骨筋膜室综合征患者VSD术后中药与高压氧联合治疗与常规治疗对比

发布时间：2018-04-07 17:39

本文选题：骨筋膜室综合征　切入点：VSD　出处：《大连医科大学》2017年硕士论文

【摘要】：骨筋膜室综合征是肢体创伤后发生在四肢特定的筋膜间隙内的进行性改变,其主要特点为血循环障碍进行性加重,随之出现神经肌肉的严重缺血的症状,甚至组织坏死,最多见于前臂掌侧和小腿。骨筋膜室综合征的早期诊断和及时治疗尤为重要,因为神经肌肉组织缺血缺氧达到一定时间后随即会出现不可逆的坏死及损害。不仅严重影响了肢体功能,甚至可以导致截肢,危及患者的生命,因此一旦确诊需立即切开减压。1994年,VSD负压封闭引流技术被引入后,在外科领域中,这一技术被广泛应用。VSD负压引流术的优势:骨筋膜室综合征减张术后的切口可以有效处理,避免传统减压术后频繁换药,降低了术后并发症的发生。但是单纯VSD负压引流术仍然存在改善患肢缺血情况相对缓慢、发生并发症的风险大、病程长、住院天数多、患者经济负担重等问题。目的:本研究主要对骨筋膜室综合征患者VSD术后通过中药与高压氧联合治疗的方法与常规治疗进行对比,探讨中西医结合治疗方法的疗效,指导临床工作。方法:通过对符合标准的研究对象分组,分为A常规组、B常规+中药治疗组、C常规+高压氧治疗组、D常规+中药+高压氧联合治疗组。A常规组:给予骨筋膜室综合征患者VSD术后消肿、预防静脉血栓、定期换药以预防切口感染等常规治疗;B常规+中药组:给予常规治疗的基础上行口服中药(身痛逐瘀汤)辅助治疗;C常规+高压氧组:给予常规治疗基础上行高压氧(HBO)辅助治疗;D常规+中药+高压氧联合治疗组:给予常规治疗基础上行中药内服与高压氧HBO联合治疗。运用spss19.0分组对比,对常规组、常规+中药组、常规+高压氧组、常规+中药+高压氧联合治疗组的各项数据进行分析,对各组患者的改善循环情况、血栓发生率、切口感染率、Ⅱ期伤口植皮率等方面进行对比分析。结果:A常规组患者的改善循环效果总有效率80%,发生血栓率3.2%,肉芽组织良好无感染52%,可行Ⅱ期伤口植皮术48%;B常规+中药组患者的改善循环效果总有效率88%,发生血栓的几率1.6%,肉芽组织良好无感染64%,可行Ⅱ期伤口植皮术36%;C常规+高压氧组患者的改善循环效果总有效率88%,发生血栓率2.4%,肉芽组织良好无感染72%,可行Ⅱ期伤口植皮术28%;D常规+中药+高压氧联合治疗组患者的改善循环效果总有效率92%,发生血栓率0.8%,肉芽组织良好无感染80%,可行Ⅱ期伤口植术20%。D常规+中药+高压氧联合治疗组各方面均明显优于A对照组、B常规+中药组、C常规+高压氧组,且差异有统计学意义(PO.05)。结论:1.使用中药辅助骨筋膜室综合征患者VSD术后治疗可以改善血液循环、降低静脉血栓发生率、促进组织修复减少切口感染。2.使用高压氧辅助骨筋膜室综合征患者VSD术后治疗有利于改善血液循环、促进切口愈合、降低切口感染率。3.骨筋膜室综合征VSD术后患者使用中药与高压氧联合治疗具有消除患肢肿胀、改善血液循环;降低静脉血栓的发生率;促进创面修复、减少切口感染的优点。
[Abstract]:Osteofascial compartment syndrome occurred after limb trauma in compartment specific limbs within the change, the main characteristics of blood circulation disorder progressive, severe ischemia appears neuromuscular symptoms, even necrosis is seen most frequently in the palmar side of the forearm and lower leg. Early diagnosis of compartment syndrome and timely treatment is particularly important, because the nerve muscle tissue ischemia and hypoxia immediately after a certain period of time will appear necrosis and irreversible damage. Not only seriously affected limb function, and can lead to amputation, endangering the lives of patients, so once the diagnosis should immediately open decompression.1994, VSD vacuum sealing drainage technology is introduced, in the field of surgery, this technology has been widely applied in.VSD negative pressure drainage advantage: compartment syndrome reduce tension after the incision can be treated effectively, avoid the traditional decompression after frequent Dressing, reduce the incidence of postoperative complications. However, there are still VSD negative pressure drainage improve limb ischemia is relatively slow and the risk of complications, disease duration, hospitalization days, problems of the economic burden of the patients weight. Objective: This study of osteofascial compartment syndrome in patients with VSD after operation method traditional Chinese Medicine combined with hyperbaric oxygen therapy compared with conventional therapy, to evaluate the clinical efficacy of combined treatment of traditional Chinese medicine and Western medicine, to guide clinical work. Methods: the research object to conform to the standards of the grouping, divided into A normal group, conventional B plus traditional Chinese medicine treatment group