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

摘要
图/表
参考文献(27)
相关文章 (0)

全文: PDF (674 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	郭春兰席祖洋戴德兰

关键词 ：慢性伤口, 纳米银敷料, 病原菌, 耐药菌, 微环境

Abstract：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.

Key words： Chronic wound Nano silver dressing Pathogenic bacteria Drug-resistant bacteria Micro environment

基金资助:湖北省宜昌市医疗卫生科技项目（A14301-07）。

通讯作者: 席祖洋（1969-），女，硕士，副教授，宜昌市中心人民医院护理部主任；研究方向：护理管理及心血管介入护理。

作者简介: 郭春兰（1968-），女，主任护师；研究方向：慢性伤口的治疗与护理。

引用本文:

郭春兰席祖洋戴德兰. 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[J]. 中国医药导报, 2017, 14(28): 60-64.
GUO Chunlan XI Zuyang DAI Delan. Research on intervention effect of nano silver dressing in combination with antibiotics for chronic wound infection. 中国医药导报, 2017, 14(28): 60-64.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I28/60

[1] Carville K. Wound Care Manual [M]. 5th ed. Osborne Park：Silver Chain Nursing Association，2005：82-93.
[2] Michaels JA，Campbell WB，Maclntyre JM，et al. A prospective randomised controlled trial and economic modeling of antimicrobial silver dressing for versus non-adherent control dressings for venous leg ulcers：the VULCAN trial [J]. Health Technol Assess，2009，13（56）：1.
[3] Bowler PG，Welsby S，Towers V，et al. Multidrug-resistant organisms，wounds and topical antimicrobial protection [J]. Int Wound J，2012，9（4）：387-396.
[4] Jones J，Barr W，Robinson J，et al. Depression in patients with chronic venous ulceration [J]. Br J Nurs，2006，15（11）：S17-S23.
[5] Koivisto L，Heino J，Hkkinen L，et al. Integrins in wound healing [J]. Adv Wound Care，2014，3（12）：762-783.
[6] Carter MJ，Tingley-Kelley K，Warriner RA. Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers：A systematic review and meta-analysis [J]. J Am Acad Dermatol，2010，63（4）：668-679.
[7] Adhya A，Bain J，Ray O，et al. Healing of burn wounds by topical treatment：A randomized controlled comparison between silver sulfadiazine and nano-crystalline silver [J]. J Basic Clin Pharm，2015，6（1）：29-35.
[8] 郭春兰，席祖洋，邓红艳.银离子藻酸盐抗菌敷料对腿部静脉溃疡的减痛促愈效果[J].中国医药导报，2015，12（3）：68-72.
[9] 郭春兰，邓红艳，席祖洋，等.含银敷料用于59例下肢静脉溃疡的效果评价[J].重庆医学，2016，45（7）：999-1001.
[10] 郭春兰，席祖洋，邓红艳，等.纳米银敷料用于体表慢性难愈合伤口的效果及安全性评价[J].广东医学，2016， 10（24）：48-51.
[11] Morones-Ramires JR，Winkler JA，Spina CS，et al. Silver enhances antibiotic activity against gramnegative bacteria [J]. Sci Translat Med，2013，5（190）：181-190.
[12] Falanga V，Saap LJ，Ozonoff A. Wound bed score and its correlation with healing of chronic wounds [J]. Dermatol Ther，2006，19（6）：383-390.
[13] Ammons MB，Ward LS，James GA. Anti-biofilm efficacy of a lactoferrin/xylitol wound hydrogel used in combination with silver wound dressings [J]. Int Wound J，2011， 8（3）：268-273.
[14] 仇铁英，黄金.“TIME”原则在伤口床准备中的应用研究现状[J].中华护理杂志，2013，48（9）：855-858.
[15] 蒋琪霞，李晓华，彭青，等.负压伤口治疗技术用于53例慢性伤口的效果评价[J].中华护理杂志，2012，47（4）：293-296.
[16] 郭春兰，田玉凤，张万玲，等.蜂蜜敷料治疗创伤性体表溃疡效果研究[J].中华护理杂志，2012，47（10）：919-922.
[17] Jean SS，Hsueh PR. High burden of antimicrobial resistance in Asia [J]. Int J Antimicrob Agents，2011，37（4）：291-295.
[18] Smith F，Dryburgh N，Donaldson J，et al. Debridement for surgical wounds [J]. Cochrane Database Syst Rev，2011， 20（5）：CD006214.
[19] Kostenko V，Lyczak J，Turner K，et al. Impact of silvercontaining wound dressings on bacterial biofilm viability and susceptibility to antibiotics during prolonged treatment [J]. Antimicrob Agents Chemother，2010，54（12）：5120-5131.
[20] Wiegand C，Abel M，Ruth P，et al. PH influence on antibacterial efficacy of common antisepticsubstances [J]. Skin Pharmacol Physiol，2015，28（3）：147-158.
[21] Gethin GT，Cowman S，Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds [J]. Int Wound J，2008，5（2）：185-194.
[22] Hostacka A，Ciznar L，Stefkovicova M. Temperature and PH affect the production of bacterial biofilm [J]. Folia Microbiol（Praha），2010，55（1）：75-78.
[23] Schultz GS，Davidson JM，Kirsner RS，et al. Dynamic reciprocity in the wound microenvironment [J]. Wound Repair Regen，2011，19（2）：134-148.
[24] Shukla VK，Shukla D，Tiwary SK，et al. Evaluation of pH measurement as a method of wound assessment [J]. J Wound Care，2007，16（7）：291-294.
[25] Percival SL，Mccarty S，Hunt JA，et al. The effects of pH on wound healing，biofilms，and antimicrobial efficacy [J]. Wound Repair，2014，22（2）：174-186.
[26] 孙德利.表皮生长因子联合纳米银敷料对糖尿病足患者的治疗效果及药理作用探究[J].中国医药科学，2017，7（5）：181-183，186.DOI：10.3969/j.issn.2095-0616. 2017. 05.053.
[27] 邓红艳，郭春兰，周欣，等.两种银敷料用于慢性伤口感然对伤口愈合和渗液酸碱度影响的比较[J].护理学杂志，2017，32（6）：39-41.