中医药联合治疗开放性骨折及对围手术期炎性相关因子的影响

Integrated Chinese Medicine Therapy for Open Fracture and the Effect on Related Inflammatory factors in Perioperative Period

目的:观察中医药联合治疗在开放性骨折切口(Ⅲ类骨折切口)围手术期防治感染中的临床疗效。方法:将在本院住院的80例四肢开放性骨折患者(上、下肢各40例),采用随机原则各自分为对照组及观察组各20例。对照组采用临床常规用药治疗,观察组采用中药配合临床常规用药治疗。各组术前、术后1天、术后5天抽血行ELISA检测查肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)及白细胞介素-6(IL-6)等指标含量。结果:2组开放上肢手术切口各时间段TNF-α、IL-1、IL-6等指标比较:(1)治疗前后不同时间段TNF-α、IL-1、IL-6分别比较,差异均有统计学意义(P<0.05),提示各指标的变化存在时间效应。(2)观察组各指标与对照组在总体上比较,差异均无统计学意义(P>0.05),提示各指标不存在分组效应。(3)2组IL-6的时间因素与分组因素均不存在交互效应,差异无统计学意义(P>0.05)。而TNF-α、IL-1的时间因素与分组因素存在交互效应,差异均有统计学意义(P<0.05)。综上提示,术后1天2组各项指标TNF-α、IL-1、IL-6均最高,后随时间逐渐降低,且2组间比较,观察组各指标下降值更明显。2组开放下肢手术切口各时间段TNF-α、IL-1、IL-6等指标比较:(1)治疗前后不同时间段TNF-α、IL-1、IL-6分别比较,差异均有统计学意义(P<0.05),提示各指标的变化存在时间效应。(2)观察组各指标与对照组在总体上比较,差异均无统计学意义(P>0.05),提示各指标不存在分组效应。(3)2组TNF-α、IL-1的时间因素与分组因素均不存在交互效应,差异均无统计学意义(P>0.05);IL-6的时间因素与分组因素则存在交互效应,差异有统计学意义(P<0.05)。2组开放上肢、下肢皮肤切口愈合时间比较,差异均无统计学意义(P>0.05)。结论:中医药联合治疗方案对在开放骨折围手术期炎性细胞因子释放具有一定的抑制作用,对切口的愈合具有一定促进作用。

Objective： To observe the clinical effect of integrated Chinese medicine therapy in the prevention and treatment of infection of open fracture incision（type Ill fracture incision） during perioperative period. Methods. Divided 80 cases of patients with open limb fracture（upper limb fracture and lower limb fracture, 40 cases for each type） in the hospital into the control group and the observation group randomly, 20 cases in each group. The control group received routine medication, while the observation group was treated with Chinese medicine combined with routine medication. Before operation, and on the first day and the fifth day after operation, enzyme-linked immunosorbent assay（ELISA） was used to determine the content of tumor necrosis factor-cx （TNF-co）, interleukin-1 （IL-1） and interleukin-6（IL-6） in both groups by haemospasia. Results： Compared TNF-α, IL-1 and IL-6 of open upper limb incision at different periods： ①Respectively compared TNF-α, IL-1 and IL-6 at different periods before and after treatment, differences were significant （P 〈 0.05）, suggesting that changes of all indexes showed time effect. ②Compared all indexes in the observation group with those in the control group, there was no significance being found in differences（P〉0.05）, which indicated that the indexes showed no grouping effect. ③There was no interaction effect between time factor and grouping factor of IL-6 in both groups, the difference being not significant（P 〉0.05）. However, time factors and grouping factors of TNF-α and IL-1 in both groups showed interaction effect, differences being significant（P〈0.05）. The above results implied that TNF-α, IL-1 and IL-6 in both group were the highest on the first day after operation, and then decreased with time. Each index was reduced more obviously in the observation group. Compared TNF-α, IL-1 and IL-6 of open lower limb incision at different periods： （α Respectively compared TNF-α, IL-1 and IL-6 at different periods before and after treatment, differences were significant （P〈0.05）, suggesting that changes of all indexes showed time effect. ② Compared all indexes in the observation group with those in the control group, there was no significance being found in differences（P〉0.05）, which indicated that the indexes showed no grouping effect. ③There was no interaction effect between time factors and grouping factors of TNF- α and IL-1 in both groups, the difference being not significant（P〉 0.05）. Never the less, time factor and grouping factor of IL-6 in both groups showed interaction effect, the difference being significant（P〈0.05）. There was no significance being found in the comparison of the healing time between open upper limb incision and lower limb incision in the two groups （P 〉 0.05）. Conclusion. Integrated Chinese medicine therapy has certain inhibiting effect on inflammatory factors of open fracture incision during perioperative period, and it can promote the healing of skin incision.