曹思涵 唐甜 邵心怡 王聪 冯泽宇 朱智媛 陈绪 姚昶

摘要 目的：初步觀察拔毒生肌散治疗非哺乳期乳腺炎脓腐，促进创面愈合的临床功效与可能机制。方法：选取非哺乳期乳腺炎脓肿期、窦道期患者20例，分为观察组与对照组，每组10例，观察组将拔毒生肌散均匀洒向并覆盖创面脓腐，以黄芩油纱条覆盖，对照组仅以黄芩油纱条覆盖创面；创面敷药隔日1次，敷药7次为1个疗程。治疗前后进行肿块大小、创面脓腐积分与创周皮肤状况评估，测定创面肉芽IL-6，并进行肝肾功能及尿汞临床安全性测定。结果：观察组的肿块范围评分、创面脓腐评分、创周皮肤状况评分，从治疗第6次起，显著低于对照组（P<0.05），其中创周温度从治疗第2次起即显著低于对照组。治疗后观察组脓腐周围肉芽组织中IL-6含量及病理免疫组化表达显著低于对照组（P<0.05）。且观察组患者血常规、肝肾功能及尿汞测定均在正常值范围，与对照组比较，差异无统计学意义。结论：拔毒生肌散对非哺乳期乳腺炎患者创面具有良好的提脓去腐功效，显著改善炎性反应而促进愈合，临床使用2周安全，未见不良反应，有一定推广运用价值。

关键词 拔毒生肌散；非哺乳期乳腺炎；脓腐；白细胞介素-6；临床安全性

AbstractObjective：TopreliminarilyobservetheclinicalefficacyandpossiblemechanismofthetherapeuticeffectofBaduShengjiPowderinthetreatmentofnon-lactatingmastitisthrougheliminatingpusandnecrotictissues.Methods：Atotalof20patientswithnon-lactationmastitiswereselectedinstageofabscess，sinusanddividedintothetreatmentandthecontrolgroupwith10casesineachgroup.Inthetreatmentgroup，BaduShengjiPowderwasevenlyspreadandcoveredthepusareaofthewound，alongwithradixscutellariaeoilgauzetocoverthesurface，whereas，inthecontrolgroup，thewoundareaswereonlycoveredwithradixscutellariaeoilgauze.Thewoundsweretreatedeveryotherday7timesfor1treatment.Thesizeofthetumormass，thescoreoftheinthewoundandtheskinconditionaroundthewoundwereassessedbeforeandaftertreatment.IL-6contentsinthewoundgranulationweremeasuredaswellastheclinicalsafetyindicesofthehepatorenalfunctionsandthelevelofurinemercury.Results：Thescoresofbreastmassrange，thepusandnecrotictissuesandtheskinconditionsbeyondwoundinthetreatmentgroupweresignificantlylowerthanthoseinthecontrolgroupsincethesixthevaluation（P<0.05），amongwhich，theskintemperaturesofthewoundareawerelowerthanthoseofcontrolgroupsincethesecondevaluation.ThecontentsofIL-6aswellastheirexpressionsbyhistopathologicimmunohistochemistryintheperipheralgranulationtissueofthetreatmentgroupweresignificantlylowerthanthoseinthecontrolgroupaftertreatment（P<0.05）.Thebloodroutine，hepatoralfunctionandurinemercuryofthepatientsafter14daysofclinicaluseinthetreatmentgroupwereallnormalandwithoutsignificantdifferencesascomparedwiththeresultsofcontrolgroup.Conclusion：BaduShengjiPowdersignificantlyamelioratedinflammationandpromotedwoundhealingonthepatientswithnon-lactationmastitisthroughitsgoodefficaciesofeliminatingpusandnarcotictissues.Noclinicaladverseeventshappenedwithin2weeksofclinicalapplication.Thereshouldbecertainvaluesforpopularizationandapplication.

KeyWordsBaduShengjiPowder；Non-lactatingmastitis；Pusandslough；IL-6；Clinicalsafety

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.06.017

2.2创面脓腐评分2组患者在治疗前创面附着少至中等量疏松脓腐组织，平均积分在1.3分左右，脓腐色泽晦暗发紫，平均积分3.0分左右，脓腐渗液浑浊不清，脓量以浸湿1至4层纱布为主。观察组治疗第4次开始脓腐性质、色泽及渗液开始改善，治疗第6次起，患者脓腐基本脱尽，仅有极少量渗液及腐肉，且稠厚易脱，创面趋向生肌收口，平均积分降为治疗前的1/3至1/4，间接显示创面脓腐好转70%左右。对照组创面脓腐换药第6次起开始轻度改善，治疗结束时仅较治疗前改善30%左右。治疗第6次起，脓腐各项指标，观察组均显著优于对照组，差异有统计学意义（P<0.05）。见表2。

2.3创周皮肤状况评分2组患者在治疗前创周皮肤初始以微热与肤色暗淡微红为主，创周温度评分约为1.2分作用，创周肤色评分约为1.6分左右，显示创周皮肤急性炎性反应浸润不明显。……