[1]黄晓涛,方略,谢长发,等.五味消毒饮合当归补血汤联合抗生素预防四肢骨折术后感染的临床观察[J].中医正骨,2017,29(01):31-35.
　HUANG Xiaotao,FANG Lue,XIE Changfa,et al.Clinical observation on Wuwei Xiaodu Yin(五味消毒饮)combined with Danggui Buxue Tang(当归补血汤)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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五味消毒饮合当归补血汤联合抗生素预防四肢骨折术后感染的临床观察()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年01期
页码:
31-35
栏目:
临床研究
出版日期:
2017-01-20

文章信息/Info

Title:
Clinical observation on Wuwei Xiaodu Yin(五味消毒饮)combined with Danggui Buxue Tang(当归补血汤)and antibiotics in preventing postoperative infection in patients with limb fractures
作者:
黄晓涛; 方略; 谢长发; 张弛
浙江省慈溪市中医医院,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
关键词:
五味消毒饮;  当归补血汤;  抗菌药;  感染;  骨折;  围手术期;  临床试验
Keywords:
Wuwei Xiaodu Yin;  Danggui Buxue Tang;  anti-bacterial agents;  infection;  fractures; bone;  perioperative period;  clinical trial
摘要:
目的:探讨五味消毒饮合当归补血汤联合抗生素预防四肢骨折术后感染的临床疗效。方法:2014年10月至2016年3月收治80例四肢骨折患者。开放性骨折患者40例,其中上肢和下肢骨折患者各20例; 闭合性骨折患者40例,其中上肢和下肢骨折患者各20例。所有患者均进行手术治疗,常规应用抗生素,同时于术后第1天开始口服五味消毒饮合当归补血汤,每天1剂,连用5 d。分别于术前和术后1、5 d在患者肘正中静脉或贵要静脉抽血,测定静脉血白细胞数量、中性粒细胞比例、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)及血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1)、IL-6的含量。同时随访观察患者的切口愈合情况。结果:开放性上肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(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)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后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)。开放性下肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(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)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后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)。闭合性上肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(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)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后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)。闭合性下肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(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)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后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)。术后所有患者均未发生感染,切口均愈合良好。开放性上肢骨折患者切口愈合时间(13.60±2.80)d,开放性下肢骨折患者切口愈合时间(14.10±1.29)d,闭合性上肢骨折患者切口愈合时间(11.80±1.51)d,闭合性下肢骨折患者切口愈合时间(13.60±1.10)d。结论:五味消毒饮合当归补血汤联合抗生素可明显改善血液炎性指标,预防四肢骨折术后感染。
Abstract:
Objective:To explore the clinical curative effects of Wuwei Xiaodu Yin(五味消毒饮,WWXDY)combined with Danggui Buxue Tang(当归补血汤,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.

参考文献/References:

[1] 王辉,李世娟,李春峰.骨折患者术后医院感染相关因素调查分析[J].中华医院感染学杂志,2008,18(11):1580-1580.
[2] BECKLES VL,JONES HW,HARRISON WJ.Chronic haematogenous osteomyelitis in children:a retrospective review of 167 patients in Malawi[J].J Bone Joint Surg Br,2010,92(8):1138-1143.
[3] 辛红,庞丽娜,刘浩.感染和炎症与骨质再生的关系[J].解剖学研究,2012,34(4):303-306.
[4] 董晓宇,周新社,朱坤.骨折内固定术后感染分期及治疗进展[J].创伤外科杂志,2015,17(3):277-280.
[5] 谢强,雷光华.血液炎性标志物用于关节假体感染诊断的研究与应用[J].中国组织工程研究,2012,16(44):8271-8278.
[6] 李国栋.骨科金属内固定物置入后患者血清C-反应蛋白和红细胞沉降率的变化[J].中国组织工程研究,2015,19(25):3967-3971.
[7] 吴坚.丹参注射液对四肢骨折术后患者血液流变学及血清炎性因子影响研究[J].中国现代医生,2011,49(26):26-27.
[8] MONTSERRAT-DE LA PAZ S,GARCÍA-GIMÉNEZ MD,ÁNGEL-MARTÍN M,et al.Long-chain fatty alcohols from evening primrose oil inhibit the inflammatory response in murine peritoneal macrophages[J].J Ethnopharmacol,2014,151(1):131-136.
[9] 郑银驹,范回生,张杰.活血解毒饮对骨折术后患者血沉、C-反应蛋白、TNF-a及IL-1的影响[J].中医药导报,2015,21(12):54-56.
[10] 陈渊,张音,胡龙均,等.五味消毒饮在预防四肢骨折术后感染中的应用研究[J].新中医, 2015,47(4):141-142.
[11] 张自强,于继岗,祁文兵.五味消毒饮在成人慢性胫骨骨髓炎治疗中的应用[J].陕西中医,2015,36(8):991-992.
[12] 罗海恩,冯帅华,汤英.中西医结合治疗胫腓骨开放性骨折35例疗效观察[J].湖南中医杂志,2013,29(2):57-58.
[13] 叶世静,姚权,张军,等.当归补血汤加味在全膝关节置换术后贫血20例中的应用[J].中国民族民间医药,2015,24(14):39-39.
[14] 周宗波,朱华亮.补中益气汤合五味消毒饮预防老年四肢骨折术后切口感染的临床研究[J].中医药导报,2015,21(22):56-58.

备注/Memo

备注/Memo:
基金项目:浙江省中医药科技计划项目(2014ZB108)
通讯作者:方略 E-mail:249792141@qq.com
更新日期/Last Update: 2017-01-20