清热解毒中药外敷治疗外伤感染创面的疗效观察及作用机制研究  

A clinical study on the curative effect and mechanism of action of external applications of antipyretic- detoxicate traditional Chinese drugs for treatment of traumatic infected wounds

作　　者：杨洪杰 周利 吴海红 胡纪文 

机构地区：[1]广东省深圳市罗湖区中医院,广东深圳518001

出　　处：《中医正骨》2016年第8期13-18,23,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：深圳市罗湖区科技创新局软科学项目(2015-55)

摘　　要：目的:观察清热解毒中药外敷治疗外伤感染创面的疗效并探讨其作用机制。方法:将100例外伤感染创面患者随机分为2组,每组50例,分别采用清热解毒中药外敷和呋喃西林外敷治疗,连续治疗至创面愈合。比较治疗前及治疗第7天和第14天2组患者感染创面面积、外周血单个核细胞表面Toll样受体4(toll-like receptor 4,TLR4)的表达情况及外周血血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素1β(interleukin^(-1) beta,IL^(-1)β)、白细胞介素6(interleukin-6,IL-6)的表达情况,并于治疗开始后2周比较2组患者的临床疗效。结果:清热解毒中药组的感染创面愈合时间短于呋喃西林组[(16.10±3.15)d,(18.26±3.72)d,t=3.133,P=0.002]。治疗前后不同时间点感染创面面积比较,差异有统计学意义,存在时间效应,治疗后创面面积逐渐缩小(F=13.250,P=0.002);2组患者感染创面面积比较,差异有统计学意义,存在分组效应(t=2.040,P=0.044);治疗前2组患者感染创面面积比较,差异无统计学意义[(12.80±1.61)cm^2,(13.00±2.21)cm^2,t=0.517,P=0.606];治疗第7天和第14天清热解毒中药组的感染创面面积均小于呋喃西林组[(6.50±0.97)cm^2,(8.30±0.94)cm^2,t=9.422,P=0.000;(3.00±0.66)cm^2,(5.70±0.67)cm^2,t=20.300,P=0.000];时间因素与分组因素存在交互效应(F=6.830,P=0.003)。治疗前后不同时间点TLR4表达量比较,差异有统计学意义,存在时间效应,治疗后TLR4表达量逐渐减少(F=6.864,P=0.017);2组患者TLR4表达量比较,差异有统计学意义,存在分组效应(t=2.185,P=0.031);治疗前2组患者TLR4表达量比较,差异无统计学意义[(5.81±0.78)ng·m L^(-1),(5.79±0.73)ng·m L^(-1),t=0.132,P=0.890];治疗第7天和第14天清热解毒中药组的TLR4表达量均低于呋喃西林组[(4.10±0.33)ng·m L^(-1),(4.69±0.27)ng·m L^(-1),t=9.784,P=0.000;(2.82±0.55)ng·m L^(-1),(3.80±0.59)ng·m L^(-1),t=8.591,P=0.000];时间因素与分组因素存在交互效应(F=6.01Objective：To study the curative effect and mechanism of action of external applications of antipyretic - detoxicate tradition-al Chinese drugs（TCD）for treatment of traumatic infected wounds. Methods：One hundred patients with traumatic infected wounds were randomly divided into 2 groups,50 cases in each group. The patients were treated with external applications of antipyretic - detoxicate TCD （group A）and nitrofurazone（group B）continuously until the wounds healed. The infected wound areas,the expression of toll - like receptor 4（TLR4）on the surface of peripheral blood mononuclear cell and the expression of tumor necrosis factor - α（TNF - α）,interleukin - 1 be-ta（IL - 1β）and interleukin - 6（IL - 6）in peripheral blood serum were compared between the 2 groups before treatment and at the 7th and 14th day after the beginning of the treatment respectively,and the clinical effects were evaluated and compared between the 2 groups at 2 weeks after the begining of treatment. Results：The healing time of infected wounds were shorter in group A compared to group B （16. 10 ＋ / - 3. 15 vs 18. 26 ＋ / - 3. 72 days,t = 3. 133,P = 0. 002）. There was statistical difference in the infected wound areas between different timepoints before and after the treatment,in other words,there was time effect,and the wound areas decreased gradually after treat-ment（F = 13. 250,P = 0. 002）. There was statistical difference in the infected wound areas between the 2 groups in general,in other words, there was group effect（t = 2. 040,P = 0. 044）. There was no statistical difference in the infected wound areas between the 2 groups before treatment（12. 80 ＋ / - 1. 61 vs 13. 00 ＋ / - 2. 21 cm（2）,t = 0. 517,P = 0. 606）. The infected wound areas were smaller in group A com-pared to group B at the 7th and 14th day after the beginning of the treatment（6. 50 ＋ / - 0. 97 vs 8. 30 ＋ / - 0. 94 cm（2）,t = 9. 422,P =0. 000;3. 00 ＋ / - 0. 66 vs 5. 70 ± 0. 67 cm（2）,t = 20. 300,P = 0. 0

关 键 词：清热解毒药 中药外敷 呋喃西林 伤口感染 Toll样受体4 肿瘤坏死因子α 白细胞介素1Β 白细胞介素6 临床试验 

分 类 号：R269[医药卫生—中西医结合]