纳米银敷料结合抗生素用于慢性伤口感染干预效果的研究

Research on intervention effect of nano silver dressing in combination with antibiotics for chronic wound infection

目的观察纳米银敷料结合抗生素治疗慢性感染伤口的效果,为临床合理使用银敷料和优化伤口治疗方案提供依据。方法选择2012年1月~2016年6月在兰州大学第二医院、湖北医药学院附属人民医院及三峡大学第一临床医学院伤口门诊就诊的189例慢性伤口感染患者,采用多中心随机对照的方法分为A、B、C三组,每组各63例。按操作流程统一评估和清创后,遵照试验设计要求入组干预,即遵医嘱A组局部使用纳米银敷料处理结合全身敏感抗生素治疗,B组仅局部使用纳米银敷料处理,C组按常规方法处理即静脉输注敏感抗生素,局部使用凡士林敷料处理,干预30 d,随访30 d,从首诊至治疗结束,全程给予营养、活动、疼痛、减压等整体干预。观察三组干预后不同时间病原菌和耐药菌阳性率、伤口床评分、伤口渗液pH值及60 d内伤口愈合率和愈合时间。结果随着干预时间的延长,除C组耐药菌阳性率下降不明显外,其他组病原菌和耐药菌阳性率、渗液pH值均有下降,伤口床评分明显升高(P<0.05);组间比较,干预14 d和21 d时,A组的各项观察指标明显优于B组和C组,B组优于C组,差异均有高度统计学意义(P<0.01);A组伤口愈合率显著高于B、C组,愈合时间显著短于B、C组,差异有高度统计学意义(P<0.01)。结论纳米银敷料结合抗生素治疗慢性感染伤口具有协同抗菌作用而优化伤口微酸环境有助于伤口愈合,为临床合理使用银敷料和优化伤口治疗方案提供循证依据。

Objective To evaluate the effect of nano silver dressing in combination with antibiotics for chronic wound infection treatment, in order to provide the basis for rational use of silver dressing and optimization of wound treatment in clinic. Methods 189 cases of patients with chronic wound infection treated in Wound Outpatient of the Second Hospital of Lanzhou University, People＇s Hospital Affiliated to Hubei University of Medicine, the First Clinical Medical College of China Three Gorges University from January 2012 to June 2016 were selected. According to multi-center randomized controlled method, patients were divided into group A, B and C, each group had 63 cases. After the operation process unified assessment and debridement, according to the test design requirements, with the doctor＇s advice, group A was locally used systemic sensitive antibiotic treatment in combination with nano silver dressing process, group B was only partial used nano silver dressing treatment, group C was given intravenous infusion of sensitive antibiotics, and locally used vaseline dressing processing with 30 days intervention. All patients followed up for 30 days, they were treated by overall intervention, such as full nutrition, activity, pain, stress. The pathogens and resistant bacteria positive rates, wound scores and pH value at different time after intervention, healing time and wound healing rate within 60 days were recorded. Results With the longer duration of intervention, except the group C had no significant decreasing of positive rate of resistant bacteria, in other groups the positive rates of pathogenic bacteria and resistant bacteria, and pH values were all decreased, and wound scores increased （P 〈 0.05）. Comparison in the three groups： after the intervention for 14 d and 21 d, the observation indexes of group A were significantly better than group B and group C, in which, group B were better than those of group C, the differences were statistically significant （P 〈 0.01）. The wound healing rate of group A was higher than that of group B and group C, and the healing time was shorter than group B and group C, with statistically significant differences （P 〈 0.01）. Conclusion Antibiotic treatment in combination with nano silver dressing for chronic chronic wound infection has synergistic antibacterial effect, which can optimize the wound microacid environment, promot wound repair, in order to provide the basis for the evidence-based treatment.