四妙汤加减口服联合湿性敷料对Ⅳ期压力性损伤患者PUSH评分、肉芽组织生长因子的影响

Effects of modified Simiao decoction orally combined with wet dressing on PUSH score and granulation tissue growth factor in patients with stageⅣpressure injury

目的探讨中医四妙汤加减联合湿性敷料治疗Ⅳ期压力性损伤患者的临床效果。方法前瞻性选取2018年6月至2020年6月廊坊市中医医院收治的52例Ⅳ期压力性损伤患者,采用随机数字表法将其分为两组,每组各26例。治疗组采用中医四妙汤加减联合湿性敷料治疗,对照组采用湿性敷料治疗。对比两组的压疮综合评分(PUSH)、压疮渗出液中基质金属蛋白酶9(MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)、创面面积、肉芽组织覆盖相关指标、临床治疗效果。结果治疗前,两组患者的PUSH评分比较,差异均无统计学意义(P>0.05);治疗1、2、4周后,两组患者的PUSH评分均较治疗前降低,且治疗组PUSH评分为(9.75±1.96)、(7.40±1.65)、(3.67±0.86)分,均低于对照组[(11.04±2.26)、(9.16±1.92)、(4.50±1.21)分],差异均有统计学意义(P<0.05)。治疗前,两组的创面面积比较,差异均无统计学意义(P>0.05);治疗2、4周后,两组患者的创面面积均较治疗前降低,且治疗组的创面面积为(6.03±1.82)、(3.41±0.89)cm 2,显著低于对照组[(7.47±1.89)、(4.34±1.10)cm 2],差异均有统计学意义(P<0.05)。治疗前,两组的渗液中的MMP-9、TIMP-1水平比较,差异均无统计学意义(P>0.05);治疗2周后,两组患者的MMP-9、TIMP-1水平均较治疗前降低,治疗组的渗液中的MMP-9、TIMP-1水平为(113.0±23.6)、(3.91±0.80)ng/L,显著低于对照组[(126.6±25.1)、(4.42±0.86)ng/L],差异均有统计学意义(P<0.05)。治疗组的肉芽组织出现时间、肉芽组织覆盖创面时间分别为(5.56±1.83)、(25.15±2.77)d,均低于对照组[(6.62±1.50)、(26.83±2.80)d],差异均有统计学意义(P<0.05)。治疗4周后,治疗组的总体治疗效果优于对照组,差异有统计学意义(P<0.05)。结论中医四妙汤加减联合湿性敷料治疗Ⅳ期压力性损伤有利于减少渗出液,促进肉芽组织生长,促进创面愈合。

Objective To investigate the clinical effect of TCM Simiao Decoction combined with wet dressing in the treatment of patients with stageⅣpressure injury.Methods A total of 52 patients with stage IV pressure injury admitted to Langfang Traditional Chinese Medicine Hospital from June 2018 to June 2020 were retrospectively selected and divided into a treatment group and a control group with 26 cases in each group by random number table method.The control group was treated with wet dressing.The pressure ulcer comprehensive score(PUSH),matrix metalloproteinase 9(MMP-9)and matrix metalloproteinase inhibitor-1(TIMP-1)in the pressure ulcer exudate,wound area,appearance time of granulation tissue,time of granulation tissue covering the wound,and treatment effect were compared between the two groups.Results Before treatment,there was no statistically significant difference in the PUSH score between the treatment group and the control group(P>0.05);after 1,2,and 4 weeks of treatment,the PUSH scores of the two groups were lower than those before treatment,and the PUSH scores of the treatment group were(9.75±1.96),(7.40±1.65),and(3.67±0.86)points,which were lower than those of the control group[(11.04±2.26),(9.16±1.92),(4.50±1.21)points],the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the wound area between the treatment group and the control group(P>0.05);after 2 and 4 weeks of treatment,the wound areas of the two groups were reduced compared with those before treatment,and the wound areas of the treatment group were(6.03±1.82)and(3.41±0.89)cm 2,which were significantly lower than those of the control group[(7.47±1.89),(4.34±1.10)cm 2],the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the levels of MMP-9 and TIMP-1 in the exudate between the treatment group and the control group(P>0.05);after 2 weeks of treatment,the levels of MMP-9 and TIMP-1 in the two groups were lower than those before treatment,and the levels of MMP-9 and TIMP-1 in the exudate of the treatment group were(113.0±23.6),(3.91±0.80)ng/L,which were significantly lower than the control group[(126.6±25.1),(4.42±0.86)ng/L],the differences were statistically significant(P<0.05).The appearance time of granulation tissue and the time of granulation tissue covering the wound surface in the treatment group were(5.56±1.83)and(25.15±2.77)d,which were lower than those in the control group[(6.62±1.50),(26.83±2.80)d],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the overall therapeutic effect of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Modification of TCM Simiao Decoction combined with wet dressing in the treatment of stage IV pressure injury is beneficial to reduce exudate,promote the growth of granulation tissue,and promote wound healing.