负压封闭引流术配合伤科黄水外敷治疗手背部皮肤逆行撕脱伤的临床研究
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摘要
目的观察负压封闭引流术配合伤科黄水(纱布)外敷治疗手背部皮肤逆行撕脱伤的临床效果。方法选取2016年1月至2018年1月在佛山市中医院行急诊手术治疗的手背部皮肤逆行撕脱伤患者共64例,按就诊先后顺序随机分为观察组和对照组。观察组彻底清创后行负压封闭引流术配合伤科黄水纱布外敷治疗,对照组彻底清创后行负压封闭引流术配合酒精纱外敷治疗。观察记录两组患者术后第1天、第3天、第7天、第10天伤肢肿胀程度及视觉疼痛模拟评分(VAS),并记录伤口愈合时间及撕脱皮肤存活情况。结果术后2周观察组撕脱皮肤存活率高于对照组(P <0.05);观察组术后第3天、第7天伤肢肿胀程度及VAS评分均低于对照组(P <0.05);观察组伤口愈合时间短于对照组(P <0.05)。结论负压封闭引流术配合伤科黄水纱布外敷治疗手背皮肤逆行撕脱伤,可减少术后伤肢肿胀及疼痛,有利于促进伤口愈合,降低回植皮肤坏死率,安全有效。
Objective: To investigate the clinical effects of vacuum sealing drainage(VSD) combined with Shangke Huangshui Dressing on skin reversed avulsion of the back of hand. Methods: 64 patients were randomly divided into the observation group and the control group. The observation group was completely debrided and treated with VSD combined with Shangke Huangshui Dressing;the control group was completely debrided and treated with VSD and alcohol gauze. On the 1 st,3 rd,7 th and 10 th days after the surgery,the swelling degree,the scores of VAS,the wound healing time and the avulsion of skin survival were compared and recorded. Results: In the two weeks after the surgery,the survival rate of avulsed skin was higher in the observation group than that in the control group(P < 0.05). On the 3 rd and 7 th days after the surgery,the swelling degree and VAS scores in the observation group were both lower than those in the control group(P < 0.05). The wound healing time in the observation group was significantly shorter than that in the control group(P < 0.05). Conclusion: VSD combined with Shangke Huangshui Dressing can effectively relieve postoperative pain and swelling and the rate of skin necrosis after replantation,and help to promote wound healing in patients of skin reversed avulsion of the back of hand. The method is safe,with the definite clinical efficacy.
Objective: To investigate the clinical effects of vacuum sealing drainage(VSD) combined with Shangke Huangshui Dressing on skin reversed avulsion of the back of hand. Methods: 64 patients were randomly divided into the observation group and the control group. The observation group was completely debrided and treated with VSD combined with Shangke Huangshui Dressing;the control group was completely debrided and treated with VSD and alcohol gauze. On the 1 st,3 rd,7 th and 10 th days after the surgery,the swelling degree,the scores of VAS,the wound healing time and the avulsion of skin survival were compared and recorded. Results: In the two weeks after the surgery,the survival rate of avulsed skin was higher in the observation group than that in the control group(P < 0.05). On the 3 rd and 7 th days after the surgery,the swelling degree and VAS scores in the observation group were both lower than those in the control group(P < 0.05). The wound healing time in the observation group was significantly shorter than that in the control group(P < 0.05). Conclusion: VSD combined with Shangke Huangshui Dressing can effectively relieve postoperative pain and swelling and the rate of skin necrosis after replantation,and help to promote wound healing in patients of skin reversed avulsion of the back of hand. The method is safe,with the definite clinical efficacy.
引文
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[13]郑勇凤,王佳婧,傅超美,等.黄芩的化学成分与药理作用研究进展[J].中成药,2016,38(1):141-147.
[14]宓伟,王志强,邱世翠,等.紫草体外抑菌作用研究[J].时珍国医国药,2007,18(9):2217-2217.
