活血化瘀法在泥石流伤员救治中作用的病例对照研究

目的：观察活血化瘀中药对泥石流损伤患者血清肿瘤坏死因子-α、白细胞介素-6的影响,探讨活血化瘀中药在灾害救治中的作用机制。方法：以2010年8月12日起由甘肃舟曲和成县转运至兰州的泥石流伤员为研究对象,分为2组。A组25例,男15例,女10例;平均年龄（39.0±3.9）岁;AIS评分1分2例,2分3例,3分17例,4分3例,无5分患者;ISS评分〈16分16例,16～25分7例,〉25分2例。B组25例,男11例,女14例;平均年龄（40.1±3.6）岁;AIS评分1分3例,2分4例,3分16例,4分2例,无5分患者;ISS评分〈16分15例,16～25分9例,〉25分1例。2组患者入院后完善全身检查,A组8例手术治疗,其中3例行切开复位钢板内固定术,4例行扩创引流术,1例行异物取除术;B组6例手术治疗,其中颅脑手术1例,胸部手术2例,软组织清创术3例。2组患者均常规预防感染、预防并发症、支持及消肿治疗,A组在此基础上另内服消肿止痛合剂,每次50ml,每日2次;外用伤科洁肤液外敷患部,每次20ml,每日4次,每次外敷20～30min。2组患者均以7d为1个疗程,共治疗2个疗程,分别于入院第2、7、14天运用免疫度量法测定促炎症细胞因子TNF-α、IL-6于血清中的含量,所测TNF-α、IL-6不同时间点的数据采用SPSS16.0统计学软件进行处理。结果：入院第2天,2组患者血清TNF-α、IL-6的含量比较,差异无统计学意义;第7、14天2组血清TNF-α、IL-6的含量比较,差异有统计学意义。入院第7、14天与入院第2天血清TNF-α、IL-6含量比较,差异有统计学意义。结论：活血化瘀中药能抑制创伤后致炎症因子释放。

Case-control study on therapeutic effects of Chinese herb of promoting blood circulation to dissipate blood stasis in the treatment of mudslide injuries

Objective：To observe the effects of Chinese herb of promoting blood circulation to dissipate blood stasis on the levels of tumor necrosis factor alpha（TNF-α）and interleukin 6（IL-6） in serum of patients with mudslide injuries,and investigate the mechanisms of Chinese herb of promoting blood circulation to dissipate blood stasis in the treatment of mudslide injuries. Methods：Patients with mudslide injuries who were translated from Zhouqu and Chengxian to Lanzhou from 12th August 2010 were divided into two groups（group A and group B）. Twenty-five patients in group A,containing 15 males and 10 females,with an average age of （39.0±3.9） years. According to AIS scoring system,1 point in 2 cases,2 points in 3,3 points in 17 and 4 points in 3. No patients got 5 points. Based on ISS rating system,16 cases got 16 points or less,7 cases rated between 16 and 25,only 2 cases were equal to 25 points or more. Another 25 patients were in group B,including 11 males and 14 females,with a mean age of（40.1±3.6） years;AIS score showed 3 cases got 1 point,4 got 2 points,16 got 3 and 2 got 4 points,no patients got 5 points. Patients in group B were divided into three parts by ISS score：15 cases（16 points or less）;9 cases（range 16 to 25 points） and 1 case（25 points or more）. All the patients accepted general physical checkup. Eight patients were treated by surgical treatment in group A（3 patients were treated with open reduction plate fixation,4 patients were treated with debridement BHID,and 1 patient underwent foreign body removal） and 6 cases in group B（1 patient was treated with craniocerebral surgery,2 patients were treated with chest surgery,and 3 patients were treated with soft tissue debridement）. All the patients of two groups were treated by support treatment,detumescence treatment and preventing infection,complications. A seven days course of treatment with detumescence analgesic mixture 50 ml p.o. bid,traumatologic cleansing liquid 20 ml ad us,ext 20 to 30 min qid to group A,continuous treatment of two courses. Using immunometric assay to determine serum levels of inflammatory cytokine TNF-α,IL-6 at the 2nd,7th,14th days after admission. Analysis of data were done with the help of SPSS 16.0 statistic software. Results：There were no statistical differences of TNF-α,IL-6 between two groups at the second day after admission,and there were statistical differences at the 7th and 14th days between two groups. There were significant differences of TNF-α and IL-6 levels between the 7th day and the 2nd day,the 14th day and 2nd day after admission. Conclusion：The Chinese herb of promoting blood circulation to dissipate blood stasis can inhibit the release of inflammatory factor after traumatism.