黄洋峰，蒋　薇



甘露醇联合地塞米松治疗肢体软组织肿胀时机的选择

黄洋峰，蒋薇

目的观察20%甘露醇联合地塞米松短程治疗创伤后肢体软组织肿胀的临床疗效及使用时机。方法将90例创伤后肢体软组织肿胀患者分为实验组和对照组各45例，对照组采用理疗，实验组在理疗基础上，给予20%甘露醇联合地塞米松静脉滴注。将两组按照创伤后接受治疗的时间再分为3组（＜8 h组、8～24 h组、＞24 h组）；按照创伤后肿胀的严重程度分为3组（轻度组、中度组、重度组），于治疗后第3 d，观察比较各组肢体软组织肿胀情况。结果治疗后3 d，实验组的中度及重度肿胀组患肢周径差大于对照组(P＜0.05)，而轻度组与对照组无统计学差异(P＞0.05)；不同治疗起始时间组间治疗前后比较，实验组的8～24 h组和＞24 h组肢体周径差大于对照组(P＜0.05)；＜8 h组与对照组患肢周径差比较无统计学差异(P＞0.05)。结论20%甘露醇联合地塞米松短程治疗创伤后肢体肿胀，效果优于单纯物理治疗，尤其对中度及重度肢体肿胀的消肿作用较为明显。对就诊时间在伤后8 h甚至24 h以上的患者，药物治疗效果并不显著低于受伤后早期治疗的患者，此时更应该积极采用药物干预。

甘露醇；地塞米松；创伤；肢体；肿胀

[Abstract]Objective To observe the clinical curative effects of 20%mannitol combined with dexamethasone on the short-range treatment of post-traumatic limb soft tissue swelling and the selection of use timing.Methods 90 patients with post-traumatic limb soft tissue swelling were equally divided into experimental group and control group.The control group received physical therapy,and the experimental group received intravenous drip with 20%mannitol combined with dexamethasone based on physical therapy.The two groups were again divided into three groups according to the time of receiving the treatment(＜8 h group,8-24 h group,and＞24 h group).According to the severity of post-traumatic swelling,the two groups were also divided into three groups(mild group, moderate group,and severe group).On the 3rd day after the treatment,observation and comparison weremade in the limb soft tissue swelling among each group.Results On the 3rd after the treatment,the affected limbs circumference difference of themoderate and the severe group in the experimental group was larger than that in the control group(P＜0.05).However,there was no significantdifference between themild group in the experimental group and the control group(P＞0.05).In the comparison among the groups with different starting and ending time of treatment,the affected limbs circum ference difference of the 8-24 h and＞24 h groups in the experimental group was larger than that in the control group(P＜0.05).Therewas no significant difference between the＜8 h group in the experimental group and the control group(P＞0.05).Conclusion The short-range treatment of limbs swelling after trauma with 20%mannitol combined with dexamethasone has superior effects to those of the simple physical therapy,especially on the detumescence ofmoderate and severe limb swelling.As to the patients starting the treatment inmore than 8 to 24 h after the trauma, the curative effects of drug treatment are not significantly inferior to those of patients receiving early treatment after injury,and therefore drug intervention should be positively applied.

1　资料与方法

1.1病例资料将我科2012年3月～2015年3月期间收治的90例因创伤性肢体软组织肿胀患者，按就诊时间顺序分为3组（＜8 h组、8～24 h组、＞24 h组），每组各30例；再按肿胀程度分为3组[1]（轻度组、中度组、重度组）。所有患者均有明确外伤病史，均在受伤后2～72 h内就诊。根据患者就诊后的治疗意愿，分为实验组（理疗加药物）和对照组（单纯理疗）。……