几种消毒剂对烧伤创面清创作用的比较研究

目的：比较复合季铵盐、0.1%醋酸氯己定、0.5%碘伏对烧伤创面清创时的临床疗效及安全性。方法选取2012年6～9月收治的120例需要清创的烧伤科门诊或住院患者，按随机数字表法分配至复合季铵组、醋酸氯己定组和碘伏组，每组各40例患者。清创前后取样行细菌培养并计算单位面积菌落数及各组清创剂对不同细菌的有效率。清创时行疼痛程度评分，随访观察不良反应。对数据行卡方检验、秩和检验、Fisher确切概率法检验和方差分析。结果本次试验烧伤创面细菌培养结果以金黄色葡萄球菌及铜绿假单胞菌为主。复合季铵盐组的清创有效率（93.75%）显著高于醋酸氯己定组（70.59%）和碘伏组（66.67%），差异有统计学意义（P＜0.05）；复合季铵盐组对金黄色葡萄球菌及铜绿假单胞菌的清创有效率高于其他两组，但差异无统计学意义（P＞0.05）。各组患者在清创时的疼痛评分无显著差异（P＞0.05）。120例患者试验期间均未见与清创剂使用相关的不良反应。结论在烧伤创面使用复合季铵盐消毒剂消毒能更有效地清除致病菌，相较于传统的消毒剂，其对创面表面的耐药菌可能有更好的清创效果。

A comparative study of several disinfectants used for burn debridement

Objective To compare the clinical efficacy and safety between the quaternary ammonium salt compound, 0.1%chlorhexidine acetate and 0.5%iodophor on burn debridement. Methods 120 cases with burn wound who were in admission from June 2012 to September 2012 were randomly allocated accordingly to the quaternary ammonium salt compound group, 0.1% chlorhexidine acetate group and the iodophor group. There were 40 cases in each group. Bacteriological cultures were made before and after debridement. The numbers of colonies per unit area were calculated for each and the efficient of debridement was evaluated. The pain scores and the adverse reactions were also observed. The data was analyzed by Chi-square test, rank sum test, Fisher exact test and analysis of variance. Results The main bacteria cultured from tested wounds were staphylococcus aureus and pseudomonas aeruginosa. The effective rates of the quaternary ammonium salt compound group, 0.1%chlorhexidine acetate group and the iodophor group were：93.75%, 70.59%, 66.67%（P〈0.05）. The efficiency of the quaternary ammonium salt compound against staphylococcus aureus and pseudomonas aeruginosa was higher than the other two groups, but the difference was not statistically significant （P〉0.05）. The pain scores in each group showed no significant difference （P〉0.05）. 120 patients showed no adverse reactions during the trial. Conclusion Using the quaternary ammonium salt compound disinfectant can more effectively remove bacteria on burn wound surface, especially drug-resistance bacteria.