拔毒生肌散治疗非哺乳期乳腺炎脓肿窦道脓腐临床观察
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摘要
目的:初步观察拔毒生肌散治疗非哺乳期乳腺炎脓腐,促进创面愈合的临床功效与可能机制。方法:选取非哺乳期乳腺炎脓肿期、窦道期患者20例,分为观察组与对照组,每组10例,观察组将拔毒生肌散均匀洒向并覆盖创面脓腐,以黄芩油纱条覆盖,对照组仅以黄芩油纱条覆盖创面;创面敷药隔日1次,敷药7次为1个疗程。治疗前后进行肿块大小、创面脓腐积分与创周皮肤状况评估,测定创面肉芽IL-6,并进行肝肾功能及尿汞临床安全性测定。结果:观察组的肿块范围评分、创面脓腐评分、创周皮肤状况评分,从治疗第6次起,显著低于对照组(P<0.05),其中创周温度从治疗第2次起即显著低于对照组。治疗后观察组脓腐周围肉芽组织中IL-6含量及病理免疫组化表达显著低于对照组(P<0.05)。且观察组患者血常规、肝肾功能及尿汞测定均在正常值范围,与对照组比较,差异无统计学意义。结论:拔毒生肌散对非哺乳期乳腺炎患者创面具有良好的提脓去腐功效,显著改善炎性反应而促进愈合,临床使用2周安全,未见不良反应,有一定推广运用价值。
Objective: To preliminarily observe the clinical efficacy and possible mechanism of the therapeutic effect of Badu Shengji Powder in the treatment of non-lactating mastitis through eliminating pus and necrotic tissues.Methods: A total of 20 patients with non-lactation mastitis were selected in stage of abscess,sinus and divided into the treatment and the control group with 10 cases in each group.In the treatment group,Badu Shengji Powder was evenly spread and covered the pus area of the wound,along with radix scutellariae oil gauze to cover the surface,whereas,in the control group,the wound areas were only covered with radix scutellariae oil gauze.The wounds were treated every other day 7 times for 1 treatment.The size of the tumor mass,the score of the in the wound and the skin condition around the wound were assessed before and after treatment.IL-6 contents in the wound granulation were measured as well as the clinical safety indices of the hepatorenal functions and the level of urine mercury.Results: The scores of breast mass range,the pus and necrotic tissues and the skin conditions beyond wound in the treatment group were significantly lower than those in the control group since the sixth evaluation( P < 0.05),among which,the skin temperatures of the wound area were lower than those of control group since the second evaluation.The contents of IL-6 as well as their expressions by histopathologic immunohistochemistry in the peripheral granulation tissue of the treatment group were significantly lower than those in the control group after treatment( P < 0.05).The blood routine,hepatoral function and urine mercury of the patients after 14 days of clinical use in the treatment group were all normal and without significant differences as compared with the results of control group.Conclusion: Badu Shengji Powder significantly ameliorated inflammation and promoted wound healing on the patients with non-lactation mastitis through its good efficacies of eliminating pus and narcotic tissues.No clinical adverse events happened within 2 weeks of clinical application.There should be certain values for popularization and application.
Objective: To preliminarily observe the clinical efficacy and possible mechanism of the therapeutic effect of Badu Shengji Powder in the treatment of non-lactating mastitis through eliminating pus and necrotic tissues.Methods: A total of 20 patients with non-lactation mastitis were selected in stage of abscess,sinus and divided into the treatment and the control group with 10 cases in each group.In the treatment group,Badu Shengji Powder was evenly spread and covered the pus area of the wound,along with radix scutellariae oil gauze to cover the surface,whereas,in the control group,the wound areas were only covered with radix scutellariae oil gauze.The wounds were treated every other day 7 times for 1 treatment.The size of the tumor mass,the score of the in the wound and the skin condition around the wound were assessed before and after treatment.IL-6 contents in the wound granulation were measured as well as the clinical safety indices of the hepatorenal functions and the level of urine mercury.Results: The scores of breast mass range,the pus and necrotic tissues and the skin conditions beyond wound in the treatment group were significantly lower than those in the control group since the sixth evaluation( P < 0.05),among which,the skin temperatures of the wound area were lower than those of control group since the second evaluation.The contents of IL-6 as well as their expressions by histopathologic immunohistochemistry in the peripheral granulation tissue of the treatment group were significantly lower than those in the control group after treatment( P < 0.05).The blood routine,hepatoral function and urine mercury of the patients after 14 days of clinical use in the treatment group were all normal and without significant differences as compared with the results of control group.Conclusion: Badu Shengji Powder significantly ameliorated inflammation and promoted wound healing on the patients with non-lactation mastitis through its good efficacies of eliminating pus and narcotic tissues.No clinical adverse events happened within 2 weeks of clinical application.There should be certain values for popularization and application.