and routine C + HBO group, D + + conventional Chinese medicine hyperbaric oxygen combined treatment group.A group were given conventional osteofascial compartment syndrome in patients with VSD after swelling, prevention of venous thrombosis, regular dressing to prevent wound infection and other conventional treatment; B group: conventional + traditional Chinese medicine based on routine treatment in oral administration The medicine (Shentongzhuyu Decoction) adjuvant therapy; conventional C + hyperbaric oxygen group was given conventional treatment plus hyperbaric oxygen (HBO) therapy; D + TCM + hyperbaric oxygen combined with conventional treatment group: treated with the combination therapy of conventional treatment based on Chinese medicine and hyperbaric oxygen HBO. Using the spss19.0 group compared to the conventional the conventional group, and traditional Chinese medicine group, normal + hyperbaric oxygen group, the conventional data + Chinese medicine + hyperbaric oxygen combined treatment group were analyzed to improve the circulation of patients in each group, the incidence of thrombosis, wound infection rate, wound grafting rate on phase II were analyzed. Results: improve the circulation effect of A patients in the conventional group the total efficiency of 80%, thrombosis rate was 3.2%, 52% good granulation tissue without infection, wound skin grafting feasible II 48%; improve the circulation effect of conventional B + Chinese medicine group total effective rate 88%, the probability of thrombosis in 1.6%, infection in 64% no good granulation tissue, feasible Phase II wound skin grafting in 36%; improve the circulation effect of conventional C + hyperbaric oxygen group with total efficiency of 88%, thrombosis rate was 2.4%, 72% good granulation tissue without infection, wound skin grafting feasible II 28%; improve the circulation effect of D plus conventional medicine + hyperbaric oxygen combined with patients in the treatment group the total effective rate was 92%, incidence thrombosis rate was 0.8%, 80% good granulation tissue without infection, wound implantation feasible II routine 20%.D + Chinese medicine + hyperbaric oxygen combined therapy group were significantly better than the conventional A control group, B + Chinese medicine group, conventional C + HBO group, and the difference was statistically significant (PO.05). Conclusion: treatment of 1. Chinese medicine auxiliary osteofascial compartment syndrome patients after VSD can improve blood circulation, reduce the incidence of venous thrombosis, promote tissue repair wound infection.2. using hyperbaric oxygen therapy of osteofascial compartment syndrome patients after VSD therapy can improve blood circulation, promote wound healing To reduce wound infection rate,.3. combined with hyperbaric oxygen therapy after VSD for patients with osteofascial compartment syndrome can eliminate limb swelling and improve blood circulation, reduce incidence of venous thrombosis, promote wound repair and reduce wound infection.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R686.3

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