五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀)随机平行对照研究
|
摘要
[目的]观察五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀)疗效。[方法]使用随机平行对照方法,将60例住院患者按随机数字表法随机分两组。对照组30例麻醉下行病灶切开清创置管闭式灌洗引流,手术清创过程中应将脓性分泌物或坏死组织彻底清除,保留内固定装置,病灶清理后用双氧水及生理盐水反复冲洗,医用无醇安尔碘液浸泡数分钟后,生理盐水冲洗病灶,术后根据细菌培养结果选用敏感抗生素配于冲洗液中进行持续灌洗引流。维持负压引流3～5d。治疗组30例五味消毒饮(金银花、野菊花、紫花地丁、冬葵子、蒲公英各10g,肿胀明显加泽泻10g,茯苓15g;肿痛明显加虎杖10g;皮温高加生地、丹皮各10g); 1剂/d,水煎500mL,早晚口服;西医治疗同对照组。连续治疗7d为1疗程。观测临床表现、抗生素使用时间、感染治愈时间、创口边缘上皮组织覆盖愈合时间、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效12例,有效16例,无效2例,总有效率93. 33%;对照组显效8例,有效12例,无效10例,总有效率66. 67%;治疗组疗效优于对照组(P <0. 05)。抗生素使用时间、感染治愈时间、创口边缘上皮组织覆盖愈合时间治疗组均优于对照组(P <0. 01)。[结论]五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀),疗效满意,无严重不良反应,值得推广。
[Objective] To investigate the effect of Wuwei Xiaodun Yin combined with closed lavage and drainage on early infection( Qi stagnation and blood stasis) patients with lumbar internal fixation. [Methods]Sixty inpatients were randomly divided into two groups according to the random number table method.Control group( 30 cases) was treated with lesions debridement catheter closed lavage drainage after anesthesia. The surgical debridement or necrotic tissue purulent secretion should be thoroughly removed,keeping the internal fixation device. After cleaning up,we repeatedly washed the lesions with hydrogen peroxide solution and physiological saline. After no alcohol based medical iodine solution soak for a few minutes,saline was used for flushing lesions. According to the results of bacterial culture,we chose sensitive antibiotic for continuous irrigation drainage in the lotion. The negative pressure drainage was maintained for 3-5 d. In the treatment group,30 patients were treated with Wuwei Xiaodun Yin[Jinyinhua( honeysuckle) 10 g,Yejuhua( wild chrysanthemum) 10 g,Zihua Diding( purple flower) 10 g,Dongkuizi( anemone seed) 10 g,Pugongying( dandelion) 10 g. If there was obvious swelling,Zexie( alisma) 10 g and Fuling( poria cocos) 15 g were added. If there was swelling and pain,Huzhang( polygonum cuspidatum) 10 g was added. If there was high skin temperature,Shengdi( dried rhizome of rehmannia) 10 g and Danpi( tree peony bark) 10 g],1 dose/d,decocted in 500 mL water,taken orally in the morning and evening. Western medicine was the same as the control group. Continuous treatment for 7 days was a course of treatment. Clinical manifestations,antibiotic use time,infection healing time,wound edge epithelial tissue cover healing time,and adverse reactions were observed. After treatment 1 course,the curative effect was judged. [Results] In the treatment group,there were 12 significant cases,16 effective cases and 2 ineffective cases,and the total effective rate was 93. 33%. In the control group,8 cases showed significant effect,12 cases were effective,and 10 cases were invalid,and the total effective rate was 66. 67%. The efficacy of treatment group was better than that of control group( P < 0. 05). Antibiotic use time,infection healing time and wound edge epithelial tissue covering healing time were all better in the treatment group than those in the control group( P < 0. 01). [Conclusion]Wuwei Xiaodun Yin combined with closed lavage and drainage in the treatment of early postoperative infection( Qi stagnation and blood stasis) after lumbar internal fixation has satisfactory efficacy and no serious adverse reactions,which is worthy of promotion.
