rhGM-CSF、纳米银外用对深Ⅱ°烫伤创面病原菌的影响

Effect of Recombinant Human Granulocyte/Macrophage Colonystimulating Factor and Nano-Silver on Pathogens of Deep Burn DegreeⅡ

目的:研究重组人粒细胞-巨噬细胞集落刺激因子(rhGM-CSF)、纳米银外用,对深Ⅱ°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°烫伤模型,分为A、B、C 3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,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、B组、C组分别于伤后第4,10天出现细菌生长,第10,14,21天各组间差异有统计学意义(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,革兰阳性菌主要对青霉素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,革兰阴性菌主要对哌拉西林、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C组>B组>A组。结论:rhGM-CSF、纳米银外用,均减少深Ⅱ°烫伤创面细菌生长;提高病原菌对抗菌药物的敏感性,并且rhGM-CSF优于纳米银。

Objective：To study the distribution and drug resistance of the pathogens after the combined application of recombinant human Granulocyte/macrophage colonystimulating factor（rhGMCSF）and nano-silver as treatment for deep burn degreeⅡ.Methods：The burn models were established on Wistar rats.They were randomly divided into three groups according to the treatment of petrolatum（group A,n=30）,nano-silver（group B,n=30）,and rhGM-CSF（group C,n=30）.The distribution and drug resistance of the pathogens on wound of the three groups at the end of 1,4,7,10,14,21 dafter treatment were assayed.Results：Bacteria were found in all the three groups at 4and 10 dafter treatment,and the numbers increased at 10,14,and 21d（all P〈0.05）.The results of susceptibility test indicated that gram-positive bacteria were resistant to Penicillin G,Ciprofloxacin,Rifampicin,Oxacillin,Ofloxacin,Gentamicin,and Teteacycline,while gram-negative bacteria were resistant to Piperacillin,Netilmicin,Cefepime,Piperacillin tazobactam,and Gentamicin.The antimicrobial susceptibility of pathogens ranked from high to lowa as：group Cgroup Bgroup A.Conclusion：rhGM-CSF and nano-silver treatment could reduce bacteria growth,improve the antimicrobial susceptibility of pathogens.And rhGM-CSF shows better effect than nano-silver does.