引文
[1]许锐,郭倩倩,杨乐平,等.非哺乳期乳腺炎患者血液中自身抗体和免疫指标的变化及其临床意义[J].南方医科大学学报,2016,36(8):1157-1159,1168.
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[8]李层,涂扬茂.拔毒生肌散外用治疗跟骨骨折术后伤口不愈合临床观察[J].内蒙古中医药,2014,33(17):38-39.
[9]李从容.中西医结合治疗复杂性肛瘘的临床观察.湖北中医杂志,2007,29(10):45.
[10]姚昶,许芝银.红升丹提毒祛腐机理的实验研究[J].南京中医药大学学报:自然科学版,2001,17(4):227-229.
[11]姚昶,许芝银.升丹制剂对小鼠机械性创面微循环影响的实验研究[J].南京中医药大学学报:自然科学版,2000,16(4):217-218.
[12]M.Gail Woodbury,Pamela E.Houghton,Karen E.Campbell,et al.Development,Validity,Reliability,and Responsiveness of a New Leg Ulcer Measurement Tool[J].ADV SKIN WOUND CARE,2004,17:187-196.
[13]Robert Rennert,BA;Michael Golinko,MD;Dave Kaplan,et al,Standardization of Wound Photography Using the Wound Electronic Medical Record[J].ADVANCES IN SKIN&WOUND CARE,2009,22(1):32-38.
[14]张晶,姚昶,尹恒,等.生肌玉红膏促进下肢慢性创面愈合257例随机对照多中心临床研究[J].中医杂志,2013,54(1):35-38.
[15]尹恒,应语,姚昶,等.生肌玉红膏治疗下肢慢性溃疡祛腐生肌疗效的临床研究[J].南京中医药大学学报,2013,29(2):121-124.
[16]程塞渊.慢性下肢溃疡“脓”“腐”“肌”局部临床信息表达谱建立研究[D].上海:上海中医药大学,2013.
[17]Liu Y,Zhang J,Zhou YH,Jiang YN,et al.IL-6/STAT3 signaling pathway is activated in plasma cell mastitis[J].Int J Clin Exp Pathol,2015,8(10):12541-12548.
[18]Wang JY,Xiao HB,Sun ZL,et al.Angiopoietin-like protein 2 may mediate the inflammation in murine mastitis through the activation of interleukin-6 and tumour necrosis factor-α.World J Microbiol Biotechnol,2015,31(8):1235-1240.
[19]路艳丽,贺蓉,彭博,等.拔毒生肌散中配伍药味对汞、铅成分毒性的影响[J].中国中药杂志,2011,36(15):2118-2123.
[20]路艳丽,贺蓉,余启华,等.外用含汞制剂拔毒生肌散诱导肾早期损伤的敏感监测指标的比较研究[J].中国中药杂志,2012,37(6):706-710.
[21]路艳丽,贺蓉,彭博,等.拔毒生肌散对不同皮肤损伤条件大鼠的肾毒性比较[J].中国中药杂志,2012,37(6):711-714.
[22]江虹,许岩磊,姚昶,等.生肌玉红膏对下肢慢性溃疡患者组织学指标影响的临床研究——附117例临床资料[J].江苏中医药,2014,46(12):29-31.
