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

Clinical observation on Wuwei Xiaodu Yin(五味消毒饮) combined with Danggui Buxue Tang(当归补血汤) and antibiotics in preventing postoperative infection in patients with limb fractures

目的:探讨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疗效。方法:2014年10月至2016年3月收治80例四肢骨折患者。开放性骨折患者40例,其中上肢和下肢骨折患者各20例;闭合性骨折患者40例,其中上肢和下肢骨折患者各20例。所有患者均进行手术治疗,常规应用抗生素,同时于术后第1天开始口服五味消毒饮合当归补血汤,每天1剂,连用5 d。分别于术前和术后1、5 d在患者肘正中静脉或贵要静脉抽血,测定静脉血白细胞数量、中性粒细胞比例、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)及血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1)、IL-6的含量。同时随访观察患者的切口愈合情况。结果:开放性上肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(F=8.245,P=0.001;F=15.783,P=0.000;F=20.205,P=0.000;F=16.033,P=0.000;F=67.183,P=0.000;F=170.230,P=0.000;F=142.375,P=0.000)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后5 d(P=0.041,P=0.034,P=0.025,P=0.013,P=0.000,P=0.000,P=0.000;P=0.000,P=0.002,P=0.048,P=0.001,P=0.000,P=0.000,P=0.000)。开放性下肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(F=4.509,P=0.017;F=15.395,P=0.000;F=27.359,P=0.000;F=21.646,P=0.000;F=82.889,P=0.000;F=32.989,P=0.000;F=129.262,P=0.000)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后5 d(P=0.000,P=0.008,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000;P=0.000,P=0.000,P=0.000,P=0.001,P=0.000,P=0.000,P=0.000)。闭合性上肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(F=14.733,P=0.000;F=16.875,P=0.000;F=16.358,P=0.000;F=13.280,P=0.000;F=53.733,P=0.000;F=25.037,P=0.000;F=145.598,P=0.000)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后5 d(P=0.013,P=0.004,P=0.030,P=0.049,P=0.000,P=0.000,P=0.000;P=0.000,P=0.000,P=0.000,P=0.008,P=0.000,P=0.000,P=0.000)。闭合性下肢骨折患者手术前后不同时点之间的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6比较,差异均有统计学意义(F=49.447,P=0.000;F=16.576,P=0.000;F=30.166,P=0.000;F=30.022,P=0.000;F=38.500,P=0.000;F=32.951,P=0.000;F=44.530,P=0.000)。术后1 d时的白细胞数量、中性粒细胞比例、ESR、CRP、TNF-α、IL-1、IL-6均高于术前和术后5 d(P=0.000,P=0.000,P=0.003,P=0.000,P=0.000,P=0.000,P=0.000;P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。术后所有患者均未发生感染,切口均愈合良好。开放性上肢骨折患者切口愈合时间(13.60±2.80)d,开放性下肢骨折患者切口愈合时间(14.10±1.29)d,闭合性上肢骨折患者切口愈合时间(11.80±1.51)d,闭合性下肢骨折患者切口愈合时间(13.60±1.10)d。结论:五味消毒饮合当归补血汤联合抗生素可明显改善血液炎性指标,预防四肢骨折术后感染。

Objective： To explore the clinical curative effects of Wuwei Xiaodu Yin（ 五味消毒饮,WWXDY） combined with Danggui Buxue Tang（ 当归补血汤,DGBXT） and antibiotics in preventing postoperative infection in patients with limb fractures. Methods： Eighty patients with fractures in limbs were recruited from Octomber 2014 to March 2016. Forty patients belonged to open fractures and the factures located in upper limbs for 20 patients and lower limbs for 20 patients. Forty patients belonged to closed fractures and the factures located in upper limbs for 20 patients and lower limbs for 20 patients. All patients were treated with surgery and conventional antibiotics,meanwhile,the patients were treated with oral application of WWXDY and DGBXT from the 1st day after surgery,one dose a day for consecutive 5days. The blood was drawn from the median cubital vein or basilic vein before the surgery and at 1 and 5 days after the surgery respectively.The number white blood cells,neutrophil granulocyte ratio,erythrocyte sedimentation rate（ ESR）,C- reactive protein（ CRP） in the venous blood and the serum contents of tumor necrosis factor- α（ TNF- α）,interleukin- 1（ IL- 1） and IL- 6 were measured. Meanwhile,the patients were followed up for observing incision healing. Results： There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 between different timepoints before and after the surgery for patients with open upper limb fractures（ F = 8. 245,P = 0. 001; F = 15. 783,P = 0. 000; F = 20. 205,P = 0. 000; F = 16. 033,P = 0. 000;F = 67. 183,P = 0. 000; F = 170. 230,P = 0. 000; F = 142. 375,P = 0. 000）. The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 were higher at postoperative day 1 compared to pre- surgery and postoperative day 5（ P = 0. 041,P = 0. 034,P = 0. 025,P = 0. 013,P = 0. 000,P = 0. 000,P = 0. 000; P = 0. 000,P = 0. 002,P = 0. 048,P = 0. 001,P =0. 000,P = 0. 000,P = 0. 000）. There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 between different timepoints before and after the surgery for patients with open lower limb fractures（ F = 4. 509,P = 0. 017; F = 15. 395,P = 0. 000; F = 27. 359,P = 0. 000; F = 21. 646,P = 0. 000; F = 82. 889,P = 0. 000; F =32. 989,P = 0. 000; F = 129. 262,P = 0. 000）. The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 were higher at postoperative day 1 compared to pre- surgery and postoperative day 5（ P = 0. 000,P = 0. 008,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000; P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 001,P = 0. 000,P = 0. 000,P =0. 000）. There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 between different timepoints before and after the surgery for patients with closed upper limb fractures（ F =14. 733,P = 0. 000; F = 16. 875,P = 0. 000; F = 16. 358,P = 0. 000; F = 13. 280,P = 0. 000; F = 53. 733,P = 0. 000; F = 25. 037,P =0. 000; F = 145. 598,P = 0. 000）. The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 were higher at postoperative day 1 compared to pre- surgery and postoperative day 5（ P = 0. 013,P = 0. 004,P = 0. 030,P = 0. 049,P = 0. 000,P = 0. 000,P = 0. 000; P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 008,P = 0. 000,P = 0. 000,P = 0. 000）. There was statistical difference in the number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 between different timepoints before and after the surgery for patients with closed lower limb fractures（ F = 49. 447,P = 0. 000; F =16. 576,P = 0. 000; F = 30. 166,P = 0. 000; F = 30. 022,P = 0. 000; F = 38. 500,P = 0. 000; F = 32. 951,P = 0. 000; F = 44. 530,P =0. 000）. The number of white blood cells,neutrophil granulocyte ratio,ESR,CRP and serum contents of TNF- α,IL- 1 and IL- 6 were higher at postoperative day 1 compared to pre- surgery and postoperative day 5（ P = 0. 000,P = 0. 000,P = 0. 003,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000; P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000,P = 0. 000）. No infections were found in all patients after surgery and all incisions healed well. The incision healing times for patients with open upper limb fractures,open lower limb fractures,closed upper limb fractures and closed lower limb fractures were 13. 60 ＋ /- 2. 80,14. 10 ＋ /- 1. 29,11. 80 ＋ /- 1. 51 and 13. 60 ＋ /-1. 10 days respectively. Conclusion： The application of WWXDY combined with DGBXT and antibiotic can obviously improve blood inflammatory indexes and prevent postoperative infection in patients with limb fractures.