甲壳胺膜负压封闭引流疗法治疗多重耐药菌感染创面

摘要

目的 观察应用甲壳胺膜负压封闭引流疗法治疗多重耐药菌感染创面的效果.方法 2015年1月至2017年12月青岛市胶州中心医院烧伤整形科收治108例皮肤溃疡创面合并多重耐药菌感染病例,根据治疗方案不同分为A组与B组,每组各54例.A组创面在外科换药治疗基础上,组合应用甲壳胺人工皮膜负压封闭引流疗法进行干预治疗;B组创面则只采用外科换药方案进行治疗.治疗过程中观察创面变化,并定期行创面细菌培养及抗菌药物敏感试验检测,对比分析2组创面感染治疗效果,观察创面感染细菌种类的变化及感染治愈时间.结果 A组创面感染治愈时间:压疮创面(14.00±1.28)d、糖尿病足创面(13.40±1.27)d、外伤性皮肤溃疡创面(12.44± 1.55)d;B组创面感染治愈时间:压疮创面(25.17±2.73)d、糖尿病足创面(23.85±1.73)d、外伤性皮肤溃疡创面(19.81±1.94)d,A组创面感染治愈时间较B组短,创面感染多重耐药菌被非多重耐药菌取代或无致病性细菌生长,2组比较差异有统计学意义(P＜0.05).结论 在外科换药治疗基础上组合应用甲壳胺人工皮膜负压封闭引流疗法治疗多重耐药菌感染创面,通过高效引流,抑制细菌生物膜形成,改变优势致病性细菌繁殖生长微环境,可有效控制创面多重耐药菌感染,促进创面愈合,缩短临床治疗周期.%Objective To evaluate the outcome of negative pressure closed drainage with chitosan membrane in the treatment of multiple drug-resistant bacterial infections.Methods From January 2015 to December 2017,108 patients with skin ulcer wound complicated by multiple drug-resistant bacterial infection were admitted in the department of burn and plastic surgery,Qingdao Jiaozhou Central Hospital.Among them,36 patients had pressure ulcers,40 cases had diabetic foot wounds,and 32 were traumatic skin ulcer wounds.Patients were divided into group A or group B for different treatments.In group A,besides the basic surgical dressing change,patients were treated by negative pressure closed drainage with chitosan membrane.The patients in Group B were only treated with basic surgical dressing change.The changes of wound were closely observed during the phases,and the wound bacterial culture and antimicrobial drug sensitivity test were performed regularly.The therapeutic effects of the 2 groups were compared.The changes of bacterial species of wound infection and the healing time were recorded.Results In group A,the healing time of wound infection was:pressure ulcers (14.00± 1.28) days,diabetic foot wounds (13.40±1.27) days,traumatic skin ulcer wounds (12.44± 1.55) days.In group B,the wound healing time was:pressure ulcers (25.17 ± 2.73) days,diabetic foot wounds (23.85 ± 1.73) days,traumatic skin ulcer wounds (19.81 ± 1.94) days.The wound healing time of group A was shorter than group B.In group A,the muhiple drug-resistant bacteria was replaced by non-multiple drug-resistant bacteria,or there was no pathogenic bacterial growth.The differences between the two groups was statistically significant (all P＜0.05).Conclusions Additional to the basic surgical dressing change,negative pressure closed drainage with chitosan membrane could promote wound healing,when it's associated with multiple drug-resistant bacteria infection.This method has benefits in efficient drainage,preventing the formation of bacterial biofilm and changing local microenvironment for the dominant propagation.Therefore,it could effectively control the multiple drug-resistant bacterial infections,promote wound healing and save treatment time.