백서 하악골 골수염의 감염세균에 대한 고압산소요법의 억제효과에 관한 연구

Abstract

[한글]

하악골에 발생하는 골수염은 그 원인균에 있어서 구강내 다양한 세균총과 혼합되어 호기성 및 혐기성세균의 복합감염으로 이루어지는 질환으로 그 중요성이 인식되어 왔고, 적절한 외과적 및 항생제 치료에도 불구하고 치료가 잘되지 않고 치유가 지연되는 난치성의

골수염에서 고압산소요법이 중요한 역할을 수행한다고 알려져 왔다.

특히, 고압의 산소가 호기성 및 혐기성 세균의 증식을 특수환경하에서 억제할 수 있다는 고압산소요법의 항균효과와 창상치유 기전에 미치는 영향 등에 대하여 지금까지 다양하고 활발하게 연구되어지고 있다. 이에 저자는 골수염에서 고압산소요법의 호기성 및 혐기성 세균에 대한 항균효과를 연구하기 위하여 하악골 골수염에 대한 주된 원인균으로 알려져 있는 호기성 세균인 Staphylococcus aureus와 혐기성세균인 Bacteroides melaninoge

nicus 균주를 이용하여 백서 하악골에 골수염을 유발시키고 S. aureus에 대하여는 고압산소요법(1일 2시간, 2.4기압), 항생제 요법, 두가지의 병용요법군 등으로, B. melaninogenicus에 대하여는 동일한 고압산소 요법을 1일 1회 시행군 및 1일 2회 시행군으로 분류하여 치료를 시행하고 그 결과를 세균학적으로 비교하였으며, 시험관내(in vitro) 조건하에서 동일한 치료방법들이 세균에 어떤 영향을 나타내는가에 관하여 비교 연구하여 다음과 같은 결론을 얻었다.

1. in vitro 실험에서 Staphylococcus aureus에 대하여 고압산소요법을 시행한 결과 대기 중에 보관한 대조군과 유사한 균주의 성장을 보여, 고압산소의 직접적인 정균효과는 나타나지 않았고. 고압산소와 항생제를 병용한 실험군에서는 항생제만을 사용한 실험군과 유사한 항균효과를 나타냈다.

2. Staphylococcus aureus의 감염에 의한 백서 하악골수염의 치료시 각 치료군은 대조군에 비하여 현저한 치유효과를 보였고(P<0.01), 고압산소요법이 항생제 요법과 대등한 치유효과를 나타냈으며, 고압산소요법만을 시행한 실험군과 고압산소요법과 항생제 투여를 동시에 시행한 실험군 사이에는 치유율에 있어서 통계학적으로 유의할만한 차이를 보이지는 않았다(P>0.05).

3. in vitro 실험에서 Bacteroides melaninogenicus에 대한 고압산소요법의 살균효과는 대조군에 비하여 통계학적으로 유의할 만한 차이를 보여 비교적 높은 살균효과를 나타냈으며, 고압산소요법을 2회(4시간) 시행한 실험군이 1회(2시간) 시행한 실험군보다 높은 살균효과를 나타냈다.

4. Bacteroides melaninogenicus의 감염에 의한 백서 하악골수염의 치료시 고압산소요법을 시행한 치료군은 대조군에 비하여 현저한 치유효과를 보였고(P<0.71), 고압산소요법 1회 시행군과 2회 시행군 사이에는 치유율에 있어서 통계학적으로 유의할만한 차이를 보이지는 않았다(P>0.05).

EXPERIMENTAL STUDY ON THE ANTIMICROBIAL EFFECT OF HYPERBARIC OXYGEN THERAPY ON THE

MICROORGANISMS OF THE MANDIBULAR OSTEOMYELITIS IN ALBINO RATS

In Joo Han, D.D.S., M.S.D.

Department of Dental Science, The Graduate School, Yonsei University

(Directed by Prof. Jung Ho Yoon, D.D.S., Ph.D.)

The main objective of this study was to observe the antimicrobial effect of

hyperbaric oxygen therapy(HBO) on the infected microorganisms, aerobic and

anaerobic, of the mandibular osteomyelitis in Albino rats.

The experimental osteomyelitis was induced by formation of bone hole into the

medullary cavity and inoculation of Staphylococcus aureus as aerobic microorganism,

and Bacteroides melaninogenicus as anaerobic microorganism separately.

