CAJ | 학술논문

目的：通过动物模型探讨止血带对切口感染的影响，以及探讨缺血预处理对切口感染的作用，为临床中合理使用止血带提供实验基础。方法100只 BALB／c 小鼠随机分为4组，每组25只小鼠，A 组：止血带＋切口耐甲氧西林金黄色葡萄球菌（MRSA）感染；B 组：缺血预处理＋切口 MRSA 感染；C 组：切口 MRSA 感染；D 组：空白对照。比较各组小鼠生存率、体温、血常规及股骨内侧切口周围软组织变化。结果观察期内 A 组小鼠生存率为68％，B、C、D 组小鼠生存率均为100％。生存分析结果表明，A 组小鼠生存率低于 B、C、D 组小鼠（P ＜0．05）。A、B、C 组小鼠各个时间点体温比较，差异有统计学意义（P ＜0．01）；4组小鼠体温曲线组间比较，差异有统计学意义（P ＜0．01）；除基础体温外，其余时间点4组小鼠体温差异均有统计学意义（均 P ＜0．01）。第3天、第7天4组小鼠血常规（白细胞总数、粒细胞总数、淋巴细胞总数）比较，差异均有统计学意义（均 P ＜0．05）。第7天4组小鼠血常规均恢复至正常范围内，但 A 组小鼠血常规各指标均相对于 B、C、D 组仍偏高。A 组小鼠切片上皮组织均未愈合，周围组织炎症反应最重；B 组小鼠切片中，10只上皮组织愈合，部分切片可见炎症反应；C 组小鼠中，4只上皮组织愈合，大部分切片可见炎症反应。结论小鼠下肢应用止血带可加重切口感染程度，延缓切口愈合，延长机体恢复正常的时间，甚至导致死亡。制造切口模型前进行缺血预处理可减轻切口感染程度，缩短切口愈合时间。
목적：통과동물모형탐토지혈대대절구감염적영향，이급탐토결혈예처리대절구감염적작용，위림상중합리사용지혈대제공실험기출。방법100지 BALB／c 소서수궤분위4조，매조25지소서，A 조：지혈대＋절구내갑양서림금황색포도구균（MRSA）감염；B 조：결혈예처리＋절구 MRSA 감염；C 조：절구 MRSA 감염；D 조：공백대조。비교각조소서생존솔、체온、혈상규급고골내측절구주위연조직변화。결과관찰기내 A 조소서생존솔위68％，B、C、D 조소서생존솔균위100％。생존분석결과표명，A 조소서생존솔저우 B、C、D 조소서（P ＜0．05）。A、B、C 조소서각개시간점체온비교，차이유통계학의의（P ＜0．01）；4조소서체온곡선조간비교，차이유통계학의의（P ＜0．01）；제기출체온외，기여시간점4조소서체온차이균유통계학의의（균 P ＜0．01）。제3천、제7천4조소서혈상규（백세포총수、립세포총수、림파세포총수）비교，차이균유통계학의의（균 P ＜0．05）。제7천4조소서혈상규균회복지정상범위내，단 A 조소서혈상규각지표균상대우 B、C、D 조잉편고。A 조소서절편상피조직균미유합，주위조직염증반응최중；B 조소서절편중，10지상피조직유합，부분절편가견염증반응；C 조소서중，4지상피조직유합，대부분절편가견염증반응。결론소서하지응용지혈대가가중절구감염정도，연완절구유합，연장궤체회복정상적시간，심지도치사망。제조절구모형전진행결혈예처리가감경절구감염정도，축단절구유합시간。
Objective To evaluate the effect of tourniquet on incisional infection based on animal model,and evaluate the effect of ischemia preconditioning on incisional infection,so as to provide experimental basis for the ra-tional use of tourniquet in clinic.Methods 100 BALB/c mice were randomly divided into 4 groups,with 25 mice in each group.Group A:tourniquet+methicillin-resistant Staphylococcus aureus (MRSA)incisional infection;group B:ischemic preconditioning+ MRSA incisional infection ;group C :MRSA incisional infection;group D:blank control.The survival rates,temperature,routine blood testing,and change in soft tissue beside femoral incision were compared among 4 groups.Results During observation period ,the survival rate in group A was 68%,in group B,C,and D were all 100%,group A was lower than group B,C,and D (P <0.05).The temperature at each time point was significantly different among group A,B,and C (P <0.01 );temperature curves of 4 groups were significantly different (P <0.01 );except basal body temperature,temperature at the other time points among 4 groups were significantly different(all P <0.01);routine blood testing results (white blood cell count,total granu-locyte count,and total lymphocyte count)among 4 groups on the third,and seventh day were significantly different (all P <0.05);on the seventh day,routine blood testing results of 4 groups all returned to normal level,but group A was slightly higher than group B,C,and D.Section of epithelial tissue revealed that epithelial tissue in group A was not healed,inflammatory response of peripheral tissue was most serious;epithelial tissue in 10 mice in group B was healed,partial peripheral tissue revealed inflammatory response;epithelial tissue in 4 mice in group C was healed,most peripheral tissue revealed inflammatory response.Conclusion Mice incisional infection will be aggrava-ted by using lower limb tourniquet,incision healing and body function recovery time will be delayed,even lead to death.Ischemic preconditioning before making an incision model can reduce the severity of incisional infection,and shorten wound healing time.