Chatterji Rishi, Bou-Akl Therese, Wu Bin, Dietz Paula, Ren Wei-Ping, Markel David C
Orthopaedic Surgery Ascension Providence Hospital, Southfield, MI, USA.
Department of Biomedical Engineering at Wayne State University, Detroit, MI, USA.
Arthroplast Today. 2022 Oct 30;18:130-137. doi: 10.1016/j.artd.2022.08.019. eCollection 2022 Dec.
Despite desirable microbicidal actions of irrigation solutions in surgical site infection treatment, several studies demonstrate potential cytotoxic effects. This study investigated tissue damage caused by irrigation solutions in the presence or absence of infection.
Air pouches were created in 60 mice and evenly divided into 2 groups as infected with and control. Groups were then subdivided both by type of solution and by timing after irrigation. Solutions included control (0.9% saline), bacitracin (33 IU/ml), 0.2% sodium oxychlorosene, 0.05% chlorhexidine gluconate, and 0.013% benzalkonium chloride.
Inflammation decreased in infected pouches compared to the sterile ones for all solutions except bacitracin on day 0 and for all on day 7. On day 0, infected pouches had increased necrosis with bacitracin ( = .006), chlorhexidine gluconate ( = .18), and benzalkonium chloride ( = .07); on day 7, there was decreased necrosis in infected pouches for all solutions ( < .05) except for sodium oxychlorosene ( = .18). Edema decreased in infected pouches on day 0 for all solutions. On day 7, infected pouches had decreased edema with 0.9% saline, bacitracin, and benzalkonium chloride ( < .05) and increased edema with chlorhexidine gluconate ( < .05) and sodium oxychlorosene ( = .069). Bacitracin allowed for more bacteria growth than sodium oxychlorosene ( = .024), chlorhexidine gluconate ( = .025), and benzalkonium chloride ( = .025).
The presence of bacteria led to less immediate tissue inflammation and edema, while tissue necrosis varied over time. The current study may guide surgeons on which solution to use and whether to irrigate a possibly sterile wound or joint.
尽管冲洗液在手术部位感染治疗中具有理想的杀菌作用，但多项研究表明其存在潜在的细胞毒性作用。本研究调查了在有无感染情况下冲洗液所造成的组织损伤。
在60只小鼠身上制造气袋，并均匀分为感染组和对照组。然后根据溶液类型和冲洗后的时间对各组进行再细分。溶液包括对照组（0.9%生理盐水）、杆菌肽（33 IU/ml）、0.2%次氯酸钠、0.05%葡萄糖酸氯己定和0.013%苯扎氯铵。
除第0天的杆菌肽以及第7天的所有溶液外，所有溶液处理的感染气袋与无菌气袋相比，炎症均有所减轻。在第0天，杆菌肽（P = .006）、葡萄糖酸氯己定（P = .18）和苯扎氯铵（P = .07）处理的感染气袋坏死增加；在第7天，除次氯酸钠（P = .18）外，所有溶液处理的感染气袋坏死均减少（P < .05）。第0天所有溶液处理的感染气袋水肿均减轻。在第7天，0.9%生理盐水、杆菌肽和苯扎氯铵处理的感染气袋水肿减轻（P < .05），葡萄糖酸氯己定和次氯酸钠处理的感染气袋水肿增加（P < .05），次氯酸钠处理的感染气袋水肿增加（P = .069）。杆菌肽比次氯酸钠（P = .024）、葡萄糖酸氯己定（P = .025）和苯扎氯铵（P = .025）更有利于细菌生长。
细菌的存在导致即时组织炎症和水肿减轻，而组织坏死随时间变化。本研究可为外科医生选择使用哪种溶液以及是否冲洗可能无菌的伤口或关节提供指导。
