外科手术中防腐剂使用情况的重新评估。
A reappraisal of the use of antiseptics in surgical practice.
作者信息
Gilmore O J
出版信息
Ann R Coll Surg Engl. 1977 Mar;59(2):93-103.
The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.
由于抗生素耐药菌问题日益严重，人们对抗菌剂的使用进行了重新评估。研究了一种甲醛（诺西硫脲）和一种卤素（聚维酮碘），它们是最合适的抗菌剂类别。聚维酮碘溶液显著降低了患有腹膜炎的小鼠（P<0.01）和大鼠（P<0.01）的死亡率。诺西硫脲（1%和0.5%）则没有。在大鼠结肠吻合术前和术后进行抗菌冲洗，结果显示“不良”吻合显著减少（P<0.05），且不影响愈合。2.5%和1%的诺西硫脲显著减少了大鼠腹膜粘连的形成，但一种新配制的聚乙烯吡咯烷酮含量增加的聚维酮碘溶液比1%和0.5%的诺西硫脲更有效。聚维酮碘既不抑制大鼠腹部伤口愈合，也不诱导细菌耐药性。在随后的3项对照临床试验中，一种干粉状聚维酮碘制剂使麦氏阑尾切除术后伤口感染率减半（P<0.025），降低了择期“清洁”手术中的感染率，并显著降低了各种“潜在污染”腹部手术后的感染率（P<0.01）。提倡回归李斯特的原则。
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