蛭龙活血通瘀胶囊在断指再植术后抗凝替代的临床应用研究

发布时间：2018-05-30 02:47

本文选题：断指再植 + 蛭龙活血通瘀胶囊　；参考：《四川医科大学》2015年硕士论文

【摘要】：目的:评价蛭龙活血通瘀胶囊(leech earthworm activating blood stasis capsule)在断指再植术后抗凝替代应用的有效性及安全性。方法:⑴纳入泸州医学院附属中医院手外科2014年6月至2014年12月符合条件的住院病人100例,随机分为两组:研究组在常规抗感染,抗痉挛基础上联合口服蛭龙活血通瘀胶囊抗凝治疗;对照组在再植术后予常规治疗(三抗治疗),⑵采集两组人口学特征、手术后两周内对比两组临床大体观察指标(包括伤口愈合情况、指体肿胀消退时间、住院天数、指体温度、伤口出血情况、指体弹性、毛细血管充盈时间、指体颜色);收集比较术前、术后血液炎性反应指标(白细胞计数、C反应蛋白定量,降钙素原),血液流变学指标,凝血功能指标;比较药物不良反应及术后3月功能康复情况;对比研究蛭龙活血通瘀胶囊在断指再植术后抗凝替代应用的有效性及安全性。⑶所有数据均应用SPSS18.0软件进行统计学分析,P0.05定义为差异有统计学意义。结果:⑴研究组(A组)50例68根断指病例,其中男性断指患者30例,占60%,女性断指患者20例,占40%。年龄跨度20~60岁,年龄均数为37.96±11岁。断指部位及平面:拇指近节离断6例占8.82%,远节离断14例占20.59%,食指近节离断6例占8.82%,中节离断6例占8.82%,远节离断7例占10.29%,中指近节离断2例占2.94%,中节离断5例占7.35%,远节离断3例占4.41%,无名指近节离断4例占5.88%,中节离断1例占1.47%,远节离断2例占2.94%,小指近节离断6例占8.82%,小指中节5例占7.35%,小指远节1例占1.47%。⑵对照组(b组)50例67根断指病例,其中男性断指患者28例,占56%,女性断指患者22例,占44%。年龄跨度18~58岁,年龄均数为36.6±9.8岁。断指部位及平面:拇指近节离断7例,占10.45%,远节离断11例占16.42%,食指近节离断3例占4.48%,中节离断8例占11.94%,远节离断10例占14.93%,中指近节离断2例占2.99%,中节离断3例占4.48%,远离断节6例占8.96%,无名指近节离断3例占4.48%,中节离断1例占1.49%,远节离断2例占2.99%,小指近节离断4例占5.97,中节6例占8.96%,远节离断1例占1.49。⑶两组的基线人口学特征、受伤情况比较差异无统计学意义。⑷a组血管危象2指,发生率2.94%,再植坏死1指,成活率98.5%。b组血管危象9指,发生率13.4%,再植坏死8指,成活率88.1%。血管危象发生率及再植手指成活率两组对比有统计学差异(p=0.026,0.036)。(5)a组与b组凝血功能同组治疗前对比无统计学差异(p0.05),治疗后两组凝血功能无统计学差异(p0.05),(6)血液流变学指标两组术前,术后一小时,术后一天指标无统计学意义(p0.05),术后5天及12天两组之间有统计学意义(p=0.000)。(7)研究组一般情况评分,术后3天,6天(包括指体弹性、毛细血管充盈时间、指体颜色)评分优于对照组,两组之间有统计学差异(p=0.000);(8)研究组伤口一期愈合65指占95.59%,对照组一期愈合57指占85.07%,两组比较有统计学差异(p=0.038)。(9)指体肿胀消退时间研究组6天以内者占57指占83.82%,对照组6天以内消退者35指占52.24%,两组比较有统计学意义(p=0.000)。(10)住院天数研究组平均住院时间为12天,对照组平均住院时间为14天,两组之间有统计学意义(p=0.000)。(11)指体温度治疗后研究组平均温度较对照组高,两组之间比较有统计学意义(p=0.000)。(12)术前两组白细胞计数比较无统计学意义,术后六天白细胞计数研究组平均数较对照组低,两组之间有统计学意义(p=0.000),术前两组c反应蛋白定量比较无统计学意义,术后六天c反应蛋白定量研究组平均较对照组低,两组之间有统计学意(p=0.000),术前两组降钙素原定量比较无统计学意义,术后3天降钙素原研究组平均较对照组低,两组之间有统计学意义(p=0.000),(13)药物不良反应(胃肠道反应,上消化道出血,过敏等),研究组未出现,对照组6例,两组比较有统计学意义(p=0.026)。(14)伤口出血,研究组未出现,对照组2例患者2指出现,两组比较,两组之间无统计学意义(p=0.244)。(15)术后3月患者指体功能康复情况:研究组优良者64指,对照组优良者50指,两组间比较有统计学差异(p=0.040)。结论:一、在常规抗感染、抗痉挛治疗的基础上联合应用蛭龙活血通瘀胶囊,对比传统三抗治疗具有更优越的高效性:①提高了断指再植术后成活率,显著改善断指再植患者流变学指标,改善断指再植患者术后微循环障碍,有效预防血管危象,有降低断指坏死率的优越疗效;②改善患者大体临床观察指标,包括伤口愈合情况、指体肿胀消退时间、住院天数、指体温度、伤口出血情况、指体弹性、毛细血管充盈时间、指体颜色等均明显优于对照组;③研究组炎症反应轻于对照组,无术后感染情况出现;④改善断指再植患者凝血功能比传统药物作用更加优越,⑤研究组术后3月功能恢复情况较对照组优良,二、研究组对比传统三抗治疗,其更具有经济性、安全性、可控性、低副作用等优点:①减少了药物注射的疼痛及疼痛引起血管危象;②研究表明蛭龙活血通瘀胶囊口服无明显胃肠道反应,无伤口异常出血情况;③无凝血功能异常,可控性较好;④抗凝费用低廉,有较好的经济性。手外伤患者筋络受损,血液瘀滞,蛭龙活血通瘀胶囊上述优越性,使其不失成为断指再植术后预防并发症的良药。
[Abstract]:Objective: To evaluate the efficacy and safety of leech earthworm activating blood stasis capsule after replantation of finger replantation of hirudon. Methods: (1) 100 cases of hospitalized patients who were eligible in the hand surgery of the Affiliated Hospital of Luzhou Medical College from June 2014 to December 2014 were randomly divided into two groups: the study group was in the usual way. Anti infection, anti spasticity based on the combination of oral leech Huoxue Tongyu capsule anticoagulant therapy, the control group was given routine treatment (three anti treatment) after replanting, and two groups of demographic characteristics were collected, and two groups of clinical gross observation indexes were compared within two weeks after the operation (including wound healing condition, time of swelling and decline of finger body, number of days of hospitalization, temperature of finger body, injury of finger body, injury) Bleeding situation, body elasticity, capillary filling time, finger color); collection and comparison of preoperative, postoperative blood inflammatory response index (white blood cell count, C reactive protein quantitative, calcitonin), blood rheology index, coagulation function index; comparison of adverse drug reactions and postoperative recovery of postoperative function; comparative