血府逐瘀汤在闭合性肝损伤保守治疗中的临床应用

Clinical Study of Xuefu Zhuyu Decoction in Closed Hepatic Injury with Conservative Treatment

目的:探讨血府逐瘀汤在闭合性肝损伤保守治疗中的临床效果。方法:回顾性分析收治的58例闭合性肝损伤患者资料,根据美国创伤学会器官损伤分级(OIS)均为I级-III级损伤,其中28例单纯采用常规治疗方法(常规组),30例在常规治疗基础上联合口服血府逐瘀汤(中药组),比较两组不同分级患者的手术中转率、腹腔积液平均好转天数、肝内挫伤平均好转天数及包膜下血肿消失平均天数。结果:在OIS为I级、II级、III级肝损伤患者中,中药组的腹腔积液平均好转天数、肝内挫伤平均好转天数分别为OIS I(3.2±1.0)d,(4.8±1.2)d;OIS II(3.0±0.8)d,(4.6±1.0)d;OIS III(4.3±0.6)d,(6.3±0.6)d。而常规组的腹腔积液平均好转天数、肝内挫伤平均好转天数分别为OIS I(4.6±1.0)d,(6.3±1.6)d;OIS II(5.7±2.1)d,(5.8±1.5)d;OIS III(7.0±1.4)d,(10.0±2.8)d。两组比较有差异。OIS为II级的肝损伤患者中,中药组无中转手术率,而常规组为25%,有显著差异(P<0.05)。结论:加服血府逐瘀汤有助于降低OIS II级肝损伤的手术中转率,缩短OIS I级、II级、III级肝损伤腹腔积液及肝内挫伤的好转,具有一定的临床应用价值。

Objective To explore the clinical effect of Xuefu Zhuyu Decoction（XFZYD） in closed hepatic injury with conservative treatment. Methods Fifty-eight cases with closed hepatic injury were retrospectively analyzed, according to the organ injury scale（OIS） by American Association for Surgery of Trauma, all injuries were grade I to grade Ⅲ. Among them, 28 cases were treated by routine methods only （routine treatment group）, the other 30 cases were treated by routine methods combined with oral XFZYD（Chinese traditional medicine group）. The conversion to surgery rate, the mean days for improvement of peritoneal effusion, liver contusion and the mean days for disappearance of subcapsular hematoma were compared in different grades of the two groups. Results In patients with liver injury OIS grades I, II and III, the mean days for improvement of peritoneal effusion and liver contusion in Chinese traditional medicine （TCM）group were OIS I（3.2±1.0）d,（4.8±1.2）d;OIS II（3.0±0.8）d,（4.6±1.0）d;OIS Ⅲ（4.3±0.6）d,（ 6.3±0.6）d respectively. Yet the mean days for improvement of peritoneal effusion and liver contusion in routine treatment group were OIS I（4.6±1.0）d,（6.3±1.6）d;OIS II （5.7±2.1）d,（ 5.8±1.5）d;OISⅢ（7.0±1.4）d,（ 10.0±2.8）d respectively. There were differences between the two groups. In patients with liver injury OIS II grade, there was no conversion to surgery rate in TCM group, yet the conversion to surgery rate was 25% in routine treatment group, with significant differences between the two groups（P〈0.05）. Conclusion Combination with XFZYD could reduce the mean days for improvement of peritoneal effusion and liver contusion in OIS I, II and Ⅲ patients and reduce the conversion to surgery rate in OIS II patients, with certain clinical value.