创伤后伤口感染的病原学分析及中药熏洗治疗的效果观察

Pathogenic analysis of wound infection after trauma and observation of the effect of traditional Chinese medicine fumigation and washing

目的总结创伤后伤口感染的病原学特点,探讨中药熏洗的治疗效果。方法选择2017年6月至2018年10月期间河源市中医院骨科收治的54例创伤后伤口感染患者为研究对象,分析其病原学资料及药敏情况。根据随机数表法将患者分为对照组和观察组,每组27例,对照组患者予常规换药、抗感染治疗,观察组在此基础上联合中药熏洗,疗程均为14 d。比较两组患者治疗前后的血清C反应蛋白(CRP)、血沉(ESR)水平,并比较伤口愈合时间和住院时间。结果伤口感染病原菌以革兰阳性菌为主,占55.71%,前三位细菌分别为金黄色葡萄球菌(37.14%)、凝固酶阴性葡萄球菌(15.71%)、大肠埃希菌(15.71%),主要革兰阳性菌均对万古霉素敏感,大肠埃希菌对亚胺培南敏感;治疗后,观察组患者的血清CRP、ESR水平分别为(13.4±3.4) mg/L、(10.7±2.9) mm/h,明显低于对照组的(18.9±4.1) mg/L、(13.8±3.5) mm/h,差异均有统计学意义(P<0.05);观察组患者的伤口愈合时间及住院时间分别为(17.6±4.3) d、(20.8±3.1) d,均明显短于对照组的(21.4±6.8) d、(23.1±4.7) d,差异均有统计学意义(P<0.05)。结论创伤后伤口感染患者病原菌以革兰阳性菌为主,对万古霉素敏感性较好;中药熏洗治疗可以有效抑制炎症反应、促进伤口的愈合。

Objective To summarize the pathogenic characteristics of wound infection after trauma and to explore the therapeutic effect of traditional Chinese medicine fumigation and washing. Methods A total of 54 cases of wound infection after trauma were selected as objects, which were treated in the Department of Orthopaedics at Heyuan Hospital of Traditional Chinese Medicine from June 2017 to October 2018. The pathogenic data and drug sensitivity were summarized. According to the random number table method, patients were divided into control group and observation group, with 27 cases in each group. The control group were given routine dressing change and anti-infection treatment. On this basis, the observation group was given combined treatment of traditional Chinese medicine fumigation and washing. Both treatments were 14 days. The levels of serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were compared between the two groups before and after treatment, and wound healing time and hospitalization time were compared. Results Gram-positive bacteria were the main pathogens of wound infection, accounting for 55.71%, mainly Staphylococcus aureus (37.14%), coagulase-negative Staphylococci (15.71%), and Escherichia coli (15.71%). Major Gram-positive bacteria were sensitive to Vancomycin, and Escherichia coli was sensitive to Imipenem. After treatment, the levels of serum CRP and ESR in the observation group were respectively (13.4 ± 3.4) mg/L and (10.7±2.9) mm/h, which were significantly lower than corresponding (18.9±4.1) mg/L and (13.8±3.5) mm/h in the control group (P<0.05). The wound healing time and hospitalization time in the observation group were (17.6±4.3) d and (20.8± 3.1) d, respectively, which were significantly shorter than corresponding (21.4±6.8) d and (23.1±4.7) d in the control group (P<0.05). Conclusion Gram-positive bacteria are the main pathogens of wound infection after trauma, and are sensitive to vancomycin. The traditional Chinese medicine fumigation and washing can effectively inhibit inflammation and promote wound healing.