VSD联合伤科黄水治疗四肢开放性创面感染的临床研究

Clinical research of vacuum sealing drainage combined with Huang Shui in the treatment of wound infection in extremities

目的探讨封闭式负压引流(VSD)联合伤科黄水治疗四肢开放性创面感染的临床疗效,并初步探讨其相关作用机制。方法选择2016年3月至2017年11月龙川县人民医院外科60例住院的四肢开放性创面感染患者,根据随机数字表法分为VSD联合伤科黄水组(实验组)与VSD负压引流组(对照组)。于治疗后第1、7、14天清晨空腹抽取患者静脉血检测红细胞沉降率(ESR)、C反应蛋白(CPR),并对外周血白细胞(WBC)进行计数;取两组患者治疗第7、14天的创面渗出液,采用ELISA法测定其中白细胞介素-6 (IL-6)及肿瘤坏死因子-α(TNF-α)的表达水平;比较两组患者的肉芽组织生长时间、创面封闭的天数、接受住院治疗的天数、患者发热天数以及换药的次数等临床资料,并对两组患者的总体疗效及创面外观进行评价。结果实验组患者的治疗总有效率为93.3%,明显高于对照组的80.0%,差异具有统计学意义(P<0.05);治疗第7、14天后,两组患者WBC、CRP、ESR均较治疗前显著降低,且实验组患者明显低于同时间点对照组,差异均有统计学意义(P<0.05);治疗第7、14天后,实验组患者的IL-6、TNF-α均较治疗前显著降低,且低于对照组,创面外观评分较治疗前显著升高,且高于对照组,差异均有统计学意义(P<0.05);实验组患者创面封闭、肉芽组织生长及住院时间、发热天数及换药次数分别为(8.7±0.9) d、(10.5±0.8) d、(26.3±1.9) d、(5.6±0.4) d、(6.7±0.4)次,均明显少于对照组的(13.8±1.2) d、(15.6±13.5) d、(39.5±2.7) d、(14.2±1.1) d、(19.8±1.5)次,差异均有统计学意义(P<0.05)。结论联合VSD及伤科黄水治疗四肢开放性创面感染效果显著,其促进创面修复的机制可能与抑制IL-6、TNF-α的表达,改善创面的炎症反应密切相关。

Objective To observe the clinical effect and mechanism of vacuum sealing drainage(VSD) combined with Huang Shui in the treatment of wound infection in extremities. Methods Sixty patients with wound infection in extremities in Department of Surgery, People’s Hospital of Longchuan County from March 2016 to November2017 were selected and divided into two groups: VSD combined with Huang Shui group(study group) and VSD group(control group). Blood samples were collected from peripheral vein 1, 7 and 14 days after treatment for measurement of erythrocyte sedimentation rate(ESR), C-reactive protein(CPR), and white blood cell(WBC). Wound fluid were taken from wound 7 and 14 days after treatment for measurement of interleukin 6(IL-6) and tumor necrosis factor α(TNF-α)by ELISA. The time of granulation tissue growth, the time of wound closure, the days of hospitalization, the times of dressing change, the time of fever, the time of infection control were compared. The overall efficacy and wound appearance of the two groups were evaluated. Results The study group had a higher overall effective rate than the control group(93.3% vs 80.0%, P<0.05). The WBC, CPR, and ESR in the study group at 7 and 14 days after treatment were significantly lower than those before treatment and those in control group at 7 and 14 days after treatment(P<0.05). IL-6 and TNF-α in the study group at 7 and 14 days after treatment were significantly lower than those before treatment, and also significantly lower than those in the control group after treatment. The wound appearance score was significantly higher than that before treatment, and also significantly higher than the corresponding scores in the control group(P<0.05). The time of wound closure, time of granulation tissue growth, days of hospitalization, time of fever, and times of dressing change in the study group were(8.7±0.9) d,(10.5±0.8) d,(26.3±1.9) d,(5.6±0.4) d,(6.7±0.4) times respectively, significantly less than(13.8±1.2) d,(15.6±13.5) d,(39.5± 2.7) d,(14.2±1.1) d,(19.8±1.5) times in the control group(P<0.05). Conclusion VSD combined with Huang Shui is highly effective and safe for the treatment of wound infection in extremities. The wound healing mechanism of VSD combined with Huang Shui in wound infection have been demonstrated to be related to the reduce of the expression of IL-6 and TNF-α.