电灼会降低剖腹手术感染的污染阈值。
Electric cautery lowers the contamination threshold for infection of laparotomies.
作者信息
Soballe P W, Nimbkar N V, Hayward I, Nielsen T B, Drucker W R
机构信息
Naval Medical Research Institute and the Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
出版信息
Am J Surg. 1998 Apr;175(4):263-6. doi: 10.1016/s0002-9610(98)00020-8.
BACKGROUND
Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel.
METHODS
Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess.
RESULTS
Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached 10(5). Above this threshold most wounds were infected in all groups.
CONCLUSIONS
Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify.
背景
伤口抵抗因素与细菌接种量之间的相互作用决定了手术感染的风险。由于电灼造成的组织损伤比手术刀更大，我们的假设是，相较于用手术刀造成的伤口，感染电灼造成的伤口所需的细菌数量更少。
方法
用冷刀、切割电流或凝固电流在375只大鼠身上切开腹部筋膜。用逐渐增加数量的细菌接种伤口，并在7天时进行组织学评分，评估坏死、炎症和脓肿情况。
结果
在所有细菌水平下，凝固电流比手术刀造成更多的炎症、坏死和脓肿。电切割电流的损伤程度介于两者之间，仅在污染达到10⁵ 后造成的损伤比手术刀更多。高于此阈值时，所有组的大多数伤口都被感染。
结论
仅当对精确止血的需求超过感染风险显著增加时，才应使用电凝电流。电切割电流的破坏性较小，但止血效果也较差；其使用指征难以确定。
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