含银敷料联合营养支持配合中药熏洗对慢性创面患者创面恢复的应用  

Silver dressings and nutritional support combined with traditional Chinese medicine fumigation in effectiveness on wound healing

作　　者：郭丽[1] 单荣芳[2] 郭正刚[3] 顾丽培[1] GUO Li;SHAN Rongfang;GUO Zhenggang;GU Lipei(Department of Burns,Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001;Department of Surgery,Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001;Department of Traditional Chinese Medicine,Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001)

机构地区：[1]南通大学第二附属医院烧伤科,江苏南通226001 [2]南通大学第二附属医院外科,江苏南通226001 [3]南通大学第二附属医院中医科,江苏南通226001

出　　处：《河北中医》2022年第8期1322-1326,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：2019年度南通市市级科技计划(指导性)项目(编号:MSZ19174)。

摘　　要：目的观察含银敷料联合营养支持配合中药熏蒸在慢性创面患者创面恢复中的应用效果。方法将88例慢性创面患者按照随机数字表法分为2组,对照组44例予亲水性纤维含银敷料联合营养支持,治疗组44例在对照组治疗基础上联合中药熏蒸。2组均治疗14 d。记录2组创面情况、换药次数、住院时间、不良反应情况、皮肤功能及汗腺功能减退发生情况,比较2组治疗前后伤口渗液pH值、微炎症状态相关因子[单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)]、血管内皮生长因子(VEGF)水平。结果治疗组14 d残余创面面积、换药次数均低于对照组(P<0.05),14 d细菌清除率高于对照组(P<0.05),创面愈合时间、住院时间均短于对照组(P<0.05)。2组治疗3、7、14 d伤口渗液pH值均较本组治疗前降低(P<0.05),且治疗组治疗3、7、14 d均低于对照组同期(P<0.05)。2组治疗后MCP-1、TNF-α水平均较本组治疗前降低(P<0.05),IL-10、VEGF水平均升高(P<0.05),且治疗组治疗后MCP-1、TNF-α水平均低于对照组(P<0.05),IL-10、VEGF水平均高于对照组(P<0.05)。治疗组两点辨别觉减退和汗腺功能减退发生率均低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论含银敷料联合营养支持配合中药熏蒸可减少慢性创面患者皮肤两点辨别觉和汗腺功能减退的发生,促进创口愈合,可能与改善机体微炎症状态、调节pH值和VEGF表达有关。Objective To observe the effect of silver dressings combined with nutritional support and traditional Chinese medicine(TCM)fumigation for wound healing in patients with chronic wound.Methods Totally 88 patients with chronic wound were randomly assigned a 1∶1 ratio to the treatment group and the control group.All patients were managed by hydrophilic fiber silver-contained dressings combined with nutritional support,and those in the treatment group were additionally treated with TCM fumigation.The key observation was the wound condition,frequency of dressing change,hospitalization time,adverse reactions,skin function and sweat gland hypofunction,the pH levels of wound exudate,micro-inflammatory state-related factors(monocyte chemoattractant protein-1[MCP-1],tumor necrosis factor-α[TNF-α],interleukin-10[IL-10]),vascular endothelial growth factor(VEGF).Results Compared with the control group,the residual wound area and frequency of dressing change on day 14 in treatment group were decreased(P<0.05),the bacterial clearance rate on day 14 was increased(P<0.05),the wound healing time and hospitalization time were decreased(P<0.05);the pH levels of wound exudate on days 3,7,14 in groups was decreased(P<0.05),which was lower in the treatment group than in the concurrent control group(P<0.05);MCP-1 and TNF-αin groups were decreased(P<0.05),while IL-10 and VEGF were increased(P<0.05);lower MCP-1 and TNF-αlevels,and higher IL-10 and VEGF levels were detected in the treatment group than those in the control group(all P<0.05);the two-point discrimination and sweat gland function weakened in the treatment group as compared to the control group(P<0.05).None of the incidence of adverse reactions differed significantly between groups(P>0.05).Conclusion For patients with chronic wound,silver dressings combined with nutritional support and TCM fumigation can weaken two-point discrimination and sweat gland function,and promote wound healing by improving the micro-inflammation status and regulating pH levels and VEGF.

关 键 词：皮肤溃疡 外治法 中药疗法 伤口愈合 

分 类 号：R364.16[医药卫生—病理学] R244[医药卫生—基础医学]