抗菌藥物陶瓷緩釋體在延遲高原彈片傷外科處理中的應(yīng)用

摘要： 目的探討延長(zhǎng)高原彈片傷傷員初期外科處理時(shí)間的措施。方法在海拔3658m的拉薩地區(qū),以滑膛槍發(fā)射1.03g的鋼球擊中豬后肢股中部,避免傷及股骨、大血管。實(shí)驗(yàn)豬隨機(jī)分為緩釋體組和口服對(duì)照組。傷后1小時(shí)在緩釋體組實(shí)驗(yàn)豬傷道內(nèi)放置生物陶瓷藥物緩釋體,內(nèi)盛裝原藥環(huán)丙沙星25mg,替硝唑60mg,包扎傷道,24小時(shí)后更換敷料,48小時(shí)后取出緩釋體,清創(chuàng)后閉合傷道,傷后第9天觀察傷道愈合情況。于傷后1、24、48小時(shí)測(cè)定傷道組織的細(xì)菌數(shù),并做藥敏試驗(yàn),于傷后24、48小時(shí)切取傷道組織,測(cè)定琥珀酸脫氫酶(SDH)、三磷酸腺苷(ATP)酶活性。對(duì)照組實(shí)驗(yàn)豬傷后口服環(huán)丙沙星和替硝唑,余處理同緩釋體組。結(jié)果傷后24、48小時(shí)緩釋體組傷道細(xì)菌數(shù)為104/g濕組織,傷道組織SDH、ATP酶活性高于對(duì)照組,傷后48小時(shí)清創(chuàng)后,傷道愈合良好?？诜?duì)照組傷后48小時(shí)傷道感染明顯,傷道細(xì)菌數(shù)達(dá)108/g濕組織。結(jié)論在高原彈片傷傷道內(nèi)放置抗菌藥物陶瓷緩釋體,可防止感染,推遲清創(chuàng)至傷后48小時(shí)。
Objective To explore the management of delayed fragment wounds at high altitude.Methods The pigs hind legs were hit by steel balls(weight 1.03g) using a smooth gun,and the damage of major vessels and femur was avoided.The wounded pigs were randomly arranged into the ceramic carrier group and the control group.The ceramic carriers,which carried cinrofloxacin and tinidazole were placed into the wound tracks of the ceramic carrier group 1h after wounds.The dressings were changed 24h after wounds.The carriers were removed from the wound tracks,dead tissue of wound track excised and the wound tracks were irrigated,drained out,and then sutured 48h after wounds. The wound healing was observed 9 days after wounds.The bacteria number at the wound track and the sensitivity to antibiotic were assayed 1,24,48h after wounds.The tissue samples of the wound tracks were excised,activities of succinate dehydrogenase(SDH) and ATPase were assayed 24,48h after wounds.These antibiotic agents,carried by biological ceramic carriers were orally administered to the pigs of control group and other treatments were coincident with those mentioned in the ceramic carrier group.Results The bacterial number in the wound track of the ceramic carrier group was 104/g wet tissue,and activities of SDH,ATPase were higher than those in the control group 24,48h after wounds.The wound track of the ceramic carrier group,in which debridment was carried out 48h after wounds,was healing well 9d after wounds.Infection of the wound track in the control group was obvious and bacterial number was 108/g wet tissue 48h after wounds.Conclusion The results suggest that placement of ceramic carriers containing cinrofloxacin and tinidazole to the delayed fragment wound track may prevent wounded tissue infection,and the debridment can be delayed 48h after wounds at high altitude.