一效膏外敷联合负压封闭引流治疗臁疮随机平行对照研究

Yixiao Ointment(一效膏) combined with Vacuum Sealing Drainage in the Treatment of a Randomized Controlled Trial of Ecthyma

[目的]观察一效膏外敷联合负压封闭引流治疗臁疮疗效。[方法]使用随机平行对照方法,将36例住院患者按病志号抽签方法简单随机分为两组。对照组18例一效膏外敷（朱砂、煅石膏、滑石、冰片等）适量,与香油调和至稠状;急性期疮周红肿消退后,均匀涂抹于油砂上,消毒清创后外敷于患处,勿过疮面范围,以免腐蚀周围正常皮肤;治疗期间蚕食清创,以使药效充分发挥。治疗组18例负压封闭引流,仰卧位,清除坏死组织,按疮面形状裁剪负压封闭引流敷料,充分接触疮面,避免压迫疮缘皮肤,内置引流管;半透膜覆盖,范围〉疮周2~3cm,封闭术区,借助三通接头将引流管接引流瓶,连接床头负压吸引装置,压力0.02~0.04m Pa,填入泡沫块明显瘪陷,引流管凸显,薄膜下无积液,持续负压封闭吸引7~10d,其间使用0.9%氯化钠500m L及5%甲硝唑250m L,1次/d,冲洗疮面,并冲管,观察有无引流管堵塞及泡沫鼓起,及时处理,确保负压引流有效进行;7~10d后,解除负压装置,打开敷料,观察疮面,根据肉芽、腐肉及分泌物情况,决定是否清疮,如疮面仍较差,更换敷料,再行负压吸引一周甚至更长;待疮面肉芽红活,分泌物及腐肉减少后,行疮面细菌培养,以一效膏外敷。连续治疗7d为1疗程。观测临床症状、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组痊愈13例,显效3例,有效1例,无效1例,总有效率94.44%。对照组痊愈7例,显效1例,有效2例,无效8例,总有效率66.67%。治疗组疗效优于对照组（P〈0.05）。[结论]一效膏外敷联合负压封闭引流技术治疗臁疮,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the efficacy of Yixiao ointment and vacuum sealing drainage in the treatment of patients with ecthyma.[Methods] Using random parallel control method,36 cases of hospitalized patients were randomly divided into two groups according to the random number of the disease.Control group （n=18） taked appropriate Yixiao ointment （cinnabar, calcined gypsum, talc, borneol, etc.）to apply,and sesame oil to reconcile in the form of a thick; acute sore weeks swelling subsided, evenly coated in the oil sands, disinfection after debridement and external application on the surface of the skin,avoid exceeding the scope of the wound, lest corrosion in the surrounding normal skin; during treatment nibble dehridement, in order to make the effect into full play.Treatment group （n=18）used VSD,taked supine,and removalled of necrotic tissue,cutted VSD dressings according to the shape of wound to full contact sores,avoid pressure sores edge skin,then internal tube drainage; membrane covered the range of 2-3cm weeks,sores,closed operation area,with three joint through the drainage tube connected the drainage bottle,connectted the bed pressure suction device,pressure was 0.02-0.04mPa,filled with a foam block was sunken,drainaged tube prominent,to ensure no effusion film,then continuous VSD 7-10d,with 0.9% sodium chloride 500mL and 5% metronidazole 250mL,1/d,washed the wound, and flushed pipe,observed no drainage tube blockage and the bubble up in time,ensured the effective drainage;after 7-10d, terminated the negative pressure device,and opened wound ressing,then observed,according to the granulation,carrion and secretions,decided whether to debridement.If the sore is still poor,dressing changed,then continued negative pressure attract a week or even longer;Until the wound granulation and the reduction of secretion and carrion,bacterial culture of wound surface and take appropriate Yixiao ointment to aply.Continuous treatment for 1 courses of 7d.Observation of clinical symptoms and adverse reactions.Continuous treatment for 3 courses of treatment,to determine effieaey.[Results] In the treatment group,13 cases were cured,3 cases were markedly effective,1 cases were effective,1 cases were ineffective,the total effective rate was 94.44%.In the control group,7 cases were cured,1 cases were markedly effective,2 cases were effective,8 cases were ineffective, the total effective rate was 66.67%.The curative effect of the treatment group was better than that of the control group （P〈0.05）. [Conclusion] The efficacy of Yixiao ointment combined with vacuum sealing drainage in the treatment of patients with ecthyma were satisfactory.With no serious adverse reactions, and worth to promot.