“给邪出路”理论对减少软组织急性化脓性感染抗菌药物使用的效果评估

Evaluation of effect on reducing dosage of antibiotics as ＂pathogen to outlet＂ theory applied in treatment of patients with acute suppurative infection in soft tissues

目的评估“给邪出路”理论对减少软组织急性化脓性感染抗菌药物使用的效果。方法选择2012年1月至2015年10月天津中医药大学第二附属医院中医外科收治的软组织急性化脓性感染患者80例，将患者按随机数字表法分为给邪出路组和抗菌药物组，每组40例。给邪出路组原则上所有患者治疗期间均不使用抗菌药物，但治疗期间出现全身炎症反应综合征（SRIS）时需考虑应用抗菌药物；对于痈、脓肿及甲沟炎均采用电火针洞式引流术，常规消毒皮肤后，在脓肿波动明显处皮内浸润麻醉，然后用空针自准备切口处进行穿刺抽脓，当抽到脓液后，慢慢退出针头，随退随吸，待不能继续抽出脓液时，在皮下组织内的针头长度即等于脓肿的深度，可作为切开时的参考，然后以电火针在穿刺点做一圆形切口，全层电灼气化脓肿壁组织，引流口大小视感染程度决定，一般直径在0．5～1．5cm，将其中脓性坏死组织充分清除，勿损伤炎症带，否则易引起感染扩散，电火针洞式引流术后常规负压抽吸治疗。抗菌药物组外科治疗方法与给邪出路组相同，并在菌培养结果回报前经验性给予抗菌药物治疗，菌培养结果报告后选择敏感抗菌药物针对性治疗。观察两组治疗5d后白细胞计数（WBC）、C-反应蛋白（CRP）水平及伤口愈合时间、伤口细菌培养情况、全身炎症反应综合征（SRIS）等并发症的发生情况。结果随治疗时间的延长，两组治疗后WBC、CRP均较治疗前降低，治疗后5d与治疗前比较差异有统计学意义[WBC（×109／L）：给邪出路组为6．72±1．15比10．21±1．22，抗菌药物组为6．81±1．25比10．53±1．31；CRP（mg/L）：给邪出路组为14．83±4．92比38．21±8．92，抗菌药物组为12．32±4．25比37．42±7．73，均P〈0．05]，但两组间各指标比较差异均无统计学意义（均P〉0．05）。给邪出路组与抗菌药物组痈、脓肿、甲沟炎的愈合时间[痈（d）：12．3±3．4比11．8±3．7，脓肿（d）：16．2±3．5比14．9±3．1，甲沟炎（d）：9．5±2．1比10．1±2．4]和SIRS、感染扩散等并发症例数比较差异均无统计学意义（SIRS：3例比1例，感染扩散：3例比3例，均P〉0．05）。治疗后抗菌药物组伤口病原菌株数量较给邪出路组明显减少（10例比23例），且革兰阳性（G’）菌感染数明显降低（3例比16例，P〈0．05）。结论“给邪出路”理论指导治疗软组织急性化脓性感染可减少抗菌药物使用，对改变目前国内抗菌药物滥用情况具有积极意义，也是将中医理念引入西医临床治疗的一种尝试。

Objective To evaluate the effect of ＂pathogen to outlet＂ o1＂ ＂giving an otitlet for pathogen＂ theory in traditional Chinese medicine （TCM） on reducing the antibiotic dosage used for treatment of patients with acute suppurative infection of soft tissues. Methods Eighty patients with acute suppurative infection of soft tissue admitted to the Department of TCM Surgery of the Second Affiliated Hospital, Tianjin University of TCM from January 2012 to October 2015 were randomly divided into pathogen to outlet group and antibiotic group, 40 cases in each group. The principle was no use of antimicrobial agents for all the patients in pathogen to outlet group, but when systemic inflammatory response syndrome （SRIS） occurred during the treatment, it was necessary to consider the use of antibiotics. Electric needle hole drainage was used for carbuncle, abscess and paronychia, after routine disinfection of skin abscess, intra-dermal infiltration of topical anesthesia was made at the top of prominent abscess fluctuation, and then a needle with empty syringe was used to puncture at the area ready for skin incision and suction of the pus in the abscess cavity, when the pus was continuously suctioned out into the syringe, simultaneously the needle was gradually withdrawn till the pus unable to be suctioned out, thus the needle length under the subcutaneous tissue was equal to the depth of the abscess, which could be used as a reference during making an incision; and then an eleetrocautery needle was applied to make a circular incision at the puncture point.