| [Objective]In this study,we observed the therapeutic effects of negative pressure wound therapy combined with Nano-silver dressing dressings protocol and silver dressing protocol on chronic full-thickness wounds with bacterial biofilm infection,including wound volume reduction rate,pressure ulcer scale for healing,bacterial culture results,wound temperature,pH value of the exudate and the changes in the morphology and structure of the bacterial biofilm of the wound.Then,we compared the difference in efficacy between the two groups to provide reference for the follow-up establishment of clinical intervention program for wounds with chronic bacterial biofilm infection.[Method]From April 2017 to December 2018,patients with chronic full-thickness wounds were selected as the screening population in the outpatient wound care center of Jinling Hospital affiliated to Medical College of Nanjing University.Those who met the inclusion and exclusion criteria and signed informed consent were selected as subjects.We conducted an exploratory randomized controlled study that divided the subjects into an experimental group(Negative pressure wound therapy+Nano-silver dressings)and a control group(Nano-silver dressings),30 cases in each group.The observation period of this study was 14d.The wound volume reduction rate,pressure ulcer scale for healing,bacterial culture results,wound temperature,pH value of the exudate and the changes in the morphology and structure of the bacterial biofilm of the wound were observed during treatment.SPPS 22.0 software was used for data entry and statistical analysis.[Results]A total of 60 patients were included in the study.Among them,one patient in the experimental group transferred to the local hospital due to traffic inconvenience after 7 days of intervention,and one in the control group transferred to the local hospital due to the same reason after 9 days of intervention.The remaining patients completed the intervention study.We followed the principle of intention-to-treat to deal with the missing data,and finally 60 patients were included in the statistical analysis:(1)Comparison of baseline data of study subj ects:There were no significant differences in the baseline data of gender,age,BMI,dietary intake,activity status and comorbidities between the two groups(P>0.05).The wound baseline data of wound type composition ratio,duration,wound volume,PUSH score,temperature,exudate pH,and bacterial culture results were also statistically significant between the two groups(P>0.05).The above results suggest that the baseline data of the two groups of patients are comparable.(2)Comparison of wound volume reduction rate:After 7d and 14d of treatment,the wound volume reduction rate of the experimental group was significantly higher than that of the control group(P<0.001).(3)Comparison of PUSH score:Fixed time factors:There was no significant difference in PUSH scores between the experimental group and the control group before treatment and after 7d of treatment(P>0.05).After 14d of treatment,the PUSH scores of the experimental group were significantly lower than that of the control group(P<0.05).Fixed experimental group treatment factors:After 7d and 14d of treatment,the PUSH scores were all significantly lower than that before treatment(P<0.001),and the PUSH scores of 14d after treatment were significantly lower than that of 7d after treatment(P<0.001).Fixed control group treatment factors:There was no significant difference in PUSH scores before treatment and after 7d of treatment(P>0.05),and the PUSH scores after 14d of treatment were significantly lower than that before treatment and 7d after treatment(P<0.001).(4)Comparison of bacterial culture results:There was no significant difference between the two groups after 14d of treatment(P>0.05).The most common pathogens in both groups before treatment were Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli and Enterobacter cloacae.After 14d of treatment,the experimental group turned to Staphylococcus aureus,Pseudomonas aeruginosa and Proteus mirabilis.The control group was Staphylococcus aureus,Pseudomonas aeruginosa and Enterobacter cloacae.(5)Comparison of wound temperature:Fixed time factors:There was no significant difference in wound temperature between the experimental group and the control group before treatment and after 7d of treatment(P>0.05).After 14d of treatment,the wound temperature of the experimental group was significantly higher than that of the control group(P<0.001).Fixed experimental group treatment factors:After 7d and 14d of treatment,the wound temperature was all significantly higher than that before treatment(P<0.001),and the wound temperature of 14d after treatment was significantly higher than that of 7d after treatment(P<0.001).Fixed control group treatment factors:the wound temperature of 7d after treatment was significantly higher than that of before treatment(P<0.01).But there was no significant difference between the temperature after 14d of treatment and before treatment,and there was no significant difference between the temperature after 14d and after 7d of treatment(P>0.05).(6)Comparison of pH:Fixed time factors:Before treatment,there was no significant difference in the pH between the experimental group and the control group(P>0.05).After 7d of treatment,the pH of the experimental group was significantly lower than that of the control group(P<0.01).After 14d of treatment,the pH of the experimental group was significantly lower than that of the control group(P<0.001).Fixed experimental group treatment factors:After 7d and 14d of treatment,the pH was all significantly lower than that before treatment(P<0.001),and the pH of 14d after treatment was significantly lower than that of 7d after treatment(P<0.01).Fixed control group treatment factors:there was no significant difference between the pH after 7d of treatment and before treatment,and there was no significant difference between the pH after 14d and after 7d of treatment(P>0.05).The pH after 14d of treatment was significantly lower than that before treatment(P<0.001).(7)Changes in the morphology and structure of the bacterial biofilm of the wound:A total of 5 patients underwent microscopic observation of the morphology and structure changes of wound biofilm before treatment and after 14d of treatment,including 3 cases in the experimental group and 2 cases in the control group.[Conclusion]During the 14d intervention period,both negative pressure wound therapy combined with silver dressing protocol and silver dressing protocol have a certain effect in promoting chronic wound healing of bacterial biofilm infection.Comparing the clinical and laboratory treatment effects of the two protocols,it is preliminarily considered that the negative pressure wound therapy combined with silver dressing treatment is superior to the single silver dressing treatment. |
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