[15]廖文,李明.虎杖的本草考证及药理作用[J].中华中医药学刊,2011,30(11):2511-2513.
[16]孟祥乐,李红伟,李颜,等.栀子化学成分及其药理作用研究进展[J].中国新药杂志,2011,(11):959-967.
[17]林月彬,王晖,梁庆,等.薄荷醇止痒作用的研究[J].中华中医药学刊,2009,28(7):1488-1490.
[18]徐娇,宋旭,殷中琼,等. 18味中药提取物体外抗鸭瘟病毒活性的研究[J].浙江大学学报:农业与生命科学版,2013,39(1):105-110.
[19]钟广玲.陈渭良骨伤科临证精要[M].北京:科学技术出版社,2002:126.
[20]何斌,高俊青,陈浩宇,等.负压封闭引流技术结合伤科黄水在股(腘)动脉损伤中的应用[J].中国中医急症,2014,23(12):2226-2229.
[2]蔺楚,孙雪生,朱涛,等.封闭式负压引流治疗手背皮肤撕脱伤[J].中华手外科杂志,2012,28(3):189.
[3]王澍寰.手外科学[M].北京:人民卫生出版社,2011:180.
[4]王峰,王健,张怀宝,等.七叶皂甙钠联合小剂量甘露醇防治手外伤肿胀的临床研究[J].临床医学,2006,26(9):13-14.
[5] Chapman CR,Casey KL,Dubner R,et al. Pain measurement:an overview[J]. Pain,1985,22(1):1-31.
[6]孔靖,钟格兰.大面积皮肤缺损游离植皮中传统打包技术与负压封闭引流的应用比较[J].临床和实验医学杂志,2015,14(18):1548-1551.
[7] Kudsk KA,Sheldon GF,Walton RL. Degloving injuries of the extremities and torso[J]. J Trauma,1981,21(10):835-839.
[8]杨润功,张伟佳,郑晓勇,等.交通伤所致下肢严重皮肤撕脱伤的治疗[J].中华创伤骨科杂志,2007,9(11):1034-1037.
[9]李振华,蔡新宇,李少华,等.封闭式负压引流急诊治疗前臂大面积软组织挫伤的临床观察[J].中华手外科杂志,2010,26(6):337.
[10] Hou Z,Irgit K,Strohecker KA,et al. Delayed flap reconstruction with vacuum-assisted closure management of the openⅢB tibial fracture[J]. J Trauma,2011,71(6):1705-1708.
[11]尹丽丽.黄连的药理作用及现代研究进展[J].中医临床研究,2016,8(28):144-145.
[12]张坤,丁克.复方黄柏液对大鼠感染性创面TNF-α和IL-6表达的影响[J].中国新药杂志,2015,24(19):2222-2226.
[13]郑勇凤,王佳婧,傅超美,等.黄芩的化学成分与药理作用研究进展[J].中成药,2016,38(1):141-147.
[14]宓伟,王志强,邱世翠,等.紫草体外抑菌作用研究[J].时珍国医国药,2007,18(9):2217-2217.
[15]廖文,李明.虎杖的本草考证及药理作用[J].中华中医药学刊,2011,30(11):2511-2513.
[16]孟祥乐,李红伟,李颜,等.栀子化学成分及其药理作用研究进展[J].中国新药杂志,2011,(11):959-967.
[17]林月彬,王晖,梁庆,等.薄荷醇止痒作用的研究[J].中华中医药学刊,2009,28(7):1488-1490.
[18]徐娇,宋旭,殷中琼,等. 18味中药提取物体外抗鸭瘟病毒活性的研究[J].浙江大学学报:农业与生命科学版,2013,39(1):105-110.
[19]钟广玲.陈渭良骨伤科临证精要[M].北京:科学技术出版社,2002:126.
[20]何斌,高俊青,陈浩宇,等.负压封闭引流技术结合伤科黄水在股(腘)动脉损伤中的应用[J].中国中医急症,2014,23(12):2226-2229.
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