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負(fù)壓封閉引流技術(shù)配合仙方活命飲在創(chuàng)面修復(fù)中的應(yīng)用

發(fā)布時(shí)間:2018-03-24 03:08

  本文選題:創(chuàng)面修復(fù) 切入點(diǎn):封閉負(fù)壓引流(VSD) 出處:《湖北中醫(yī)藥大學(xué)》2014年碩士論文


【摘要】:目的 本文主要針對(duì)創(chuàng)面的處理過(guò)程以及各種技術(shù)作出論述,偏重于闡述負(fù)壓封閉引流技術(shù)的運(yùn)用以及術(shù)后配合口服中藥方劑仙方活命飲在創(chuàng)面愈合過(guò)程中的運(yùn)用。 方法 本文研究病例來(lái)源于2013年6月—2014年3月湖北十堰市太和醫(yī)院創(chuàng)傷骨科和門診隨訪患者。實(shí)驗(yàn)組為使用負(fù)壓引流(VSD)來(lái)治療的18例患者。實(shí)驗(yàn)組中采用的武漢維斯第醫(yī)用科技有限公司的VSD產(chǎn)品進(jìn)行治療;對(duì)照組為18例采用了傳統(tǒng)的換藥方法治療的患者,對(duì)照組采用的是一天一次的換藥的方式進(jìn)行治療,采用的是通過(guò)雙氧水或稀碘伏沖洗的傳統(tǒng)換藥的方法進(jìn)行。觀察兩組患者發(fā)熱的時(shí)間以及使用抗生素的天數(shù)、通過(guò)手術(shù)進(jìn)行清創(chuàng)的時(shí)間、手術(shù)的方式以及手術(shù)的次數(shù);換藥的次數(shù)、創(chuàng)面處于清潔狀態(tài)的時(shí)間、創(chuàng)面關(guān)閉的時(shí)間、發(fā)生感染的幾率、患者住院治療的時(shí)間、愈合的情況以及患者是否發(fā)生并發(fā)癥。 另選擇20例糖尿病患肢創(chuàng)面,創(chuàng)面采用負(fù)壓引流技術(shù)處理后,選擇10例為實(shí)驗(yàn)組,術(shù)后采用仙方活命飲中藥口服治療,10例為對(duì)照組,并未采用中藥治療,對(duì)于其術(shù)后愈合時(shí)間以及截肢率進(jìn)行觀察比較。 動(dòng)物實(shí)驗(yàn)采用了健康白兔,對(duì)其進(jìn)行麻醉后,對(duì)背部進(jìn)行皮膚全層以及深筋膜層切開,形成3x3cm的創(chuàng)面。在vsd術(shù)后的六、十二小時(shí),一、 三、五、七天抽白兔的靜脈血進(jìn)行分析CRP,WBC,IL-6,TNF-a指標(biāo)。 結(jié)果 VSD實(shí)驗(yàn)組和對(duì)照組,在創(chuàng)面中均可以見到肉芽組織的生長(zhǎng),實(shí)驗(yàn)組中的18例中,創(chuàng)面明顯新鮮,色紅,血運(yùn)豐富,未見沒(méi)明顯組織壞死者明顯優(yōu)于對(duì)照組,同時(shí)于并發(fā)癥方面,實(shí)驗(yàn)組體溫升高,感染等并發(fā)癥也明顯少于對(duì)照組。對(duì)于術(shù)后采用中藥口服治療的實(shí)驗(yàn)組相比對(duì)照組,在愈合時(shí)間以及截肢率上均占優(yōu)勢(shì)。動(dòng)物實(shí)驗(yàn)結(jié)果,經(jīng)負(fù)壓吸引創(chuàng)面的外周WBC,CRP的含量顯著性的減少,而TNF-a和IL-6在一天之內(nèi)顯著的增加,一天之后明顯下降。 結(jié)論 對(duì)于創(chuàng)面較大,無(wú)法再一期進(jìn)行清創(chuàng)并關(guān)閉創(chuàng)面的患者,,VSD技術(shù)的運(yùn)用可以加速創(chuàng)面的愈合過(guò)程并減少感染幾率,為后期的進(jìn)一步處理提供支持。整體化的VSD治療能夠創(chuàng)造一個(gè)適合傷口愈合的外部環(huán)境,傷口創(chuàng)面宏應(yīng)變(物理)以及生物反應(yīng)(超微)。物理反應(yīng)能夠使得傷口的邊緣收縮,能夠?qū)⒏腥疚镔|(zhì)和滲出物排出,使水腫減輕,血液循環(huán)加快。超微能夠引發(fā)組織在微觀上的變化,細(xì)胞的拉伸,細(xì)胞的拉伸使得細(xì)胞朝向傷口的表面游移和增生,促進(jìn)肉芽組織的增生。VSD技術(shù)效果良好,應(yīng)當(dāng)廣泛推廣到外科創(chuàng)面的治療之中。負(fù)壓引流技術(shù)配合仙方活命飲中藥口服治療,能減少患者的痛苦以及縮短療程,為創(chuàng)面的修復(fù)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.
【學(xué)位授予單位】:湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2014
【分類號(hào)】:R687

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