1、世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230117基金项目:佛山市科技创新项目(1920001001103)作者单位:佛山市第一人民医院脊柱骨外科，广东 佛山 528000通信作者:谭健韶，Email:sishoumei2n163 com云南白药胶囊对颈椎椎管减压术、锁骨骨折切开复位术围术期出血与创面愈合的影响杨林关宏业曾明杨健齐李世渊邝满源李家颖谭健韶【摘要】目的探讨云
2、南白药胶囊在颈椎椎管减压术、锁骨骨折切开复位术围术期中的应用价值。方法选取2020 年1 月2021 年10 月期间佛山市第一人民医院脊柱骨外科收治的 120 例颈椎椎管减压术、锁骨骨折切开复位术患者作为试验对象，采用随机数字表法分为对照组和治疗组，每组各 60 例。两组患者均按照原定手术方案接受手术，治疗组辅以云南白药胶囊治疗，对照组给予空白淀粉安慰剂，围术期(术前3 d 起服至术后2 d)服用。观察比较两组患者围术期出血量、引流情况、手术相关并发症及不良反应情况、手术创面愈合情况及术前3 d、术后2 d 血清生长因子 血管内皮生长因子(Vascular endothelial growth
3、 factor，VEGF)、碱性成纤维细胞生长因子(Basicfibroblast growth factor，bEGF)水平变化。结果(1)治疗后治疗组单位出血量及总出血量均较对照组减少，差异有统计学意义(P 0 05)。(2)治疗后治疗组 24、48 h 引流量及总引流量均较对照组减少，差异有统计学意义(P 0 05)，引流管引流时间与对照组比较，差异无统计学意义(P 0 05)。(3)治疗后治疗组并发症发生率1 67%(1/60)较对照组 11 67%(7/60)降低，差异有统计学意义(P 0 05)。(4)治疗组手术创面愈合时间优于对照组，差异有统计学意义(P 0 05)。(5)术后
4、2 d，治疗组血清 VEGF、bEGF 水平均较手术前 3 d 和对照组升高，差异有统计学意义(P 0 05)。(6)治疗期间，治疗组无不良反应情况。结论云南白药胶囊有利于减少颈椎椎管减压术与锁骨骨折切开复位术患者手术出血及围术期引流量，降低手术相关并发症发生率，安全性具有保障，且有助于促进手术创口早期愈合，可能与上调血清生长因子表达有关。【关键词】颈椎椎管减压术;锁骨骨折切开复位术;围术期出血;创面愈合;生长因子【中图分类号】274 1【文献标识码】AEffects of Yunnan Baiyao Capsules on Perioperative Bleeding and Wound H
5、ealing inCervical Spinal Decompression and Open eduction of Clavicle FracturesYANG Lin，GUAN Hong ye，ZENG Ming，YANG Jian qi，LI Shi yuan，KUANG Man yuan，LI Jia ying，TAN Jian shao(Department of Spine and Bone Surgery，Foshan First Peoples Hospital，Foshan Guangdong 528000)【Abstract】ObjectiveTo explore the
6、 application value of Yunnan Baiyao capsules in the perioperative period ofcervical spinal decompression and open reduction of clavicle fractures MethodsA total of 120 patients undergoing cervi-cal spinal decompression and open reduction of clavicle fractures in the Department of Spine and Bone Surg
7、ery，FoshanFirst Peoples Hospital from January 2020 to October 2021 were included in this study and assigned into a control group(n=60)and an observation group(n=60)according to the random number table Both groups underwent surgery according tothe original plan The observation group was treated with
8、Yunnan Baiyao capsules，and the control group with blank starchplacebo during the perioperative period(from 3 days before operation to 2 days after operation)The perioperative bleedingvolume and drainage volume，the incidence of surgery related complications and adverse reactions，and surgical woundhea
9、ling were compared between the two groups Furthermore，the serum levels of growth factors including vascular endothe-lial growth factor(VEGF)and basic fibroblast growth factor(bEGF)were compared between 3 days before operation and 2days after operation as well as between the two groups esults(1)The b
10、leeding volume per unit and total bleeding vol-ume in the observation group were lower than those in the control group(P 0 05)(2)The drainage volume at the timepoints of 24 h and 48 h and the total drainage volume in the observation group were lower than those in the control group(P0 05)The drainage
11、 time of the drainage tube showed no significant difference between the two groups(P 0 05)(3)The incidence of complications in the observation group was 1 67%(1/60)，which was lower than that(11 67%，7/60)inthe control group(P 0 05)(4)The healing time of surgical wound in the treatment group was short
12、er than that in the901世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1control group(P 0 05)(5)The serum levels of VEGF and bEGF in the observation group 2 days after operation elevatedcompared with those 3 days before operation and were higher t
13、han those in the control group(P 0 05)(6)During thetreatment period，there was no adverse reaction in the observation group ConclusionYunnan Baiyao capsules can reducethe surgical bleeding and perioperative drainage in the patients undergoing cervical spinal canal decompression and openreduction of c
14、lavicular fractures，reduce the incidence of surgy related complications，ensure the safety，and promote theearly healing of surgical wound，which may be achieved by the up regulation of the expression of growth factors in the ser-um【Keywords】Cervical Spinal Canal Decompression;Open eduction of Clavicle
15、 Fractures;Perioperative Bleeding;Wound Healing;Growth Factor手术过程出血量增多会造成术野受限，影响手术进程，同时可增加失血性贫血等并发症的发生风险，影响术后康复与患者预后1。颈椎椎管减压术、锁骨骨折切开复位术是临床常见术式，能够取得良好手术效果，但减少围术期出血，保证手术顺利进行，一直是手术医师重点关注项目。云南白药是我国传统名药，具有活血止痛、化瘀止血、解毒消肿等功效，在控制手术出血、崩漏下血等方面已取得成效，近年越来越受临床重视2，3。此外，颈椎椎管减压术与锁骨骨折切开复位术手术区域特殊，患者对切口美观度要求高，因此保证创面早期
16、、一期愈合尤为重要。资料显示，云南白药除具活血化瘀、止血与抗炎作用，也具有促愈合作用，在创伤科促愈合方面作用及地位日益突出4。基于此，本研究在颈椎椎管减压术、锁骨骨折切开复位术患者围术期给予云南白药胶囊治疗，旨在明确其在上述术式中的应用价值，使更多患者获益，现报道如下。1资料与方法1 1临床资料1 1 1一般资料选取2020 年1 月2021 年10 月期间我院收治的 120 例颈椎椎管减压术、锁骨骨折切开复位术患者作为试验对象，采用随机数字表法分为对照组和治疗组，每组各 60 例。两组患者年龄、性别、手术类型、美国麻醉医师协会(ASA)分级、体质量指数(BMI)比较，差异无统计学意义(P 0 05)，具有可比性。本研究经佛山市第一人民医院伦理委员会审批(2020F0612)。结果见表 1。1 1 2诊断标准1 1 2 1西医诊断标准参照 颈椎病的分型、诊断及非手术治疗专家共识(2018)5 中颈椎病诊断标准。1 1 2 2中医诊断标准参照中医康复临床实践指南项痹(颈椎病)6 中颈椎病相关诊断标准。1 1 3纳入标准(1)符合上述诊断标准;(2)年龄18 岁且70 岁;(3)肝、肾功能
