单纯机械性清创术在减少细菌定植方面的效果如何？一项前瞻性临床研究的结果。
How effective is simple mechanical wound debridement in reducing bacterial colonisation? Results of a prospective clinical study.
机构信息
Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany.
University Hospital of Essen, Institute of Medical Psychology and Behavioral Immunobiology, Institute of Medical Education, Centre for Translational Neuro- and Behavioral Sciences, Essen, Germany.
出版信息
Int Wound J. 2024 Apr;21(4):e14824. doi: 10.1111/iwj.14824.
BACKGROUND AND AIMS
Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation.
PATIENTS AND METHODS
Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed.
RESULTS
A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time.
CONCLUSIONS
It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate.
背景与目的
伤口中的细菌会导致伤口愈合停滞，并导致局部甚至全身伤口感染，甚至可能导致致命的败血症。因此，作为伤口治疗的一部分，应减少细菌负荷。因此，应研究单纯机械性伤口清创术在减少细菌定植方面的疗效。
患者和方法
使用荧光相机评估患有急性或慢性伤口的患者在使用无菌棉垫进行机械性伤口清创前后的细菌定植情况。如果细菌定植仍然存在，则进行第二次有针对性的伤口清创。
结果
本研究共纳入 151 例患者，其中 68 例（45.0%）为男性，83 例（55.0%）为女性。通过建立图像文件的新分析方法，我们可以记录到细菌定植区域分布在伤口表面的 21.9%，伤口边缘（最高 0.5 厘米）的 60.5%，以及伤口周围（最高 1.5 厘米）的 17.6%。一次机械清创术可使伤口中的细菌定植区域平均减少 29.6%，伤口边缘减少 18.9%，伤口周围减少 11.8%，第二次清创术可使细菌定植区域进一步减少。
结论
即使使用棉垫进行简单的机械清创术也可以显著减少细菌定植，而没有明显的副作用。特别是，伤口边缘是经常受细菌污染最严重的区域，应特别注意清创。由于机械清创术后细菌仍留在伤口中，因此它不能替代抗菌治疗策略，但提供了一种补充策略来改善伤口护理。因此，可以证明简单的机械清创术在降低细菌负荷方面是有效的，并且应在适当的情况下将其纳入伤口治疗方法中。
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