[Objective] To investigate the effect of Wuwei Xiaodun Yin combined with closed lavage and drainage on early infection( Qi stagnation and blood stasis) patients with lumbar internal fixation. [Methods]Sixty inpatients were randomly divided into two groups according to the random number table method.Control group( 30 cases) was treated with lesions debridement catheter closed lavage drainage after anesthesia. The surgical debridement or necrotic tissue purulent secretion should be thoroughly removed,keeping the internal fixation device. After cleaning up,we repeatedly washed the lesions with hydrogen peroxide solution and physiological saline. After no alcohol based medical iodine solution soak for a few minutes,saline was used for flushing lesions. According to the results of bacterial culture,we chose sensitive antibiotic for continuous irrigation drainage in the lotion. The negative pressure drainage was maintained for 3-5 d. In the treatment group,30 patients were treated with Wuwei Xiaodun Yin[Jinyinhua( honeysuckle) 10 g,Yejuhua( wild chrysanthemum) 10 g,Zihua Diding( purple flower) 10 g,Dongkuizi( anemone seed) 10 g,Pugongying( dandelion) 10 g. If there was obvious swelling,Zexie( alisma) 10 g and Fuling( poria cocos) 15 g were added. If there was swelling and pain,Huzhang( polygonum cuspidatum) 10 g was added. If there was high skin temperature,Shengdi( dried rhizome of rehmannia) 10 g and Danpi( tree peony bark) 10 g],1 dose/d,decocted in 500 mL water,taken orally in the morning and evening. Western medicine was the same as the control group. Continuous treatment for 7 days was a course of treatment. Clinical manifestations,antibiotic use time,infection healing time,wound edge epithelial tissue cover healing time,and adverse reactions were observed. After treatment 1 course,the curative effect was judged. [Results] In the treatment group,there were 12 significant cases,16 effective cases and 2 ineffective cases,and the total effective rate was 93. 33%. In the control group,8 cases showed significant effect,12 cases were effective,and 10 cases were invalid,and the total effective rate was 66. 67%. The efficacy of treatment group was better than that of control group( P < 0. 05). Antibiotic use time,infection healing time and wound edge epithelial tissue covering healing time were all better in the treatment group than those in the control group( P < 0. 01). [Conclusion]Wuwei Xiaodun Yin combined with closed lavage and drainage in the treatment of early postoperative infection( Qi stagnation and blood stasis) after lumbar internal fixation has satisfactory efficacy and no serious adverse reactions,which is worthy of promotion.
引文
[1]刘明,青祖宏,高巍,等.一期清创治疗腰椎内固定术后早期感染[J].中国矫形外科杂志,2017,25(21):1997-2001.
[2]刘昱彰,张世民,董福慧,等.椎间隙灌洗法治疗腰椎后路内固定术后切口早期深部感染的疗效分析[J].中国骨伤,2012,25(10):866-869.
[3]刘景锋,冯永洪,王新强,等.中西医结合闭式灌洗引流治疗腰椎内固定术后早期感染[J].海峡药学,2015,27(7):91-93.
[4]施杞,王和鸣.中医药高级丛书·骨伤科学[S].北京:人民卫生出版社,2001.
[5]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:228-229.
[6]王军炜,孙燕,卜建仁,等.五味消毒饮加减对外科感染患者临床疗效及抗生素使用的影响[J].中国实用医药,2018,13(33):157-158.
[7]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(1):31-35.
[8]国家中医药管理局. ZY/T001. 1~001. 9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[9]倪欢.五味消毒饮加味联合抗生素治疗骨创伤术后创口感染疗效观察[J].实用中医药杂志,2017,33(4):395-396.
[10]王新强.清创后持续灌洗联合中药口服治疗腰椎内固定术后早期感染的临床分析[J].黑龙江医学,2019,43(1):12-13,16.
[11]马向阳,杨浩志,邹小宝,等.一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术治疗原发性腰椎间隙感染[J].中国脊柱脊髓杂志,2018,28(8):726-731.
[12]鲁青,马红梅.腰椎内固定术后脑脊液漏的中西医结合防护[J].中国中西医结合外科杂志,2018,24(4):498-500.
[13]高凤云.综合护理干预在椎弓根钉棒内固定术治疗胸腰椎骨折中的应用[J].承德医学院学报,2018,35(4):320-322.
[14]黄子祥.腰椎内固定术后手术部位感染临床分析[D].广州:南方医科大学,2018.
