水刀技术用于感染性创面清创效果的实验研究

An experimental study on the effect of water jet on debridement of infected wounds

[目的]探讨水刀技术(Water Jet)用于感染性创面清创的效果。[方法]取72只Wistar大鼠随机分为2大组,无菌条件下切除各大鼠背部3 cm×3 cm的全层皮肤,分别将铜绿假单胞菌菌液及金黄色葡萄球菌菌液涂抹于创面制成感染模型,然后每组采用不同的清创方法 (水动力清创系统、传统清创方法 (手术刀+脉冲冲洗)、单纯脉冲冲洗)以及更换不同冲洗液(生理盐水、洗必泰)作为冲洗介质进行清创,取清创前后感染创面的局部肌肉组织作组织细菌定量及组织病理学分析。[结果]各清创组清创前的组织细菌量相近,差异均无统计学意义(P均>0.05)。分别对铜绿假单胞及金黄色葡萄球菌感染创面进行清创时,无论以生理盐水还是洗必泰作为冲洗介质,各清创方法清创后的创面组织细菌计数均较清创前下降,清创前后比较差异有统计学意义(P<0.001)。而在清创后的组织细菌含量比较中,水刀清创组均较传统清创组及单纯脉冲冲洗组少,差异有统计学意义(P<0.05)。HE染色显示水刀清创后组织炎性细胞浸润最少,组织结构破坏最轻。[结论]对不同细菌形成的感染创面进行清创时,无论是以生理盐水为冲洗介质还是以洗必泰作为冲洗介质,水刀的清创效果均优于传统清创方法及单纯脉冲冲洗,水刀作为一种新型的清创方法能更好的清除感染,促进创面愈合。

[Objective] To explore the effect of water jet on the debridement of infected wounds. [Methods] Seventy- two Wistar rats were equally and randomly divided into two groups. The full-thickness skin on the back of the rats was resected in 3x3 cm area under sterile condition. Pseudomonas aeruginosa and Staphylococcus aureus were respectively inoculated to the wound in the two groups to make the infection model. Then, the animals were further divided into 12 subgroups with 6 animals in each subgroup based on different debridement methods, including water jet, scalpeling plus pulsed irrigation and simple pulsed irrigation, combined with normal saline or chlorhexidine. The quantitative bacterial analysis and histopathological examination of the local muscle tissue were conducted before and after debridement. [Results] There were no statistically significant differences in bacterial content among the subgroups with the same bacterial infected wounds before debridement （P〉0.05）. The bacterial contents statistically decreased after debridement with any methods aforesaid in both the Pseudomonas aeruginosa group and the Staphylococcus aureus group compared those before debridement respectively （P〈0.05）. However, bacterial cantents after debridement in the water jet subgroups were less than the scatpeling plus pulsed irrigation subgroups and simple pulsed irrigation subgroups in both bacteria infected groups, with statistical differences among them （P〈0.05）. In addition, HE staining showed that the water jet subgroups had the least infiltration of inflammatory cells with the minimized tissue damage compared with those of the remaining two debridement methods. [ Conclusion ] No matter what kinds of bacteria infected, no matter what kinds of rinse solution used, the water jet is superior to the scalpeling plus pulsed irrigation and simple pulsed irrigation in debridement outcome.