發(fā)布時(shí)間：2018-04-07 17:39

  本文選題：骨筋膜室綜合征　切入點(diǎn)：VSD　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：骨筋膜室綜合征是肢體創(chuàng)傷后發(fā)生在四肢特定的筋膜間隙內(nèi)的進(jìn)行性改變,其主要特點(diǎn)為血循環(huán)障礙進(jìn)行性加重,隨之出現(xiàn)神經(jīng)肌肉的嚴(yán)重缺血的癥狀,甚至組織壞死,最多見于前臂掌側(cè)和小腿。骨筋膜室綜合征的早期診斷和及時(shí)治療尤為重要,因?yàn)樯窠?jīng)肌肉組織缺血缺氧達(dá)到一定時(shí)間后隨即會(huì)出現(xiàn)不可逆的壞死及損害。不僅嚴(yán)重影響了肢體功能,甚至可以導(dǎo)致截肢,危及患者的生命,因此一旦確診需立即切開減壓。1994年,VSD負(fù)壓封閉引流技術(shù)被引入后,在外科領(lǐng)域中,這一技術(shù)被廣泛應(yīng)用。VSD負(fù)壓引流術(shù)的優(yōu)勢(shì):骨筋膜室綜合征減張術(shù)后的切口可以有效處理,避免傳統(tǒng)減壓術(shù)后頻繁換藥,降低了術(shù)后并發(fā)癥的發(fā)生。但是單純VSD負(fù)壓引流術(shù)仍然存在改善患肢缺血情況相對(duì)緩慢、發(fā)生并發(fā)癥的風(fēng)險(xiǎn)大、病程長(zhǎng)、住院天數(shù)多、患者經(jīng)濟(jì)負(fù)擔(dān)重等問題。目的:本研究主要對(duì)骨筋膜室綜合征患者VSD術(shù)后通過中藥與高壓氧聯(lián)合治療的方法與常規(guī)治療進(jìn)行對(duì)比,探討中西醫(yī)結(jié)合治療方法的療效,指導(dǎo)臨床工作。方法:通過對(duì)符合標(biāo)準(zhǔn)的研究對(duì)象分組,分為A常規(guī)組、B常規(guī)+中藥治療組、C常規(guī)+高壓氧治療組、D常規(guī)+中藥+高壓氧聯(lián)合治療組。A常規(guī)組:給予骨筋膜室綜合征患者VSD術(shù)后消腫、預(yù)防靜脈血栓、定期換藥以預(yù)防切口感染等常規(guī)治療;B常規(guī)+中藥組:給予常規(guī)治療的基礎(chǔ)上行口服中藥(身痛逐瘀湯)輔助治療;C常規(guī)+高壓氧組:給予常規(guī)治療基礎(chǔ)上行高壓氧(HBO)輔助治療;D常規(guī)+中藥+高壓氧聯(lián)合治療組:給予常規(guī)治療基礎(chǔ)上行中藥內(nèi)服與高壓氧HBO聯(lián)合治療。運(yùn)用spss19.0分組對(duì)比,對(duì)常規(guī)組、常規(guī)+中藥組、常規(guī)+高壓氧組、常規(guī)+中藥+高壓氧聯(lián)合治療組的各項(xiàng)數(shù)據(jù)進(jìn)行分析,對(duì)各組患者的改善循環(huán)情況、血栓發(fā)生率、切口感染率、Ⅱ期傷口植皮率等方面進(jìn)行對(duì)比分析。結(jié)果:A常規(guī)組患者的改善循環(huán)效果總有效率80%,發(fā)生血栓率3.2%,肉芽組織良好無(wú)感染52%,可行Ⅱ期傷口植皮術(shù)48%;B常規(guī)+中藥組患者的改善循環(huán)效果總有效率88%,發(fā)生血栓的幾率1.6%,肉芽組織良好無(wú)感染64%,可行Ⅱ期傷口植皮術(shù)36%;C常規(guī)+高壓氧組患者的改善循環(huán)效果總有效率88%,發(fā)生血栓率2.4%,肉芽組織良好無(wú)感染72%,可行Ⅱ期傷口植皮術(shù)28%;D常規(guī)+中藥+高壓氧聯(lián)合治療組患者的改善循環(huán)效果總有效率92%,發(fā)生血栓率0.8%,肉芽組織良好無(wú)感染80%,可行Ⅱ期傷口植術(shù)20%。D常規(guī)+中藥+高壓氧聯(lián)合治療組各方面均明顯優(yōu)于A對(duì)照組、B常規(guī)+中藥組、C常規(guī)+高壓氧組,且差異有統(tǒng)計(jì)學(xué)意義(PO.05)。結(jié)論:1.使用中藥輔助骨筋膜室綜合征患者VSD術(shù)后治療可以改善血液循環(huán)、降低靜脈血栓發(fā)生率、促進(jìn)組織修復(fù)減少切口感染。2.使用高壓氧輔助骨筋膜室綜合征患者VSD術(shù)后治療有利于改善血液循環(huán)、促進(jìn)切口愈合、降低切口感染率。3.骨筋膜室綜合征VSD術(shù)后患者使用中藥與高壓氧聯(lián)合治療具有消除患肢腫脹、改善血液循環(huán);降低靜脈血栓的發(fā)生率;促進(jìn)創(chuàng)面修復(fù)、減少切口感染的優(yōu)點(diǎn)。
[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.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R686.3

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