负压封闭引流技术配合仙方活命饮在创面修复中的应用

发布时间：2018-03-24 03:08

本文选题：创面修复　切入点：封闭负压引流（VSD）　出处：《湖北中医药大学》2014年硕士论文

【摘要】：目的本文主要针对创面的处理过程以及各种技术作出论述，偏重于阐述负压封闭引流技术的运用以及术后配合口服中药方剂仙方活命饮在创面愈合过程中的运用。方法本文研究病例来源于2013年6月—2014年3月湖北十堰市太和医院创伤骨科和门诊随访患者。实验组为使用负压引流(VSD)来治疗的18例患者。实验组中采用的武汉维斯第医用科技有限公司的VSD产品进行治疗；对照组为18例采用了传统的换药方法治疗的患者，对照组采用的是一天一次的换药的方式进行治疗，采用的是通过双氧水或稀碘伏冲洗的传统换药的方法进行。观察两组患者发热的时间以及使用抗生素的天数、通过手术进行清创的时间、手术的方式以及手术的次数；换药的次数、创面处于清洁状态的时间、创面关闭的时间、发生感染的几率、患者住院治疗的时间、愈合的情况以及患者是否发生并发症。另选择20例糖尿病患肢创面，创面采用负压引流技术处理后，选择10例为实验组，术后采用仙方活命饮中药口服治疗，10例为对照组，并未采用中药治疗，对于其术后愈合时间以及截肢率进行观察比较。动物实验采用了健康白兔，对其进行麻醉后，对背部进行皮肤全层以及深筋膜层切开，形成3x3cm的创面。在vsd术后的六、十二小时，一、三、五、七天抽白兔的静脉血进行分析CRP,WBC,IL-6，TNF-a指标。结果 VSD实验组和对照组，在创面中均可以见到肉芽组织的生长，实验组中的18例中，创面明显新鲜，色红，血运丰富，未见没明显组织坏死者明显优于对照组，同时于并发症方面，实验组体温升高，感染等并发症也明显少于对照组。对于术后采用中药口服治疗的实验组相比对照组，在愈合时间以及截肢率上均占优势。动物实验结果，经负压吸引创面的外周WBC，CRP的含量显著性的减少，而TNF-a和IL-6在一天之内显著的增加，一天之后明显下降。结论对于创面较大，无法再一期进行清创并关闭创面的患者，，VSD技术的运用可以加速创面的愈合过程并减少感染几率，为后期的进一步处理提供支持。整体化的VSD治疗能够创造一个适合伤口愈合的外部环境，伤口创面宏应变（物理）以及生物反应（超微）。物理反应能够使得伤口的边缘收缩，能够将感染物质和渗出物排出，使水肿减轻，血液循环加快。超微能够引发组织在微观上的变化，细胞的拉伸，细胞的拉伸使得细胞朝向伤口的表面游移和增生，促进肉芽组织的增生。VSD技术效果良好，应当广泛推广到外科创面的治疗之中。负压引流技术配合仙方活命饮中药口服治疗，能减少患者的痛苦以及缩短疗程，为创面的修复提供了新的思路。
[Abstract]:Purpose. This article mainly discusses the process of wound treatment and various techniques, focusing on the application of negative pressure sealing and drainage technology and the application of Xianhuoxin decoction combined with oral Chinese medicine prescription in wound healing process. Method. The cases were collected from the trauma orthopedic department and outpatient clinic of Taihe Hospital, Shiyan City, Hubei Province from June 2013 to March 2014. The experimental group was treated with negative pressure drainage and VSD. Wuhan Weiss was used in the experimental group. Medical Technology Co., Ltd. VSD products for treatment; The control group consisted of 18 patients who had been treated with traditional methods of dressing change, while the control group was treated with a daily change of medicine. The patients in the two groups were observed the time of fever and the days of using antibiotics, the time of debridement, the way of operation and the times of operation. The times of dressing change, the time of wound cleaning, the time of wound closing, the chance of infection, the time of hospitalization, the condition of healing and the complications. In addition, 20 cases of diabetic limb wounds were treated with negative pressure drainage technique, 10 cases were selected as experimental group, 10 cases were treated with Xianfang Huoxing decoction orally after operation, 10 cases were treated with traditional Chinese medicine, and 10 cases were not treated with traditional Chinese medicine. The healing time and amputation rate were observed and compared. Healthy white rabbits were used in the animal experiment. After anaesthesia, the whole skin layer and deep fascia layer of the back were cut off to form the 3x3cm wound. The venous blood samples were collected from rabbits on the third, fifth and seventh days to analyze the index of IL-6 and TNF-a. Results. The growth of granulation tissue could be seen in both VSD group and control group. In the 18 cases of experimental group, the wound was obviously fresh, red and abundant in blood supply. The complications such as temperature rise and infection in the experimental group were significantly lower than those in the control group. The healing time and amputation rate of the experimental group treated with oral Chinese medicine after operation were superior to those of the control group. The contents of WBC C C C P in peripheral wound attracted by negative pressure decreased significantly, while TNF-a and IL-6 increased significantly in one day and decreased significantly after one day. Conclusion. The use of VSD technology in patients with large wounds who are unable to debridement and close the wound in one stage can accelerate the healing process of the wound and reduce the chance of infection. Provide support for later treatment. Integrated VSD therapy can create an external environment suitable for wound healing, and wound macro strain (physics) and biological response (ultramicro physical response) can make the wound edge contract. It can expel infected substances and exudates, reduce edema, accelerate blood circulation. Ultrastructure can trigger microcosmic changes in tissue, stretching cells, stretching cells, causing cells to move and proliferate toward the surface of the wound. The technique of promoting the proliferation of granulation tissue. VSD has a good effect and should be widely used in the treatment of surgical wounds. The negative pressure drainage technique combined with the oral treatment of Xianfang Huoxing decoction can reduce the pain of patients and shorten the course of treatment. It provides a new idea for wound repair.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687

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