Author used 170 rats(Sprague-Dawley strain) dividing into a pilot study(30),

aerobic osteomyelitis(80) and anaerobic osteomyelitis(60) groups.

In aerobic osteomyelitis caused by S. aureus, the treatment regimen consisted of

HBO(2hrs, dailyat 2.4 atm.), cephalexin, a combination of both and/or no treatment

control group, and in anaerobic osteomyelitis caused by B. melaninogenicus, the

treatment regimen consisted of HBO once a day, HBO twice a day and/or no treatment

control group, and the results were compared microbiologically.

The obtained results were as fellows:

1. In vitro study, hyperbaric oxygen therapy(HBO) on Staphylococcus aureus has no

direct bacterios-tatic effect compared with control group in ambient air, due to

similar bacterial growth, and combination of HBO and antibiotic therapy revealed

similar antimicrobial effect compared with antibiotic therapy alone.

2. In treatments on experimental osteomyelitis due to Staphylococcus aureus, HBO

is at least as effective as antibiotic therapy, and no significant difference was

revealed between HBO group and a combination of HBO and antibiotic therapy group

statistically.

3. In vitro study, antimicrobial effect of HBO on Bacteroides melaninogenicus

revealed statistical significant difference compared with control group, and HBO

twice a day for 4 hours was more effective than HBO once a day for 2 hours in

bactericidal effect.

4. In treatments on experimental osteomyelitis due to Bacteroides

melaninogenicus, HBO group revealed high recovery rate compared with control group,

while there was no significant difference between HBO once a day and HBO twice a

day groups statistically.

Hyperbaric oxygen therapy was effective in anaerobic osteomyelitis due to B.

melaninogenicus by antibacterial activity and improvement of healing process, while

it did not appear to be related to antibacterial activity in aerobic osteomyelitis

due to S. aureus.

Therapeutic effectiveness of hyperbaric oxygen therapy must be considered as an

adjunctive treatment of refractory chronic osteomyelitis in respect that it is at

least as erective as antibiotic therapy.

[영문]

The main objective of this study was to observe the antimicrobial effect of hyperbaric oxygen therapy(HBO) on the infected microorganisms, aerobic and anaerobic, of the mandibular osteomyelitis in Albino rats.

The experimental osteomyelitis was induced by formation of bone hole into the medullary cavity and inoculation of Staphylococcus aureus as aerobic microorganism, and Bacteroides melaninogenicus as anaerobic microorganism separately.

Author used 170 rats(Sprague-Dawley strain) dividing into a pilot study(30), aerobic osteomyelitis(80) and anaerobic osteomyelitis(60) groups.

In aerobic osteomyelitis caused by S. aureus, the treatment regimen consisted of HBO(2hrs, dailyat 2.4 atm.), cephalexin, a combination of both and/or no treatment control group, and in anaerobic osteomyelitis caused by B. melaninogenicus, the

treatment regimen consisted of HBO once a day, HBO twice a day and/or no treatment control group, and the results were compared microbiologically.

The obtained results were as fellows:

1. In vitro study, hyperbaric oxygen therapy(HBO) on Staphylococcus aureus has no direct bacterios-tatic effect compared with control group in ambient air, due to similar bacterial growth, and combination of HBO and antibiotic therapy revealed similar antimicrobial effect compared with antibiotic therapy alone.

2. In treatments on experimental osteomyelitis due to Staphylococcus aureus, HBO is at least as effective as antibiotic therapy, and no significant difference was revealed between HBO group and a combination of HBO andantibiotic therapy group

statistically.

3. In vitro study, antimicrobial effect of HBO on Bacteroides melaninogenicus revealed statistical significant difference compared with control group, and HBO twice a day for 4 hours was more effective than HBO once a day for 2 hours in bactericidal effect.

4. In treatments on experimental osteomyelitis due to Bacteroides melaninogenicus, HBO group revealed high recovery rate compared with control group, while there was no significant difference between HBO once a day and HBO twice a day groups statistically.

Hyperbaric oxygen therapy was effective in anaerobic osteomyelitis due to B. melaninogenicus by antibacterial activity and improvement of healing process, while it did not appear to be related to antibacterial activity in aerobic osteomyelitis

due to S. aureus.

Therapeutic effectiveness of hyperbaric oxygen therapy must be considered as an adjunctive treatment of refractory chronic osteomyelitis in respect that it is at least as erective as antibiotic therapy.