| Objective1、To establish a stable model of deep Ⅱ degree burn wounds infected with Pseudomonas aeruginosathrough hot steam.2、To investigate the clinical effects of the different irrigation solutions on deep Ⅱ degree burn wounds infected with Pseudomonas aeruginosa.3、To investigate the clinical effects of the different kinds of silver agents on deep Ⅱ degree burn wounds infected with Pseudomonas aeruginosa.4、To investigate the combined clinical effects of the different irrigation solutions with different silver agents on deep Ⅱ degree burn wounds infected with Pseudomonas aeruginosa.Method1、12 adult male SD-rats were divided into four groups, the rats in each group were burned with 96 ℃ hot steam for 5s, 8s, 10 s, 15 s respectively, the degree of damage was determined by Pathological examination.2、6 adult male SD-rats with two deepⅡdegree burn wounds on their back, ones of them were injected with 50 ul, 1.0 × 109cfu/ml of Pseudomonas aeruginosa bacterial solution, the other ones were injected with the same amount of normal saline, the counts of bacteria in the wound tissue was calculated after 24 hours.3、54 adult male SD-rats with two infectious burn wounds were divided into three groups, each group received one irrigation solution including EOW, Chlorhexidine acetate solution and normal saline, and then covered with silver agents after drying. The reduction of bacterial number in the burned tissue at the early stage, the wound contraction rate, the epithelialization rate, the healing time and the concentration of VEGF in the wound edge tissues were recorded.4、72 adult male SD-rats with two infectious burn wounds were divided into four groups, each group received EOW to clean the wounds, and then covered with different silver agent including BangerkangTM Burn-aid Antibacterial cream, Silver Care® nano-silver antibacterial gel, Agem nano- silver gauze and sterile bandage after drying. The reduction of bacterial number in the wound tissue at the early stage, the wound contraction rate, the epithelialization rate, the healing time and the concentration of VEGF in the wound edge tissues were recorded.5、144 adult male SD-rats with two infectious burn wounds were divided into eight groups, each group received EOW or Chlorhexidine acetate solution to clean the wounds, and then covered with different silver agents including BangerkangTM Burn-aid Antibacterial cream,Silver Care® nano-silver antibacterial gel, Agem nano- silver gauze and sterile bandage after drying. The reduction of bacterial number in the wound tissue at the early stage, the wound contraction rate, the epithelialization rate, and the healing time were recorded. Results1、Pathological examination shows that the result of hot stream sustain 5s lead to superficial Ⅱ degree burns, 8s lead to deep Ⅱ degree burns, 10 s lead toⅢ degree burns, 15 s lead to severe burns over Ⅲ degree.2、The bacterial count of Pseudomonas aeruginosa of the normal saline group is 0 cfu/g, that of the bacterial group is(1.83±0.62)×108cfu/g, there is a significant difference between these two groups(P<0.001).3、The bacterial count significantly decreased after the first dressing, and the EOW is more powerful than Chlorhexidine acetate solution and normal saline on the antibacterial ability, the inhibition rate of EOW is 52.41%±6.42%, that of Chlorhexidine acetate solution is 42.15%±9.82%, that of normal saline is 17.30%±5.72%, and there is a significant difference among them(P<0.05).4、During the whole healing process, these three kinds of irrigation solutions(EOW, Chlorhexidine acetate solution and normal saline) have the similar effects on the wound contraction(P>0.05). EOW has a higher epithelialization rate, and there is a no difference between the other two groups. The amount of VEGF in the wound edge tissues changes periodically, the sharp increase of VEGF appears at the 4th day after burning, and then reach the peak nearby the 2 week, but the EOW group reach the peak at the 10 th day and followed with an obvious decreasing trend. The healing time of EOW group(17.75 d ± 1.49d) is the shortest, followed by saline group(22.00 d ± 2.20d), and the longest is chlorhexidine acetate solution group(24.25 d ± 2.12d).5、These three silver agents could significantly reduce the bacterial counts in the infectious wounds(P<0.05), and there is an obvious difference of the antibacterial ability among these groups(P<0.05), the best is Agem