本文選題：斷指再植 + 蛭龍活血通瘀膠囊��； 參考：《四川醫(yī)科大學》2015年碩士論文

【摘要】：目的:評價蛭龍活血通瘀膠囊(leech earthworm activating blood stasis capsule)在斷指再植術后抗凝替代應用的有效性及安全性。方法:⑴納入瀘州醫(yī)學院附屬中醫(yī)院手外科2014年6月至2014年12月符合條件的住院病人100例,隨機分為兩組:研究組在常規(guī)抗感染,抗痙攣基礎上聯(lián)合口服蛭龍活血通瘀膠囊抗凝治療;對照組在再植術后予常規(guī)治療(三抗治療),⑵采集兩組人口學特征、手術后兩周內對比兩組臨床大體觀察指標(包括傷口愈合情況、指體腫脹消退時間、住院天數(shù)、指體溫度、傷口出血情況、指體彈性、毛細血管充盈時間、指體顏色);收集比較術前、術后血液炎性反應指標(白細胞計數(shù)、C反應蛋白定量,降鈣素原),血液流變學指標,凝血功能指標;比較藥物不良反應及術后3月功能康復情況;對比研究蛭龍活血通瘀膠囊在斷指再植術后抗凝替代應用的有效性及安全性。⑶所有數(shù)據(jù)均應用SPSS18.0軟件進行統(tǒng)計學分析,P0.05定義為差異有統(tǒng)計學意義。結果:⑴研究組(A組)50例68根斷指病例,其中男性斷指患者30例,占60%,女性斷指患者20例,占40%。年齡跨度20~60歲,年齡均數(shù)為37.96±11歲。斷指部位及平面:拇指近節(jié)離斷6例占8.82%,遠節(jié)離斷14例占20.59%,食指近節(jié)離斷6例占8.82%,中節(jié)離斷6例占8.82%,遠節(jié)離斷7例占10.29%,中指近節(jié)離斷2例占2.94%,中節(jié)離斷5例占7.35%,遠節(jié)離斷3例占4.41%,無名指近節(jié)離斷4例占5.88%,中節(jié)離斷1例占1.47%,遠節(jié)離斷2例占2.94%,小指近節(jié)離斷6例占8.82%,小指中節(jié)5例占7.35%,小指遠節(jié)1例占1.47%。⑵對照組(b組)50例67根斷指病例,其中男性斷指患者28例,占56%,女性斷指患者22例,占44%。年齡跨度18~58歲,年齡均數(shù)為36.6±9.8歲。斷指部位及平面:拇指近節(jié)離斷7例,占10.45%,遠節(jié)離斷11例占16.42%,食指近節(jié)離斷3例占4.48%,中節(jié)離斷8例占11.94%,遠節(jié)離斷10例占14.93%,中指近節(jié)離斷2例占2.99%,中節(jié)離斷3例占4.48%,遠離斷節(jié)6例占8.96%,無名指近節(jié)離斷3例占4.48%,中節(jié)離斷1例占1.49%,遠節(jié)離斷2例占2.99%,小指近節(jié)離斷4例占5.97,中節(jié)6例占8.96%,遠節(jié)離斷1例占1.49。⑶兩組的基線人口學特征、受傷情況比較差異無統(tǒng)計學意義。⑷a組血管危象2指,發(fā)生率2.94%,再植壞死1指,成活率98.5%。b組血管危象9指,發(fā)生率13.4%,再植壞死8指,成活率88.1%。血管危象發(fā)生率及再植手指成活率兩組對比有統(tǒng)計學差異(p=0.026,0.036)。(5)a組與b組凝血功能同組治療前對比無統(tǒng)計學差異(p0.05),治療后兩組凝血功能無統(tǒng)計學差異(p0.05),(6)血液流變學指標兩組術前,術后一小時,術后一天指標無統(tǒng)計學意義(p0.05),術后5天及12天兩組之間有統(tǒng)計學意義(p=0.000)。(7)研究組一般情況評分,術后3天,6天(包括指體彈性、毛細血管充盈時間、指體顏色)評分優(yōu)于對照組,兩組之間有統(tǒng)計學差異(p=0.000);(8)研究組傷口一期愈合65指占95.59%,對照組一期愈合57指占85.07%,兩組比較有統(tǒng)計學差異(p=0.038)。(9)指體腫脹消退時間研究組6天以內者占57指占83.82%,對照組6天以內消退者35指占52.24%,兩組比較有統(tǒng)計學意義(p=0.000)。(10)住院天數(shù)研究組平均住院時間為12天,對照組平均住院時間為14天,兩組之間有統(tǒng)計學意義(p=0.000)。(11)指體溫度治療后研究組平均溫度較對照組高,兩組之間比較有統(tǒng)計學意義(p=0.000)。(12)術前兩組白細胞計數(shù)比較無統(tǒng)計學意義,術后六天白細胞計數(shù)研究組平均數(shù)較對照組低,兩組之間有統(tǒng)計學意義(p=0.000),術前兩組c反應蛋白定量比較無統(tǒng)計學意義,術后六天c反應蛋白定量研究組平均較對照組低,兩組之間有統(tǒng)計學意(p=0.000),術前兩組降鈣素原定量比較無統(tǒng)計學意義,術后3天降鈣素原研究組平均較對照組低,兩組之間有統(tǒng)計學意義(p=0.000),(13)藥物不良反應(胃腸道反應,上消化道出血,過敏等),研究組未出現(xiàn),對照組6例,兩組比較有統(tǒng)計學意義(p=0.026)。(14)傷口出血,研究組未出現(xiàn),對照組2例患者2指出現(xiàn),兩組比較,兩組之間無統(tǒng)計學意義(p=0.244)。(15)術后3月患者指體功能康復情況:研究組優(yōu)良者64指,對照組優(yōu)良者50指,兩組間比較有統(tǒng)計學差異(p=0.040)。結論:一、在常規(guī)抗感染、抗痙攣治療的基礎上聯(lián)合應用蛭龍活血通瘀膠囊,對比傳統(tǒng)三抗治療具有更優(yōu)越的高效性:①提高了斷指再植術后成活率,顯著改善斷指再植患者流變學指標,改善斷指再植患者術后微循環(huán)障礙,有效預防血管危象,有降低斷指壞死率的優(yōu)越療效;②改善患者大體臨床觀察指標,包括傷口愈合情況、指體腫脹消退時間、住院天數(shù)、指體溫度、傷口出血情況、指體彈性、毛細血管充盈時間、指體顏色等均明顯優(yōu)于對照組;③研究組炎癥反應輕于對照組,無術后感染情況出現(xiàn);④改善斷指再植患者凝血功能比傳統(tǒng)藥物作用更加優(yōu)越,⑤研究組術后3月功能恢復情況較對照組優(yōu)良,二、研究組對比傳統(tǒng)三抗治療,其更具有經濟性、安全性、可控性、低副作用等優(yōu)點:①減少了藥物注射的疼痛及疼痛引起血管危象;②研究表明蛭龍活血通瘀膠囊口服無明顯胃腸道反應,無傷口異常出血情況;③無凝血功能異常,可控性較好;④抗凝費用低廉,有較好的經濟性。手外傷患者筋絡受損,血液瘀滯,蛭龍活血通瘀膠囊上述優(yōu)越性,使其不失成為斷指再植術后預防并發(fā)癥的良藥。
[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.
【學位授予單位】：四川醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R658.1

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