10, 14, 21[(3.22±1.04)×104/cm2,(4.57±1.15)×104/cm2,(8.13±1.25)×104/cm2,(16.36±3.22)×104/cm2,(14.52±3.10)×104/cm2]. There were bacterias in group B and group C on postburn day 10, 14, 21 [group B:(5.67±0.77)× 104/cm2,(8.14±1.21)×104/cm2,(6.86±0.96)×104/cm2; group C:(4.38±1.44)×104/cm2,(6.80±0.85)×104/cm2,(4.94±0.40)× 104/cm2]. There were bacterias in group D on postburn day 14,21 [(4.10±0.47)×104/cm2,(2.46± 0.76)×104/cm2]. Among group A, B, C and D, on postburn day 10, 14, 21, there were significantly statistical difference(P < 0.05). Staphylococcus aureus was the most in gram-positive bacteria. Pseudomonas aeruginosa was the most in gram-negative bacteria. The results of susceptibility test indicated that Staphylococcus aureus were resistant to Penicillin G, Ciprofloxacin, Rifampicin, Oxacillin, Ofloxacin, Gen-tamicin, and Teteacycline, while Pseudomo- nas aeruginosa were resistant to Piperacillin, Netilmicin, Cefepime, Piperacillin tazobactam, and Gentamicin. The antimicrobial susceptibility testing: group D>group C>group B>group A. Conclusion rhGM-CSF combined with nano-silver treatment can reduce bacteria growth, improve the antimicrobial susceptibility of pathogens.