study on Leech blood circulation stasis glue The efficacy and safety of anticoagulant replacement after replantation of severed finger. (3) all data were statistically analyzed with SPSS18.0 software, and the P0.05 definition was statistically significant. Results: (1) there were 50 cases of 68 severed fingers in the study group (group A), of which 30 cases were male severed patients, 60% and 20 cases of female severed fingers, which accounted for 20~60 of the 40%. age span. Age and age were 37.96 + 11 years old. The position and plane of the finger: 6 cases of the proximal segment of the thumb, 14 of the distal segment and 20.59%, 6 of the proximal segment of the index finger, 8.82%, 6 in the middle segment, 8.82%, 7 in the distal segment, 6 in the distal segment, 6 in the proximal segment, and in the middle section. The cases accounted for 5.88%, 1 in middle section and 2 in distal segment, 2.94% in distal segment, 6 in proximal segment and 7.35% in 5 of small finger, 1 in 1.47%. (group B) with 1 cases of 67 root severed finger, among which male severed finger patients were 28 cases, and women's severed fingers were 18~58 years old. The position and plane of the finger: 7 cases of the proximal segment of the thumb, 10.45%, 11 of the distal segment and 16.42%, 3 in the proximal segment of the index finger, 4.48% in the proximal segment, 11.94% in the middle section, 10 in the distal segment, 14.93% in the distal segment, 2 in the middle of the middle finger, 11 in the middle segment and 11 in the middle section. The cases accounted for 1.49%, 2 of the distal segment and 2.99%, 5.97 in the proximal segment of the small finger, 6 in the middle section, 8.96% in the middle section, and 1 in the distal segment, and 1 in the group of 1.49. 3. There were no statistically significant differences in the injury situation. (4) the vascular crisis 2 of the group A was 2, the occurrence rate was 2.94%, and the survival rate of the vascular crisis 9 in group 98.5%.b, recurrence rate 13.4%, again, recurrence rate, again, recurrence rate, recurrence rate, again, recurrence rate, recurrence rate, recurrence rate, recurrence rate, recurrence rate, recurrence rate, recurrence rate, 13.4%, recurrence rate, recurrence rate, 13.4%, recurrence rate, recurrence rate, 13.4%, recurrence rate, recurrence rate 13.4%, recurrence rate, recurrence rate, recurrence rate, recurrence rate, recurrence rate, recurrence rate, 13.4%, recurrence rate, recurrence rate, 13.4%, recurrence, recurrence rate 8 finger planting necrosis, the survival rate of 88.1%. vascular crisis and the survival rate of replantation of two groups were statistically different (p=0.026,0.036). (5) there was no statistical difference between group A and group B before treatment (P0.05), and there was no statistical difference between the two groups after treatment (P0.05), (6) blood rheology index group before operation, one hour after operation, There was no statistical significance (P0.05), 5 days and 12 days after the operation (p=0.000). (7) the study group score, 3 days after operation, 6 days (including finger elasticity, capillary filling time, finger color) score better than the control group, there were statistical differences between the two groups (p=0.000); (8) the study group wound healing 6 The 5 fingers accounted for 95.59%, the primary healing 57 fingers in the control group accounted for 85.07%, and the two groups had statistical difference (p=0.038). (9) the research group of the swelling and decline of the finger was 83.82% in 6 days, and the 57 in the control group was statistically significant (p= 0). The average hospitalization time of the hospital days was the day of admission. The average hospitalization time of the group was 14 days, and there was a significant