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[1]黃曉濤,方略,謝長發(fā),等.五味消毒飲合當(dāng)歸補(bǔ)血湯聯(lián)合抗生素預(yù)防四肢骨折術(shù)后感染的臨床觀察[J].中醫(yī)正骨,2017,29(01):31-35.
　HUANG Xiaotao,FANG Lue,XIE Changfa,et al.Clinical observation on Wuwei Xiaodu Yin(五味消毒飲)combined with Danggui Buxue Tang(當(dāng)歸補(bǔ)血湯)and antibiotics in preventing postoperative infection in patients with limb fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(01):31-35.
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五味消毒飲合當(dāng)歸補(bǔ)血湯聯(lián)合抗生素預(yù)防四肢骨折術(shù)后感染的臨床觀察()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年01期
頁碼:
31-35
欄目:
臨床研究
出版日期:
2017-01-20

文章信息/Info

Title:
Clinical observation on Wuwei Xiaodu Yin(五味消毒飲)combined with Danggui Buxue Tang(當(dāng)歸補(bǔ)血湯)and antibiotics in preventing postoperative infection in patients with limb fractures
作者:
黃曉濤; 方略; 謝長發(fā); 張弛
浙江省慈溪市中醫(yī)醫(yī)院,浙江 慈溪 315300
Author(s):
HUANG Xiaotao; FANG Lue; XIE Changfa; ZHANG Chi
Cixi Hospital of Traditional Chinese Medicine,Cixi 315300,Zhejiang,China
關(guān)鍵詞:
五味消毒飲;  當(dāng)歸補(bǔ)血湯;  抗菌藥;  感染;  骨折;  圍手術(shù)期;  臨床試驗
Keywords:
Wuwei Xiaodu Yin;  Danggui Buxue Tang;  anti-bacterial agents;  infection;  fractures; bone;  perioperative period;  clinical trial
摘要:
目的:探討五味消毒飲合當(dāng)歸補(bǔ)血湯聯(lián)合抗生素預(yù)防四肢骨折術(shù)后感染的臨床療效。方法:2014年10月至2016年3月收治80例四肢骨折患者。開放性骨折患者40例,其中上肢和下肢骨折患者各20例; 閉合性骨折患者40例,其中上肢和下肢骨折患者各20例。所有患者均進(jìn)行手術(shù)治療,常規(guī)應(yīng)用抗生素,同時于術(shù)后第1天開始口服五味消毒飲合當(dāng)歸補(bǔ)血湯,每天1劑,連用5 d。分別于術(shù)前和術(shù)后1、5 d在患者肘正中靜脈或貴要靜脈抽血,測定靜脈血白細(xì)胞數(shù)量、中性粒細(xì)胞比例、紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)、C反應(yīng)蛋白(C-reactive protein,CRP)及血清中腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、白細(xì)胞介素-1(interleukin-1,IL-1)、IL-6的含量。同時隨訪觀察患者的切口愈合情況。結(jié)果:開放性上肢骨折患者手術(shù)前后不同時點之間的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6比較,差異均有統(tǒng)計學(xué)意義(F=8.245,P=0.001; F=15.783,P=0.000; F=20.205,P=0.000; F=16.033,P=0.000; F=67.183,P=0.000; F=170.230,P=0.000; F=142.375,P=0.000)。術(shù)后1 d時的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于術(shù)前和術(shù)后5 d(P=0.041,P=0.034,P=0.025,P=0.013,P=0.000,P=0.000,P=0.000; P=0.000,P=0.002,P=0.048,P=0.001,P=0.000,P=0.000,P=0.000)。開放性下肢骨折患者手術(shù)前后不同時點之間的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6比較,差異均有統(tǒng)計學(xué)意義(F=4.509,P=0.017; F=15.395,P=0.000; F=27.359,P=0.000; F=21.646,P=0.000; F=82.889,P=0.000; F=32.989,P=0.000; F=129.262,P=0.000)。術(shù)后1 d時的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于術(shù)前和術(shù)后5 d(P=0.000,P=0.008,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.001,P=0.000,P=0.000,P=0.000)。閉合性上肢骨折患者手術(shù)前后不同時點之間的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6比較,差異均有統(tǒng)計學(xué)意義(F=14.733,P=0.000; F=16.875,P=0.000; F=16.358,P=0.000; F=13.280,P=0.000; F=53.733,P=0.000; F=25.037,P=0.000; F=145.598,P=0.000)。術(shù)后1 d時的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于術(shù)前和術(shù)后5 d(P=0.013,P=0.004,P=0.030,P=0.049,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.008,P=0.000,P=0.000,P=0.000)。閉合性下肢骨折患者手術(shù)前后不同時點之間的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6比較,差異均有統(tǒng)計學(xué)意義(F=49.447,P=0.000; F=16.576,P=0.000; F=30.166,P=0.000; F=30.022,P=0.000; F=38.500,P=0.000; F=32.951,P=0.000; F=44.530,P=0.000)。術(shù)后1 d時的白細(xì)胞數(shù)量、中性粒細(xì)胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于術(shù)前和術(shù)后5 d(P=0.000,P=0.000,P=0.003,P=0.000,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。術(shù)后所有患者均未發(fā)生感染,切口均愈合良好。開放性上肢骨折患者切口愈合時間(13.60±2.80)d,開放性下肢骨折患者切口愈合時間(14.10±1.29)d,閉合性上肢骨折患者切口愈合時間(11.80±1.51)d,閉合性下肢骨折患者切口愈合時間(13.60±1.10)d。結(jié)論:五味消毒飲合當(dāng)歸補(bǔ)血湯聯(lián)合抗生素可明顯改善血液炎性指標(biāo),預(yù)防四肢骨折術(shù)后感染。
Abstract:
Objective:To explore the clinical curative effects of Wuwei Xiaodu Yin(五味消毒飲,WWXDY)combined with Danggui Buxue Tang(當(dāng)歸補(bǔ)血湯,DGBXT)and antibiotics in preventing postoperative infection in patients with limb fractures.Methods:Eighty patients with fractures in limbs were recruited from Octomber 2014 to March 2016.Forty patients belonged to open fractures and the factures located in upper limbs for 20 patients and lower limbs for 20 patients.Forty patients belonged to closed fractures and the factures located in upper limbs for 20 patients and lower limbs for 20 patients.All patients were treated with surgery and conventional antibiotics,meanwhile,the patients were treated with oral application of WWXDY and DGBXT from the 1st day after surgery,one dose a day for consecutive 5 days.The blood was drawn from the median cubital vein or basilic vein before the surgery and at 1 and 5 days after the surgery respectively.The number white blood cells,neutrophil granulocyte ratio,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)in the venous blood and the serum contents of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and IL-6 were measured.Meanwhile,the patients were followed up for observing incision healing.Results:There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 between different timepoints before and after the surgery for patients with open upper limb fractures(F=8.245,P=0.001; F=15.783,P=0.000; F=20.205,P=0.000; F=16.033,P=0.000; F=67.183,P=0.000; F=170.230,P=0.000; F=142.375,P=0.000).The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 were higher at postoperative day 1 compared to pre-surgery and postoperative day 5(P=0.041,P=0.034,P=0.025,P=0.013,P=0.000,P=0.000,P=0.000; P=0.000,P=0.002,P=0.048,P=0.001,P=0.000,P=0.000,P=0.000).There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 between different timepoints before and after the surgery for patients with open lower limb fractures(F=4.509,P=0.017; F=15.395,P=0.000; F=27.359,P=0.000; F=21.646,P=0.000; F=82.889,P=0.000; F=32.989,P=0.000; F=129.262,P=0.000).The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 were higher at postoperative day 1 compared to pre-surgery and postoperative day 5(P=0.000,P=0.008,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.001,P=0.000,P=0.000,P=0.000).There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 between different timepoints before and after the surgery for patients with closed upper limb fractures(F=14.733,P=0.000; F=16.875,P=0.000; F=16.358,P=0.000; F=13.280,P=0.000; F=53.733,P=0.000; F=25.037,P=0.000; F=145.598,P=0.000).The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 were higher at postoperative day 1 compared to pre-surgery and postoperative day 5(P=0.013,P=0.004,P=0.030,P=0.049,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.008,P=0.000,P=0.000,P=0.000).There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 between different timepoints before and after the surgery for patients with closed lower limb fractures(F=49.447,P=0.000; F=16.576,P=0.000; F=30.166,P=0.000; F=30.022,P=0.000; F=38.500,P=0.000; F=32.951,P=0.000; F=44.530,P=0.000).The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF-α,IL-1 and IL-6 were higher at postoperative day 1 compared to pre-surgery and postoperative day 5(P=0.000,P=0.000,P=0.003,P=0.000,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).No infections were found in all patients after surgery and all incisions healed well.The incision healing times for patients with open upper limb fractures,open lower limb fractures,closed upper limb fractures and closed lower limb fractures were 13.60+/-2.80,14.10+/-1.29,11.80+/-1.51 and 13.60+/-1.10 days respectively.Conclusion:The application of WWXDY combined with DGBXT and antibiotic can obviously improve blood inflammatory indexes and prevent postoperative infection in patients with limb fractures.

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備注/Memo

備注/Memo:
基金項目:浙江省中醫(yī)藥科技計劃項目(2014ZB108)
通訊作者:方略 E-mail:[email protected]
更新日期/Last Update: 2017-01-20