刘孝国 吴其科 徐周

[摘要]目的：探讨活血祛瘀类中药汤剂在手部软组织缺损皮瓣修复术后的应用效果及安全性。方法：按照随机数字表法将2019年6月-2020年6月笔者医院收治的手部软组织缺损患者100例分为对照组与观察组，每组50例。对照组患者皮瓣修复术后常规支持治疗，观察组患者在对照组的基础上加用活血祛瘀类中药汤剂，治疗1个月。比较两组治疗效果、皮瓣肿胀程度、上肢功能指数（Upper extremity functional index，UEFI）量表评分、视觉模拟量表（Visual analogue scale，VAS）评分、血液流变学指标（全血黏度，全血高切黏度，全血中切黏度，全血低切黏度，血浆黏度）及不良反应情况。结果：观察组与对照组的治疗有效率分别为96.00%（48/50）、80.00%（40/50），观察组明显高于对照组，差异有统计学意义（P<0.05）。观察组皮瓣肿胀程度明显优于对照组，差异有统计学意义（P<0.05）。治疗后，两组UEFI评分均较治疗前明显增高，VAS评分均较治疗前明显降低，且观察组UEFI评分明显高于对照组，VAS评分明显低于对照组，差异均有统计学意义（P<0.05）。治疗后，两組血液流变学指标均较治疗前明显降低，观察组明显低于对照组，差异均有统计学意义（P<0.05）。结论：活血祛瘀类中药汤剂能够明显改善手部软组织缺损皮瓣修复术后的皮瓣肿胀程度、上肢功能及疼痛情况，提高皮瓣存活率，安全性高。

[关键词]手部软组织缺损;皮瓣修复术;中药汤剂;活血祛瘀;皮瓣肿胀;皮瓣存活率;血液流变学

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）04-0074-03

Application of Traditional Chinese Medicine Decoction for Activating Blood and Removing Stasis on Hand Soft Tissue Defect after Skin Flap Repair

LIU Xiao-guo，WU Qi-ke，XU Zhou

（Department of Emergency，Mingguang Hospital of Traditional Chinese Medicine，Chuzhou 239400，Anhui，China）

Abstract： Objective  To investigate the efficacy and safety of traditional Chinese medicine（TCM） decoction for activating blood and removing rtasis on hand soft tissue defect after skin flap repair. Methods  According to the random number table method， 100 patients with hand soft tissue defect who was divided into the control group and the observation group in our hospital from June 2019 to June 2020， with 50 cases in each group. The patients were received routine supportive treatment after skin flap repair in the control group， and the patients were added TCM decoction for activating blood and removing rtasis on the basis of the control group in the observation group， the treatment was lasted for 1 month. The treatment effect， degree of flap swelling， upper extremity functional index（UEFI） scores， visual analogue scale（VAS） pain scores， hemorheology indicators （whole blood viscosity， whole blood high cut viscosity， whole blood medium cut viscosity， whole blood low cut viscosity， plasma viscosity） and adverse reactions were compared between the two groups. Results  The effective rates in the observation group and the control group was 96.00%（48/50） and 80.00%（40/50）， respectively， which the observation group was significantly higher than those of the control group， the difference was statistically significant （P<0.05）. The degree of flap swelling in the observation group was better than that in the control group（P<0.05）. After treatment， the UEFI scores in both groups were significantly higher than that before treatment， and the VAS pain scores were significantly lower than that before treatment（P<0.05）. The UEFI scores in the observation group was significantly higher than that in the control group， and the VAS pain scores were significantly lower than that in the control group（P<0.05）. After treatment， the hemorheology indicators in both groups were significantly lower than those before treatment， and those in the observation group were significantly lower than those in the control group（P<0.05）.Conclusion  Traditional Chinese medicine decoction for activating blood and removing rtasis could obviously improve the degree of flap swelling， upper limb function and pain of hand soft tissue defect after flap prosthetics. It could enhance the flap survival rate and safety was high.

Key words： soft tissue defect of hand; skin flap repair; traditional Chinese medicine decoction; activating blood and removing stasis; flap swelling; flap survival rate; hemorheology

手部软组织缺损在临床上比较常见，皮瓣修复术具有安全有效的优点，已经成为首选治疗手段[1]。但是皮瓣修复术后皮瓣的肿胀程度及相关并发症不利于患者的术后恢复[2]。目前，关于皮瓣修复术的治疗并没有统一标准方案。中医药在临床各个领域均取得到广泛应用，并取得了较好效果，但是关于活血祛瘀类中药汤剂应用于各类软组织缺损皮瓣修复术后的研究报道并不多见。基于此，本研究通过分析活血祛瘀类中药汤劑在手部软组织缺损皮瓣修复术后的应用效果及安全性，以期为临床提供参考依据。……