[2]肖蔷,张超杰.非哺乳期乳腺炎的现代研究进展[J].医学与哲学,2013,34(6):7-13.
[3]崔仁忠,杨接辉,潘承欣,等.肉芽肿性乳腺炎的6年发病情况及不同治疗方案的临床疗效观察[J].中国妇幼保健,2016,31(11):2271-2272.
[4]刘鹏熙.非哺乳期乳腺炎的中西医结合治疗[J].医学与哲学,2013,34(6):19-20,23.
[5]杨润华,程明.拔毒生肌散的研制及临床应用[J].中国卫生产业,2011,8(7):76-77.
[6]贺蓉,彭博,路艳丽,等.拔毒生肌散及其拆方对大鼠破损皮肤组织形态学的影响观察[J].中国中药杂志,2012,37(6):715.
[7]查丽春.拔毒生肌散治疗糖尿病足感染性溃疡的临床观察[J].湖北中医杂志,2013,35(4):50-51.
[8]李层,涂扬茂.拔毒生肌散外用治疗跟骨骨折术后伤口不愈合临床观察[J].内蒙古中医药,2014,33(17):38-39.
[9]李从容.中西医结合治疗复杂性肛瘘的临床观察.湖北中医杂志,2007,29(10):45.
[10]姚昶,许芝银.红升丹提毒祛腐机理的实验研究[J].南京中医药大学学报:自然科学版,2001,17(4):227-229.
[11]姚昶,许芝银.升丹制剂对小鼠机械性创面微循环影响的实验研究[J].南京中医药大学学报:自然科学版,2000,16(4):217-218.
[12]M.Gail Woodbury,Pamela E.Houghton,Karen E.Campbell,et al.Development,Validity,Reliability,and Responsiveness of a New Leg Ulcer Measurement Tool[J].ADV SKIN WOUND CARE,2004,17:187-196.
[13]Robert Rennert,BA;Michael Golinko,MD;Dave Kaplan,et al,Standardization of Wound Photography Using the Wound Electronic Medical Record[J].ADVANCES IN SKIN&WOUND CARE,2009,22(1):32-38.
[14]张晶,姚昶,尹恒,等.生肌玉红膏促进下肢慢性创面愈合257例随机对照多中心临床研究[J].中医杂志,2013,54(1):35-38.
[15]尹恒,应语,姚昶,等.生肌玉红膏治疗下肢慢性溃疡祛腐生肌疗效的临床研究[J].南京中医药大学学报,2013,29(2):121-124.
[16]程塞渊.慢性下肢溃疡“脓”“腐”“肌”局部临床信息表达谱建立研究[D].上海:上海中医药大学,2013.
[17]Liu Y,Zhang J,Zhou YH,Jiang YN,et al.IL-6/STAT3 signaling pathway is activated in plasma cell mastitis[J].Int J Clin Exp Pathol,2015,8(10):12541-12548.
[18]Wang JY,Xiao HB,Sun ZL,et al.Angiopoietin-like protein 2 may mediate the inflammation in murine mastitis through the activation of interleukin-6 and tumour necrosis factor-α.World J Microbiol Biotechnol,2015,31(8):1235-1240.
[19]路艳丽,贺蓉,彭博,等.拔毒生肌散中配伍药味对汞、铅成分毒性的影响[J].中国中药杂志,2011,36(15):2118-2123.
[20]路艳丽,贺蓉,余启华,等.外用含汞制剂拔毒生肌散诱导肾早期损伤的敏感监测指标的比较研究[J].中国中药杂志,2012,37(6):706-710.
[21]路艳丽,贺蓉,彭博,等.拔毒生肌散对不同皮肤损伤条件大鼠的肾毒性比较[J].中国中药杂志,2012,37(6):711-714.
[22]江虹,许岩磊,姚昶,等.生肌玉红膏对下肢慢性溃疡患者组织学指标影响的临床研究——附117例临床资料[J].江苏中医药,2014,46(12):29-31.