中西医联合治疗对闭合性骨折围手术期炎症的影响

The effect of combined treatment of Chinese and western medicine on perioperative inflammation of fracture

目的:探讨中西医联合治疗对闭合性骨折围手术期防治感染的疗效。方法:选取2014年10月至2016年3月慈溪市中医医院收治的四肢闭合性骨折患者80例,其中上下肢各40例,分为对照组和观察组各20例。对照组采用临床常规用药:术前消肿止血对症治疗,预防性使用抗生素;术后继续预防感染、消肿止痛、止血、促骨生长等对症治疗为主。观察组采用中药配合临床常规用药治疗:中药由五味消毒饮合当归补血汤组成,主方:金银花12 g、野菊花12 g、蒲公英30 g、天葵子15 g、紫花地丁15 g、黄芪30 g、当归6 g。各组患者于术前1 d、术后1 d、术后5 d检测C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞计数(WBC)、中性粒细胞(NEU)比值等血常规指标以及肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)及白细胞介素-6(IL-6)等指标。结果:对照组和观察组上下肢闭合性骨折患者CRP、ESR、WBC、NEU比值、TNF-α、IL-1及IL-6等指标在术后1 d最高,术后5 d逐渐降低,差异有统计学意义(P<0.01),且对比发现观察组术后各指标相同时段下降较对照组更为明显。后期随访发现对照组中有2例感染病例,观察组无感染患者。结论:骨折围手术期中西医联合治疗能拟制炎性介质释放,其在防治感染方面可能具有一定的加强效果。

Objective： To explore the clinical curative effect of combined traditional Chinese medicine and western medicine in the treatment of infection in perioperative period of fracture. Methods： A total of 80 patients with closed fractures of extremities （upper and lower limbs） in Cixi Traditional Chinese Medicine Hospital from October 2014 to March 2016 were included. They were divided into the control group （clinical routine medicine） and the observation group （traditional Chinese medicine combined with clinical routine medicine）. For each group of patients, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, white blood cell count （WBC）, neutrophil （NEU） ratio, tumor necrosis factor-α （TNF-α）, interleukin-1 （IL-1） and interleukin-6 （IL-6） were mea-sured. Results： The CRP, ESR, WBC, NEU ratio, TNF-α, IL-1, IL-6 of the control group and observation group were the highest at 1 day after operation, then decreased at 5 days after operation, the difference was statisti-cally signifcant （P〈0.01）. And the decrease of the observation group was more obvious. It was found in the late follow-up that there were 2 cases of infection in the control group and no infection patients in the observation group. Conclusion： The combined treatment of traditional Chinese medicine and Western medicine in periopera-tive period of fracture can decrease the infammatory medium release, which may produce and added effect on the prevention of infection.