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[1]陳強(qiáng),何智南,李強(qiáng),等.黃連解毒湯加減治療跟骨骨折術(shù)前腫脹的臨床研究[J].中醫(yī)正骨,2024,36(04):5-10,20.
　CHEN Qiang,HE Zhinan,LI Qiang,et al.A clinical study of modified Huanglian Jiedu Tang(黃連解毒湯)for treatment of preoperative swelling of calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(04):5-10,20.
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黃連解毒湯加減治療跟骨骨折術(shù)前腫脹的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年04期
頁(yè)碼:
5-10,20
欄目:
臨床研究
出版日期:
2024-04-20

文章信息/Info

Title:
A clinical study of modified Huanglian Jiedu Tang(黃連解毒湯)for treatment of preoperative swelling of calcaneal fractures
作者:
陳強(qiáng); 何智南; 李強(qiáng); 袁海濤; 胡和軍; 鄧雄偉
南昌市洪都中醫(yī)院,江西 南昌 330038
Author(s):
CHEN Qiang; HE Zhinan; LI Qiang; YUAN Haitao; HU Hejun; DENG Xiongwei
Nanchang Hongdu Hospital of TCM,Nanchang 330038,Jiangxi,China
關(guān)鍵詞:
黃連解毒湯;  骨折;  跟骨;  腫脹;  炎癥因子;  骨折并發(fā)癥
Keywords:
Huang Lian Jie Du Tang;  fractures; bone;  calcaneus;  swelling;  inflammatory factor;  fracture complication
摘要:
目的:觀察黃連解毒湯加減治療跟骨骨折術(shù)前腫脹的臨床療效和安全性,并探討其可能的作用機(jī)制。方法:將符合要求的70例SandersⅡ～Ⅳ型跟骨骨折患者隨機(jī)分為2組,每組35例。2組患者入院后均給予石膏托外固定制動(dòng)、抬高患肢、靜脈滴注甘露醇注射液、皮下注射那屈肝素鈣等常規(guī)治療。常規(guī)治療組在此基礎(chǔ)上口服地奧司明片,每次0.9 g,每日1次,晚餐后服用,共服用7 d; 黃連解毒湯組在常規(guī)治療基礎(chǔ)上口服黃連解毒湯加減,早晚各1次,共服用7 d。比較2組患者的患肢腫脹率、疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、血清C反應(yīng)蛋白(C-reactive protein,CRP)水平、血清腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)水平、血清白細(xì)胞介素-6(interleukin 6,IL-6)水平、中醫(yī)證候積分及并發(fā)癥發(fā)生情況。結(jié)果:①患肢腫脹率。2組患者的患肢腫脹率隨時(shí)間變化均呈先升高后降低的趨勢(shì)(F=246.771,P=0.000; F=282.982,P=0.000); 治療前2組患者患肢腫脹率的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.596,P=0.553); 治療第3天和治療第7天,黃連解毒湯組患者的患肢腫脹率均低于常規(guī)治療組(t=2.147,P=0.035; t=2.799,P=0.007)。②疼痛VAS評(píng)分。2組患者的疼痛VAS評(píng)分隨時(shí)間變化均呈逐漸降低的趨勢(shì)(F=262.877,P=0.000; F=462.471,P=0.000); 治療前2組患者疼痛VAS評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.432,P=0.667); 治療第3天和治療第7天,黃連解毒湯組患者的疼痛VAS評(píng)分均低于常規(guī)治療組(t=3.200,P=0.002; t=8.735,P=0.000)。③血清CRP水平。2組患者的血清CRP水平隨時(shí)間變化均呈先升高后降低的趨勢(shì)(F=1 355.001,P=0.000; F=2 271.167,P=0.000); 治療前2組患者血清CRP水平的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.470,P=0.570); 治療第3天和治療第7天,黃連解毒湯組患者的血清CRP水平均低于常規(guī)治療組(t=4.575,P=0.000; t=25.065,P=0.000)。④血清TNF-α水平。2組患者的血清TNF-α水平隨時(shí)間變化均呈先升高后降低的趨勢(shì)(F=366.536,P=0.000; F=811.863,P=0.000); 治療前2組患者血清TNF-α水平的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.019,P=0.312); 治療第3天和治療第7天,黃連解毒湯組患者的血清TNF-α水平均低于常規(guī)治療組(t=3.222,P=0.002; t=17.223,P=0.000)。⑤血清IL-6水平。2組患者的血清IL-6水平隨時(shí)間變化均呈先升高后降低的趨勢(shì)(F=895.505,P=0.000; F=1 184.801,P=0.000); 治療前2組患者血清IL-6水平的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.606,P=0.113); 治療第3天和治療第7天,黃連解毒湯組患者的血清IL-6水平均低于常規(guī)治療組(t=4.432,P=0.000; t=9.249,P=0.000)。⑥中醫(yī)證候積分。治療前2組患者的中醫(yī)證候積分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.595,P=0.554); 治療第7天,2組患者的中醫(yī)證候積分均較治療前減小(t=24.128,P=0.000; t=40.200,P=0.000); 治療第7天黃連解毒湯組的中醫(yī)證候積分低于常規(guī)治療組(t=9.272,P=0.000)。⑦并發(fā)癥。2組各有2例患者發(fā)生下肢深靜脈血栓,應(yīng)用那屈肝素鈣聯(lián)合華法林治療1周后血栓變小或吸收; 黃連解毒湯組2例發(fā)生胃腸道不適、常規(guī)治療組2例出現(xiàn)皮疹,均未予藥物治療,癥狀自行消失。2組患者并發(fā)癥發(fā)生率的差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.000,P=1.000)。結(jié)論:黃連解毒湯加減可有效減輕跟骨骨折患者的術(shù)前腫脹和疼痛,而且具有較高的安全性,其作用機(jī)制可能與其降低患者血清炎癥因子水平有關(guān)。
Abstract:
Objective:To observe the clinical outcome and safety of modified Huanglian Jiedu Tang(黃連解毒湯,HLJDT)in treatment of preoperative swelling in patients with calcaneal fractures,and to explore its underlying mechanism.Methods:Seventy patients with Sanders typeⅡ-Ⅳcalcaneal fractures were enrolled in the study and were randomized into conventional treatment group and HLJDT treatment group,35 ones in each group.All patients in the 2 groups were treated with conventional treatment including plaster fixing,braking,raising the injured limbs,intravenous drip infusion of mannitol injection and subcutaneous injection of nadroparin calcium after the hospital admission.In addition,the patients in conventional treatment group were treated with oral application of diosmin tablets,once a day(after supper),0.9 g at a time for consecutive 7 