Brown L L, Shelton H T, Bornside G H, Cohn I
Ann Surg. 1978 Feb;187(2):170-3. doi: 10.1097/00000658-197802000-00013.
Irrigation of wounds to remove bacteria and foreign material is an essential of wound management along with debridement. The effectiveness of saline lavage by high pressure (50 psi) pulsatile jet irrigation has been compared with conventional gravity flow and bulb syringe procedures. Experimental paravertebral incisional surface wounds in 234 randomized rats were either clean or traumatized and soiled. Wounds in 200 of the rats were seeded with E. coli (log 8.80). Swab specimens of each wound were taken at incision, after seeding, after irrigation, and at three, seven, and ten days after closure. Eulates of more than 1600 specimens were cultured. No anaerobes were found. Irrigation diminished bacterial counts in all wounds, but only pulsatile jet irrigation brought about significant (P less than 0.05) reduction of bacteria in each type of wound. After three days E. coli was significantly diminished in all wounds, regardless of irrigation or none, owing to host defense mechanisms. Nevertheless, clean contaminated wounds were infected at three days but not at seven days after lavage, while traumatized wounds remained infected at ten days except for those initially irrigated by pulsatile jet. Thus, pulsatile jet irrigation removed bacterial from experimental wounds more efficiently than conventional procedures.
伤口冲洗以清除细菌和异物是伤口处理中与清创术同样重要的环节。已将高压(50磅力/平方英寸)脉冲式喷射冲洗生理盐水的效果与传统重力引流及球囊注射器冲洗法进行了比较。在234只随机分组的大鼠身上制造了实验性椎旁切口表面伤口,这些伤口分为清洁伤口、创伤性伤口和污染伤口。200只大鼠的伤口接种了大肠杆菌(对数8.80)。在切口时、接种后、冲洗后以及伤口闭合后第3天、第7天和第10天采集每个伤口的拭子标本。对1600多个标本进行了培养。未发现厌氧菌。冲洗使所有伤口的细菌数量减少,但只有脉冲式喷射冲洗使每种类型伤口的细菌数量显著(P<0.05)减少。3天后,由于宿主防御机制,无论是否冲洗,所有伤口中的大肠杆菌数量均显著减少。然而,清洁污染伤口在冲洗后第3天被感染,但第7天未被感染,而创伤性伤口在第10天仍被感染,除了那些最初用脉冲式喷射冲洗的伤口。因此,脉冲式喷射冲洗比传统方法能更有效地清除实验伤口中的细菌。