复方黄柏液持续灌注冲洗联合封闭负压吸引治疗难愈性蛇伤溃疡36例临床观察  

Clinical Observation on Fufang Huangbai Fluid(复方黄柏液)Continuous Infusion Combined with Vaccum Sealing Drainage Treating 36 Patients of Refractory Poisonous Snakebite Ulcer

作　　者：张乃忻 潘俊卿 毛文丽[1] 严张仁[1] 孙波 王万春[1] 易军[1] ZHANG Naixin;PAN Junqing;MAO Wenli;YAN Zhangren;SUN Bo;WANG Wanchun;YI Jun(The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang,330006;Graduate School,Jiangxi University of Traditional Chinese Medicine)

机构地区：[1]江西中医药大学附属医院,江西省南昌市330006 [2]江西中医药大学研究生院

出　　处：《中医杂志》2020年第20期1807-1811,共5页Journal of Traditional Chinese Medicine

基　　金：江西省卫生计生委中医药科研计划项目(2018A067)。

摘　　要：目的观察复方黄柏液持续灌注冲洗联合封闭负压吸引(VSD)治疗难愈性蛇伤溃疡临床疗效。方法72例蛇伤溃疡患者随机分为治疗组及对照组各36例。两组患者入院后常规治疗,经彻底清创减压后行VSD持续负压引流治疗,治疗组予以复方黄柏溶液灌注冲洗,对照组以同等容量的生理盐水灌注冲洗,治疗6天后拆除VSD。观测治疗前后创面细菌感染情况及创面组织碱性成纤维细胞生长因子(bFGF)及表皮细胞生长因子(EGF)表达量,计算创面面积及愈合率,比较创面中医证候积分,并进行临床疗效评估。结果两组患者治疗后感染革兰阳性菌、革兰阴性菌例数较治疗前减少,革兰阳性菌、革兰阴性菌感染率较治疗前降低(P<0.05);治疗后,治疗组患者革兰阳性菌、革兰阴性菌感染率及感染病例数明显低于对照组(P<0.05);两组患者治疗后bFGF及FGF表达量比治疗前明显增加(P<0.05);治疗后,治疗组患者bFGF及EGF表达量较对照组升高(P<0.05)。两组治疗后较本组治疗前创面面积明显减小(P<0.01),创面愈合率明显提高(P<0.01)。两组治疗后各中医证候积分均较治疗前明显降低(P<0.05),治疗组治疗后各中医证候积分均明显低于对照组(P<0.01)。治疗组总有效率94.44%,对照组为86.11%,差异有统计学意义。结论复方黄柏液持续灌注冲洗联合封闭负压吸引治疗难愈性蛇伤溃疡,可有效减轻咬伤溃疡部的肿胀疼痛,控制创面细菌感染,促进相关生长因子的表达,从而促进创面愈合。Objective To observe the clinical efficacy of Fufang Huangbai Fluid(复方黄柏液)continuous infusion combined with vaccum sealing drainage(VSD)in the treatment of refractory poisonous snakebite ulcer.Method A total of 72 patients with refractory poisonous snakebite ulcer were randomly divided into a treatment group and a control group,with 36 cases in each group.Both groups were treated routinely after admission.After thorough debridement and decompression,VSD continuous negative pressure drainage was used.The treatment group was perfused and washed with Fufang Huangbai Fluid,and the control group was perfused and washed with the same volume of normal saline.VSD was removed after 6 days of treatment.Wound bacteriology and the expression amount of basic fibroblast growth factor(bFGF)and epidermal growth factor(EGF)in wound tissue were observed before and after treatment.Wound area and healing rate were calculated.Wound TCM syndrome scores were compared,and clinical efficacy was evaluated.Results After treatment,the number of patients infected with Gram-positive and Gram-negative bacteria decreased,and the infection rate of Gram-positive and Gram-negative bacteria was lower than that before treatment(P>0.05);after treatment,the infection rate of Gram-positive bacteria and Gram-negative bacteria and the number of infected cases in the treatment group were significantly lower than those in the control group(P<0.05);the expression of bFGF and FGF in both groups was significantly increased after treatment(P<0.05);after treatment,the expression of bFGF and EGF in the treatment group was higher than that in the control group(P>0.05).After treatment,the wound area of both groups was significantly reduced(P<0.01),and the wound healing rate was significantly improved(P<0.01).After treatment,the scores of TCM syndromes in both groups were significantly lower than those before treatment(P<0.05),and the scores of TCM syndromes in the treatment group were significantly lower than those in the control group(P<0.01).The total

关 键 词：蛇伤溃疡 复方黄柏液 封闭式负压引流 生长因子 创面面积 

分 类 号：R264[医药卫生—中医外科学]