days; and the patients in HLJDT treatment group were treated with oral application of modified HLJDT,twice a day in the morning and evening respectively for consecutive 7 days.The swelling rate of the affected limb,pain visual analogue scale(VAS)score,serum levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin 6(IL-6),TCM syndrome score and complications were compared between the 2 groups.Results:①The swelling rate of the affected limbs presented a upward firstly and downward subsequently trend over time in the 2 groups(F=246.771,P=0.000; F=282.982,P=0.000).The comparison of swelling rate of the affected limbs between the 2 groups revealed no significant differences before the treatment(t=0.596,P=0.553); while,after 3- and 7-day treatment,the swelling rate of the affected limbs was lower in HLJDT treatment group compared to conventional treatment group(t=2.147,P=0.035; t=2.799,P=0.007).②The pain VAS score presented a gradual downward trend over time in the 2 groups(F=262.877,P=0.000; F=462.471,P=0.000).There was no statistical difference in the pain VAS score between the 2 groups before the treatment(t=0.432,P=0.667); while,after 3- and 7-day treatment,the pain VAS score was lower in HLJDT treatment group compared to conventional treatment group(t=3.200,P=0.002; t=8.735,P=0.000).③The serum level of CRP presented a upward firstly and downward subsequently trend over time in the 2 groups(F=1 355.001,P=0.000; F=2 271.167,P=0.000).The difference was not statistically significant in serum level of CRP between the 2 groups before the treatment(t=-0.470,P=0.570); while,after 3- and 7-day treatment,the serum level of CRP was lower in HLJDT treatment group compared to conventional treatment group(t=4.575,P=0.000; t=25.065,P=0.000).④The serum level of TNF-α presented a upward firstly and downward subsequently trend over time in the 2 groups(F=366.536,P=0.000; F=811.863,P=0.000).The difference was not statistically significant in serum level of TNF-α between the 2 groups before the treatment(t=-1.019,P=0.312); while,after 3- and 7-day treatment,the serum level of TNF-α was lower in HLJDT treatment group compared to conventional treatment group(t=3.222,P=0.002; t=17.223,P=0.000).⑤The serum level of IL-6 presented a upward firstly and downward subsequently trend over time in the 2 groups(F=895.505,P=0.000; F=1 184.801,P=0.000).The difference was not statistically significant in serum level of IL-6 between the 2 groups before the treatment(t=1.606,P=0.113); while,after 3- and 7-day treatment,the serum level of IL-6 was lower in HLJDT treatment group compared to conventional treatment group(t=4.432,P=0.000; t=9.249,P=0.000).⑥There was no statistical difference in the TCM syndrome score between the 2 groups before the treatment(t=-0.595,P=0.554).The TCM syndrome score decreased in the 2 groups on the 7th day after the beginning of the treatment compared to pre-treatment(t=24.128,P=0.000; t=40.200,P=0.000),and it was lower in HLJDT treatment group compared to conventional treatment group(t=9.272,P=0.000).⑦The lower extremity deep venous thrombosis was found in 2 patients in each group,and the thrombus became smaller or absorbed after treatment with natroparin calcium and warfarin for 1 week; moreover,2 patients experienced gastrointestinal discomfort in HLJDT treatment group,and 2 ones experienced rash in conventional treatment group,and the symptoms disappeared spontaneously without any medication treatment.There was no statistical difference in complication incidences between the 2 groups(χ2=0.000,P=1.000).Conclusion:The modified HLJDT can effectively alleviate preoperative swelling and pain in patients with calcaneal fractures,and it exhibits a high level of safety.It may exert the effects by reducing the serum level of inflammatory factors in patients.

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備注/Memo

備注/Memo:
基金項(xiàng)目:江西省中醫(yī)藥中青年骨干人才(第一批)培養(yǎng)計(jì)劃項(xiàng)目(贛中醫(yī)藥科教字〔2020〕2號(hào)); 南昌市科學(xué)技術(shù)局醫(yī)療衛(wèi)生引導(dǎo)性科技計(jì)劃項(xiàng)目(洪科字〔2023〕336號(hào)); 南昌市市級(jí)重點(diǎn)專科建設(shè)項(xiàng)目(洪衛(wèi)體改字〔2023〕10號(hào))
通訊作者:鄧雄偉 E-mail:[email protected]
更新日期/Last Update: 1900-01-01