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清洁外科伤口不需使用抗生素药膏
Last Updated: 2006-09-04 10:30:18 -0400 (Reuters Health)
NEW YORK (Reuters Health) - An ointment containing the antibiotic mupirocin does not speed healing or prevent infection when applied to clean surgical wounds before the wound is sealed, research suggests. In fact, the ointment may increase the risk of skin edge necrosis (death), an Australian research team found.
Mupirocin is effective in treating contaminated lesions and skin infections, and is widely advocated even when wounds are not contaminated, although there is little evidence to support the latter recommendation, according to Dr. Anthony Dixon, a dermasurgeon and skin cancer specialist from Skincanceronly in Belmont.
Moreover, there are data indicating a risk of mupirocin resistance that could reduce its effectiveness over time.
To investigate further, Dixon and colleagues studied 778 patients with a total of 1801 wounds. Following surgical treatment, 510 wounds were randomly assigned to no ointment, 729 to paraffin ointment, and 562 to mupirocin ointment. Patients were asked to complete and return surveys 6 months later to ascertain long-term outcomes.
The investigators observed no significant differences among the three groups in the number of wound infections, pain or wound discomfort, long-term cosmetic outcomes or overall complications.
However, Dixon's group found it somewhat alarming that seven cases of skin necrosis occurred in the mupirocin group, versus one in the paraffin group and zero in the no-ointment group.
In a report in the British Journal of Surgery, they propose, "Existing advice regarding the role of ointments on wounds (largely antibiotic ointment) following skin lesion surgery and before dressing should be reviewed in the light of these findings."
SOURCE: British Journal of Surgery, August 2006.
清洁外科伤口不需使用抗生素药膏
最后更新：2006-09-04 10:30:18 -0400（路通社健康）
纽约（路通社健康）：研究人员发现，清洁伤口包扎前，在该伤口上涂抹含有抗生素莫匹罗星的软膏并不能加速伤口愈合或者预防伤口感染。实际上，澳大利亚的一个研究团队发现，该药膏的使用还可能增加伤口边缘皮肤坏死的风险。
莫匹罗星对于治疗污染伤口和皮肤感染都是有效的，并且甚至被提倡在伤口未被污染的情况下使用，但是贝尔模特Skincanceronly的皮肤外科和皮肤癌专家Anthony Dixon博士说没有证据支持这么做。不仅如此，还有资料表明这么做会产生对莫匹罗星的抗药性。
对此Dixon做了进一步的研究，他和同事研究了778个病人共计1801个伤口。外科治疗后，这些伤口被随机分成三组，其中510处伤口未使用莫匹罗星软膏，729处伤口则使用了莫匹罗星软膏。病人被要求按此完成治疗并且伤后6月返回医院检查以确定长期效果。结果研究人员发现在伤口感染、疼痛及其他伤口不适、长期美容效果以及所有的并发症方面三组伤口并无明显区别。而有一点值得警觉，那就是在使用莫匹罗星的病人中有七例发生了皮肤坏死，相对应的是使用石蜡软膏的只有一例发生了皮肤坏死，不使用任何软膏的病人则没有发生皮肤坏死。他们发表在英国外科杂志的一篇报道中建议说：在皮肤损伤外科治疗后和伤口包扎前对软膏（绝大多数是抗生素软膏）的使用应当考虑他们的发现成果再做出决定。
资料来源：英国外科杂志，2006年8月。
个人观点：目前在各级医疗机构，抗生素软膏用量很大，特别是一些皮肤伤口。使用原因很多则为预防感染。依据本人临床经验，确实没有发现清洁伤口方面使用或者不使用该类药物区别有多大。但是也经常在清洁伤口使用该类药物，原因主要是病人要求。当然，有感染皮肤伤口本人一直在用抗生素类软膏，效果很好。翻译这篇稿件以后，争取以后清洁伤口少用类似药物。 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-01-11 17:14
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