nano- silver gauze(the bacterial inhibition rate is 99.70%±0.03%), followed with BangerkangTM Burn-aid Antibacterial cream(the bacterial inhibition rate is 83.46%±1.38%), the last is Silver Care® nano-silver antibacterial gel(the bacterial inhibition rate is 51.71%±13.28%).6、During the whole healing process, these three kinds of silver agents have the similar effects on the wound contraction(P>0.05). Silver Care® nano-silver antibacterial gel has a higher epithelialization rate, and followed by the other two silver agents, the group with sterile gauze without any silver agent has the poorest healing. The amount of VEGF in the wound edge tissues changes periodically, the concentration of VEGF increased after burning, and reach the peak nearby the 2 week, while the group of Silver Care® nano-silver antibacterial gel reach the peak at the 10 th day, and followed with an obvious decreasing trend, which is faster than the other three groups. The healing time of Silver Care® nano-silver antibacterial gel group(16.88d±0.834d) is the shortest, followed by BangerkangTM Burn-aid Antibacterial cream(20.50d±1.195d)and Agem nano-silver gauze(22.00d±2.400d), and the longest is sterile gauze group(25.88d±2.100d).7、When different irrigation solutions combined with these three silver agents, there is no interactive function between these two factors on the antibacterial ability, the reduction of bacterial counts after the first dressing of EOW group(1.367×108cfu/g) is significantly higher than chlorhexidine acetate solution group(0.871×108 cfu/g), that of Agem nano-silver gauze(1.858×108 cfu/g) is significantly higher than the other three groups, the second is BangerkangTM Burn-aid Antibacterial cream(1.379×108 cfu/g), the third is Silver Care® nano-silver antibacterial gel(0.887×108 cfu/g), and the last is sterile gauze(0.353×108 cfu/g).8、The combination of disinfection solutions and the silver agents have no impact on the wound contraction. The result of repeatedly measured ANOVA shows that the difference between the group of EOW-Silver Care® nano-silver antibacterial gel and the group of Chlorhexidine acetate solution-sterile gauze, the group of EOW- Silver Care® nano-silver antibacterial gel and the group of EOW-sterile gauze is significant, both the P value is <0.05, while the rest of the groups’ difference between each other has no significant difference.9、The result of repeatedly measured ANOVA shows that there is a great difference of the wound epithelialization rates among the 8 groups(P<0.001). The wound epithelialization rate of EOW-Silver Care® nano-silver antibacterial gel is higher than the other seven groups, followed with EOW-Bangerkang TM Burn-aid Antibacterial cream, the group of chlorhexidine acetate solution-sterile gauze is the worst. Conclusion1、A stable model of deep Ⅱ degree burn wounds infected with Pseudomonas aeruginosa can be established by 96℃ hot steam lasting 8 seconds and injected with 50 ul, 1.0 × 109cfu/ml of Pseudomonas aeruginosa bacterial solution.2、Both EOW and chlorhexidine acetate solution could effectively reduce the bacterial counts in the wound tissues to control the wound infection, but EOW is much better than chlorhexidine acetate solution.3、Irrigating the wounds with EOW could significantly accelerate the wound’s epithelialization and healing, and is better than the other two solutions. The normal saline is better than chlorhexidine acetate solution to accelerate the healing.4、These three silver agents could effectively control the wound infection by reducing the bacterial counts in the infectious wound tissues. At the early stage, we’d better choose the Agem nano-silver gauze to reduce the bacterial counts at the largest extent. At the middle and terminal stage, it is sensible to choose Silver Care® nano-silver antibacterial gel to accelerate the wound epithelialization and shorten the healing time.5、The aspects of the clinical effects of the combined therapy are not always consistent, medical professionals should choose the different combination according to the main purpose of the stage in the healing process. At early stage, we may choose EOW combined with Agem nano-silver gauze to reduce the bacterial counts at the greatest extent. At the middle and terminal stage, we may choose EOW combined with Silver Care® nano-silver antibacterial gel to promote the healing efficiency. |
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