探讨莫匹罗星、重组牛碱性成纤维细胞生长因子(rb-bFGF)在感染创面游离植皮治疗中联合应用后对各自疗效的影响。

选取2014年3月至2016年3月行断层皮片封闭感染创面手术的患者160例，采用随机数字表法分为4组，各40例：(1)油纱组，术中直接将游离皮片覆盖于创面，用0.9%氯化钠溶液浸湿的无菌绷带固定皮片；(2)莫匹罗星组，受皮区涂抹莫匹罗星后将游离皮片覆盖创面，用浸湿莫匹罗星绷带固定皮片；(3)rb-bFGF组，受皮区喷洒rb-bFGF后将游离皮片覆盖创面，浸湿rb-bFGF绷带固定皮片；(4)莫匹罗星＋ rb-bFGF组，受皮区涂抹莫匹罗星和rb-bFGF混合液，将游离皮片覆盖创面，用浸湿莫匹罗星和rb-bFGF绷带固定皮片。观察术后第4、8、12天换药情况，评估移植皮片存活率、创面细菌清除率、创面愈合时间及愈合率。

术后第4天，莫匹罗星＋ rb-bFGF组油纱组皮片存活率为(96.69±3.38)%，分别高于油纱组、莫匹罗星组、rb-bFGF组[(82.17±6.48)%、(92.09±4.91)%、(93.22±4.61)%]，差异均有统计学意义(t＝12.570、4.875、3.850，P值均小于0.05)。术后第4天，莫匹罗星＋ rb-bFGF组细菌清除率为87.50%(5/40)，与莫匹罗星组[85.00%(6/40)]比较差异无统计学意义(χ²＝0.11，P＝0.745)，分别高于油纱组[40.00%(24/40)]和rb-bFGF组[47.50%(21/40)]，差异均有统计学意义(χ²＝19.53、14.59，P值均小于0.05)；术后第8天，莫匹罗星＋ rb-bFGF组细菌清除率为92.50%(3/40)，和莫匹罗星组[95.00%(2/40)]比较，差异无统计学意义(χ²＝0.21，P＝0.640)，分别高于油纱组[72.50%(11/40)]、rb-bFGF组[75.00%(10/40)]，差异均有统计学意义(χ²＝5.54、4.50，P＝0.020、0.030)；术后第12天，莫匹罗星＋ rb-bFGF组细菌清除率为100%(0/40)，和莫匹罗星组[100%(0/40)]相等，分别高于油纱组[95.00%(2/40)]、rb-bFGF组[92.50%(3/40)]，差异均无统计学意义(χ²＝2.05、3.12，P＝0.150、0.080)。术后第8天，rb-bFGF组创面愈合率为5.00%(2/40)，与莫匹罗星＋ rb-bFGF组[12.50%(5/40)]比较，差异有统计学意义(χ²＝18.24，P<0.05)；术后第12天，油沙组愈合率为67.50%(27/40)，分别与莫匹罗星组[72.50%(29/40)]、rb-bFGF组[77.5%(31/40)]、莫匹罗星＋ rb-bFGF组[97.5%(39/40)]比较，差异均有统计学意义(χ²＝12.40，P＝0.006)。莫匹罗星＋ rb-bFGF组平均创面愈合时间为(10.45±1.58)d，分别短于油纱组[(13.30±2.45)d]、莫匹罗星组[(12.57±1.87)d]、rb-bFGF组[(12.10±1.91)d]，差异均有统计学意义(t＝－6.175、－5.491、－4.211，P值均小于0.05)。

莫匹罗星、rb-bFGF混合后能提高感染创面游离植皮的成活率、局部抗感染能力、加速创面愈合，各自临床药效没有显著降低。

To study the efficacy of mupirocin ointment and recombinant bovine basic fibroblast growth factor(rb-bFGF)in the treatment of the infectious wounds combined with free skin graft.

One hundred and sixty patients underwent closed infectious wound surgery for split-thickness skin in the Chongqing Three Gorges Central Hospital from March 2014 to March 2016 were randomly divided into four groups, with 40 cases in each group.(1)The vaseline gauze group, use the free skin grafts covered in the surface of the infectious wounds, and fixed with saline bandage.(2)The mupirocin ointment group, the wound of group was swabbed with mupirocin ointment and the skin graft field was fixed with bandages soaked with mupirocin ointment.(3)The rb-bFGF group, the wound of group was swabbed with rb-bFGF and covered with free skin graft, fixed with bandages soaked with rb-bFGF.(4)The mixture of rb-bFGF and mupirocin ointment group, the wound of this group was swabbed with the mixture of mupirocin ointment and rb-bFGF, coverd with free skin graft, fixed with bandages soaked with rb-bFGF and mupirocin ointment.The dressing change 4 d, 8 d and 12 d after surgery was observed, and the skin graft survival rate, wound healing time, and bacterial clearance rate were evaluated.

The survival rate of skin graft in the rb-bFGF and mupirocin ointment group 4 days after surgery was (96.69±3.38)%, higher than the groups of the vaseline gauze(82.17±82.17) %, mupirocin ointment(92.09±4.91)% and rb-bFGF(93.22±4.61)%, the differences were statistically significant(t=12.570, 4.875, 3.850; with P values below 0.05). The bacterial clearance rate in the rb-bFGF and mupirocin ointment group 4 days after surgrey was 87.50%(5/40), close to the groups of mupirocin ointment 85.00%(6/40)(χ²=0.11, P=0.745), higher than the groups of the vaseline gauze and rb-bFGF, 40.00%(24/40)(χ²=19.53, P<0.05)and 47.50%(21/40)(χ²=14.59, P<0.05). The bacterial clearance rate in the rb-bFGF and mupirocin ointment group 8 days after surgrey was 92.50%(3/40), close to the groups of mupirocin ointment 95.00%(2/40)(χ²=0.21, P =0.640), higher than the groups of the vaseline gauze and rb-bFGF, 72.50%(11/40)(χ²=5.54, P=0.020)和75.00%(10/40)(χ²=4.50, P =0.030). The bacterial clearance rate in the rb-bFGF and mupirocin ointment group 10 days after surgrey was 100%(0/40), equal to the group of mupirocin ointment 100%(0/40), higher than the groups of the vaseline gauze and rb-bFGF, 95.00%(2/40)(χ²=2.05, P=0.150)and 92.50%(3/40)(χ²=3.12, P=0.080). The wound healing rate in the rb-bFGF and rb-bFGF and mupirocin ointment group 8 days after surgrey were 5.00%(2/40), 12.50%(5/40), the difference was statistically significant(χ²=18.24, P<0.05). Twelve days after surgery, vaseline gauze, mupirocin ointment, rb-bFGF, rb-bFGF and mupirocin ointment groups were 67.50%(27/40), 72.50%(29/40), 77.5%(31/40), 97.5%(39/40)(χ²=12.40, P=0.006). The wound healing time in the rb-bFGF and mupirocin ointment group after surgery was (10.45±1.58)d, shorter than the group of the vaseline gauze(13.30±2.45)d, the group of mupirocin ointment(12.57±1.87)d, and the groups of rb-bFGF(12.10±1.91)d, the differences were statistically significant (t=-6.175, -5.491, -4.211; with P values below 0.05).

The mixture of mupirocin ointment and rb-bFGF can improve the survival rate of wound infection with free skin graft, enhance local resistance to infection , and accelerate wound healing. The respective clinical efficacy was not significantly reduced.