[15]张宏林.后路钉棒内固定术治疗胸腰椎骨折的效果探讨[J].当代医药论丛,2017,15(24):72-73.
[16]孙杰,王俊,彭建国.腰椎内固定术后血清C反应蛋白和红细胞沉降率水平对中期感染的预测作用[J].实用临床医药杂志,2017,21(23):11-14.
[17]聂春燕.手术室综合护理干预在腰椎滑脱经后路椎弓根螺钉内固定术术中的应用效果观察[J].世界最新医学信息文摘,2017,17(95):8-9.
[18]樊元胜,王金凤,樊秀兰,等.五味消毒饮合复康健骨汤联合五水头孢唑林预防胫腓骨骨折术后感染疗效及对血液流变学和炎症因子的影响[J].现代中西医结合杂志,2019,28(10):1089-1093.
[19]张四清,张观辉,林鹏,等.五味消毒饮提取物对脊柱感染大鼠模型的作用价值探讨[J].光明中医,2019,34(3):376-377,444.
[20]姚腾飞,李彦弢.五味消毒饮加味配合抗菌药物预防患者骨创伤术后创口感染的疗效及其对炎症因子水平和创口愈合的影响[J].抗感染药学,2018,15(11):1891-1893.
[2]刘昱彰,张世民,董福慧,等.椎间隙灌洗法治疗腰椎后路内固定术后切口早期深部感染的疗效分析[J].中国骨伤,2012,25(10):866-869.
[3]刘景锋,冯永洪,王新强,等.中西医结合闭式灌洗引流治疗腰椎内固定术后早期感染[J].海峡药学,2015,27(7):91-93.
[4]施杞,王和鸣.中医药高级丛书·骨伤科学[S].北京:人民卫生出版社,2001.
[5]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:228-229.
[6]王军炜,孙燕,卜建仁,等.五味消毒饮加减对外科感染患者临床疗效及抗生素使用的影响[J].中国实用医药,2018,13(33):157-158.
[7]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(1):31-35.
[8]国家中医药管理局. ZY/T001. 1~001. 9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[9]倪欢.五味消毒饮加味联合抗生素治疗骨创伤术后创口感染疗效观察[J].实用中医药杂志,2017,33(4):395-396.
[10]王新强.清创后持续灌洗联合中药口服治疗腰椎内固定术后早期感染的临床分析[J].黑龙江医学,2019,43(1):12-13,16.
[11]马向阳,杨浩志,邹小宝,等.一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术治疗原发性腰椎间隙感染[J].中国脊柱脊髓杂志,2018,28(8):726-731.
[12]鲁青,马红梅.腰椎内固定术后脑脊液漏的中西医结合防护[J].中国中西医结合外科杂志,2018,24(4):498-500.
[13]高凤云.综合护理干预在椎弓根钉棒内固定术治疗胸腰椎骨折中的应用[J].承德医学院学报,2018,35(4):320-322.
[14]黄子祥.腰椎内固定术后手术部位感染临床分析[D].广州:南方医科大学,2018.
[15]张宏林.后路钉棒内固定术治疗胸腰椎骨折的效果探讨[J].当代医药论丛,2017,15(24):72-73.
[16]孙杰,王俊,彭建国.腰椎内固定术后血清C反应蛋白和红细胞沉降率水平对中期感染的预测作用[J].实用临床医药杂志,2017,21(23):11-14.
[17]聂春燕.手术室综合护理干预在腰椎滑脱经后路椎弓根螺钉内固定术术中的应用效果观察[J].世界最新医学信息文摘,2017,17(95):8-9.
[18]樊元胜,王金凤,樊秀兰,等.五味消毒饮合复康健骨汤联合五水头孢唑林预防胫腓骨骨折术后感染疗效及对血液流变学和炎症因子的影响[J].现代中西医结合杂志,2019,28(10):1089-1093.
[19]张四清,张观辉,林鹏,等.五味消毒饮提取物对脊柱感染大鼠模型的作用价值探讨[J].光明中医,2019,34(3):376-377,444.
[20]姚腾飞,李彦弢.五味消毒饮加味配合抗菌药物预防患者骨创伤术后创口感染的疗效及其对炎症因子水平和创口愈合的影响[J].抗感染药学,2018,15(11):1891-1893.