中药内服外敷治疗下肢丹毒所致淋巴水肿的临床效果

Clinical efficacy of internal and external application of Chinese materia medica in the treatment of lower extremity erysipelas-induced lymphedema

目的 探讨中药内服外敷治疗下肢丹毒所致淋巴水肿的临床效果。方法 选择杭州市第三人民医院2020年1~10月外科和急诊外科接诊的60例下肢丹毒引起淋巴水肿患者进行研究,采用随机数字表法分为观察组和对照组,每组各30例,对照组给予阿莫西林克拉维酸钾序贯抗感染治疗,观察组在对照组基础上给予大黄牡丹汤内服外敷治疗,两组患者均连续治疗2周。治疗2周后,比较两组治疗前、治疗2周后,血清C-反应蛋白(CRP)、D-二聚体(DD)、收缩期速度峰值(PSV),舒张末期血流速度(EDV),阻力指数(RI)、血流量、血液黏度、血浆黏度、红细胞比容、红细胞聚集指数水平变化情况及不良反应。结果 治疗后,观察组血清CRP、DD指标水平均明显低于对照组,差异有统计学意义(P<0.05);治疗后,观察组PSV、EDV、血流量水平均明显高于对照组,RI、血液黏度、血浆黏度、红细胞比容、红细胞聚集指数的水平均明显低于对照组,差异有统计学意义(P<0.05);两组患者不良反应发生情况进行比较,差异无统计学意义(P>0.05)。结论 中药内服外敷联合西药治疗下肢丹毒引起淋巴水肿能明显降低血清CRP、DD的表达,提高PSV、EDV、血流量的水平,改善血液流变学指标,在临床中值得推广。

Objective To explore the clinical efficacy of internal and external application of Chinese materia medica(CMM) in the treatment of lower extremity erysipelas-induced lymphedema. Methods A total of 60 patients with lower extremity erysipelas-induced lymphedema admitted to the Department of Surgery and Department of Emergency Surgery in Hangzhou Third People′s Hospital from January 2020 to October 2020 were selected as study subjects,and they were divided into the observation group and the control group according to the random number table method, with30 patients in each group. The control group was given sequential anti-infection treatment with amoxicillin and clavulanate potassium, while the observation group was given internal and external application of Dahuang Mudan decoction on the basis of the treatment in the control group. Patients in both groups were treated for 2 consecutive weeks. After 2 weeks of treatment, the two groups were compared in terms of the changes in the levels of serum C-reactive protein(CRP), D-dimer(DD), peak systolic velocity(PSV), end-diastolic velocity(EDV), resistance index(RI), blood flow,blood viscosity, plasma viscosity, hematocrit and erythrocyte aggregation index, as well as the occurrence of adverse reactions before and after 2 weeks of treatment. Results After treatment, the levels of serum CRP and DD in the observation group were significantly lower than those in the control group, with statistically significant differences(P<0.05). After treatment, the levels of PSV, EDV and blood flow were significantly higher and the levels of RI,blood viscosity,plasma viscosity, hematocrit and erythrocyte aggregation index were significantly lower in the observation group than those in the control group, with statistically significant differences(P<0.05).There were no statistically significant differences between the two groups in the occurrence of adverse reactions(P>0.05). Conclusion In the treatment of lower extremity erysipelas-induced lymphedema, internal and external application of CMM combined with western medicine can significantly reduce the expression levels of serum CRP and D-D, increase the levels of PSV, EDV and blood flow, and improve the blood rheological indexes, which is worthy of promotion in clinic.