五黄液联合VSD治疗肢体开放性损伤伴皮肤缺损患者的临床研究

Clinical Effect of Wuhuang Decoction Combined with VSD on Patients with Limbs Open Injury and Skin Defect

目的观察五黄液联合负压封闭引流技术(VSD)治疗肢体开放性损伤伴皮肤缺损的疗效及并探讨其作用机制。方法将开放性损伤伴皮肤缺损患者80例随机分为两组。在基础治疗上治疗组采用五黄液联合VSD治疗,对照组采用0.9%氯化钠注射液联合VSD治疗。比较两组患者治疗效果、平均恢复时间(肉芽组织生长时间、上皮组织生长时间)、感染率、VSD使用次数、二期植皮平均时间、平均住院费用、血管内皮细胞生长因子(VEGF)的表达等。结果治疗组优良率为92.50%,显著高于对照组的72.50%(P<0.05);治疗组使用VSD次数明显少于对照组;治疗组感染率,平均住院费用均低于对照组,平均恢复时间、二期植皮平均时间两项均短于对照组(P<0.05),免疫组化结果显示治疗组创缘组织中VEGF的表达显著高于对照组(P<0.05)。结论五黄液联合VSD治疗较单纯0.9%氯化钠注射液联合VSD对肢体开放性损伤皮肤缺损创面具有更强的修复作用,刺激创面肉芽组织VEGF表达加速可能是该作用的机制。

Objective： To investigate the clinical effect and mechanism of Wuhuang Decoction combined with vacuum sealing drainage（VSD） technique on limbs open injury with skin defect in 40 cases. Methods： 80 cases of open injury with skin defect were randomly divided into 40 cases in the treatment group and 40 cases in the control group. Based on the treatment of wound debridement and fracture for the corresponding fixation,the treatment group was treated with Wuhuang Decoction combined with VSD;the control group used saline combined with VSD. The treatment effect,mean recovery time（granulation tissue growth time,epithelial tissue growth time）,infection rate,VSD frequency,average time of two stage skin graft,average hospitalization expenses and expression of vascular endothelial growth factor（VEGF） were compared between the two groups. Results： The treatment effect evaluation of the excellent rate of the treatment group（92.50%） was significantly higher than that of the control group（72.50%）（P〈0.05）;the frequency of VSD using in the treatment group was significantly less than that of the control group;the infection rate and the average hospitalization expenses of the treatment group were lower than those the control group;the average recovery time and the average time of two stage skin grafting was shorter than that of the control group（P〈0.05）;immunohistochemistry results showed that the VEGF expression of wound margin tissues in the treatment group was significantly higher than that of the control group（P〈0.05）. Conclusion： Wuhuang Decoction combined with vacuum sealing drainage（VSD） technique has a better repair effect than only 0.9% sodium chloride injection combined with VSD on limbs open injury and skin defect,and its mechanism may be to stimulate the VEGF expression of granulation tissue,and make it accelerate.