difference between the two groups (p=0.000). (11) the average temperature of the study group was higher than the control group after the treatment of the body temperature, and there was a significant difference between the two groups (p=0.000). (12) the white blood cell count in the two groups before the operation was not statistically significant, and the average number of leucocyte count study group was lower than the control group at 6 days after the operation two. Two There was statistical significance between the groups (p=0.000). The quantitative comparison of the C reactive protein in the two groups before the operation was not statistically significant. The average of the C reactive protein study group was lower than the control group at 6 days after the operation, and the two groups were statistically significant (p=0.000). There was no statistical significance in the two groups of calcitonin before the operation, and the average of the calcitonin study group was lower than the control group 3 days after the operation. The two groups were statistically significant (p=0.000), (13) adverse drug reactions (gastrointestinal reaction, upper gastrointestinal bleeding, allergy, etc.), the study group did not appear, the control group was 6 cases, two groups were statistically significant (p=0.026). (14) the wound bleeding, the study group did not appear, 2 cases in the control group 2 fingers appeared, two groups were compared, there was no statistical significance between the two groups (p=0.24 4) (15) the rehabilitation of the finger body function in March after operation: 64 good persons in the study group and 50 fingers in the control group. The two groups were statistically different (p=0.040). Conclusion: first, on the basis of conventional anti infection and anti spasmodic therapy, the combined application of leech Huoxue Huoxue Tongyu capsule, compared with the traditional three antitherapy, is superior to the traditional three treatment. The survival rate after replantation of severed fingers significantly improved the hemorrheology index of the patients with finger replantation, improved the microcirculation disorder after the replantation of severed finger, effectively prevented the vascular crisis, and had a superior effect on reducing the necrosis rate of the finger; and improved the general clinical observation index of the patients, including the healing of the wound, the time of the swelling of the finger, the days of hospitalization, and the temperature of the hospital. Degree, bleeding of the wound, body elasticity, capillary filling time, and the color of the finger were obviously superior to the control group; (3) the inflammatory reaction in the study group was less than the control group, and there was no postoperative infection. (4) to improve the blood coagulation function of the severed finger replantation patients more superior than the traditional medicine. 5. The recovery of function in the study group in March was better than the control group. Good, two, the study group compared traditional three anti treatment, it has more economic, safety, controllability, low side effects and other advantages: 1. Reduce the pain and pain caused by the drug injection of vascular crisis; study showed that the leech dragon Huoxue Tongyu capsule has no obvious gastrointestinal reaction, no abnormal bleeding in the wound; 3. No coagulation function abnormalities, controllability It is good; (4) low cost of anticoagulant and good economy. The injury of hand injury, blood stasis, leech Huoxue Tongyu capsule are superior, which makes it a good medicine to prevent complications after replantation of severed finger.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.1

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