瘢痕手术区备皮方法的改进及其效果

目的：调查瘢痕区皮肤的细菌种类及分布情况，改进备皮方法并观察其在预防切口感染和促进愈合中的作用。方法：将49例瘢痕整形手术患者随机分为A、B两组，A组24例为常规方法对照组，B组25例为改进方法观察组。每例患者于入院日及备皮前、后作瘢痕区皮肤细菌培养和药敏试验，观察瘢痕区皮肤细菌生长的种类、分布及备皮前后的清洁、去菌效果，分析细菌生长与瘢痕严重度的相关性。比较术后两组体温变化，抗生素应用时间和伤口愈合时间，并作相关性分析。结果：瘢痕区皮肤细菌阳性率高达83．33％～88．00％，以金黄色葡萄球菌最多。11种细菌的分布与瘢痕严重度无关，但与瘢痕有无破溃有关。两种备皮方法均能减少瘢痕区细菌数量，但B组效果优于A组。两组术后切口愈合时间A组明显长于B组，术后1周内体温变化均值B组明显低于A组，而抗生素应用时间B组明显短于A组。结论：改进的备皮方法能更有效地清洁瘢痕区皮肤，去除64％的细菌，而且不引起疼痛，对预防切口感染、促进愈合有积极作用。

Method and effect of scar prepared for surgery

Objective: To survey the condition of bacteria on the scar area; to improve the method and outcome of skin with scar prepared for plastic surgery. Methods: 49 patients were divided into group A and B randomly. 24 patients in group A were enrolled in control group and 25 patients in group B were designed for investigation group. Each scar was taken 3 samples to be cultured and submitted for sensitive test on admission day, before and after the skin with scar prepared. Each case was observed on the types and the condition of bacteria distribution on the scar. The outcome of cleaning and disinfection from the area was recorded. The relationship between the bacteria reproduction and types of scar was analyzed, and the observation of the postoperative temperature was made and the duration of antibiotics used and surgical site healing were recorded. Results: The positive rate of bacterial culture was reached 83.33% -88.00%. Two methods of skin prepared can diminish the bacteria reproduction. The outcomes of Group B was better than Group A. The temperature and wound healing days had no significant difference between the two groups. The days used of antibiotics in group B were significantly shorter than group A. Conclusion: The more effective method can improve the clean ingress of the skin than with usual method. 60% bacteria on the area removed was benefit to prevent wound infection and healing.