The influence of wet compress of Yanghe Decoction on wound healing in ulcerative-stage lower limb varicose veins under wet healing theory
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摘要:
目的 探讨湿性愈合理论下阳和汤湿敷在溃疡期下肢静脉曲张患者术后促创面愈合中的应用效果，为此类患者术后促进创面愈合提供更充分的理论依据。 方法 选取2022年9月—2024年8月于绍兴文理学院附属医院治疗的溃疡期下肢静脉曲张患者96例，根据随机数字表法分为观察组和基线组，各48例。基线组术后实施常规治疗，观察组在基线组基础上实施湿性愈合理论下阳和汤湿敷。评估2组疗效、中医证候积分、溃疡面积，统计术后创面愈合时间、并发症发生率，检测血管内皮生长因子(VEGF)、缺氧诱导因子-1α(HIF-1α)、转化生长因子β1(TGF-β1)。 结果 观察组疗效优于基线组(P＜0.05)。观察组治疗后各项中医证候主症评分及总积分低于基线组(P＜0.05)；观察组治疗后溃疡面积、溃疡深度均小于基线组(P＜0.05)；观察组创面愈合时间[(28.33±4.08)d]短于基线组[(30.25±4.14)d，t=2.289，P＜0.05]；观察组治疗后血清VEGF、TGF-β1水平高于基线组，血清HIF-1α水平低于基线组(P＜0.05)；观察组并发症发生率[6.25%(3/48)]低于基线组[20.83%(10/48), χ2=4.360，P=0.037]。 结论 湿性愈合理论下阳和汤湿敷应用于溃疡期下肢静脉曲张术后患者能有效提高治疗效果，减轻患者症状，促进术后创面愈合，调节VEGF、TGF-β1、HIF-1α水平，减少并发症。 Abstract:Objective This study aims to evaluate the application of Yanghe Decoction wet dressing based on wet healing theory, promoting wound healing in postoperative patients with lower extremity varicose veins at the ulcer stage. Methods A total of 96 patients with ulcerated lower extremity varicose veins, admitted to the Affiliated Hospital of Shaoxing University from September 2022 to August 2024, were selected and divided into an observation group and a baseline group based on a random number table method, with 48 patients in each group. The baseline group received postoperative treatment, while the observation group received Yanghe Decoction wet dressing based on the wet healing theory in addition to the baseline treatment. The treatment efficacy, traditional Chinese medicine (TCM) syndrome scores, ulcer area, postoperative wound healing time, and complication rates were evaluated in both groups. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1α (HIF-1α), and transforming growth factor-β1 (TGF-β1) were also measured. Results The observation group demonstrated significantly better therapeutic efficacy compared to the baseline group (P < 0.05). After treatment, the scores for the main symptoms of TCM syndromes and the total score in the observation group were lower than those in the baseline group (P < 0.05). The ulcer area and ulcer depth in the observation group after treatment were smaller than those in the baseline group (P < 0.05). The wound healing time in the observation group [(28.33±4.08) days] was shorter than that in the baseline group [(30.25±4.14) days, t=2.289, P < 0.05]. After treatment, the levels of VEGF and TGF-β1 in the observation group were higher than those in the baseline group, while the level of HIF-1αwas lower (P < 0.05). The incidence of complications in the observation group was 6.25% (3/48), which was lower than in the baseline group (20.83%, 10/48, χ2=4.360, P=0.037). Conclusion Under the theory of wet healing, the application of Yanghe Decoction wet compress can effectively improve treatment effect, reduce symptoms of patients, promote postoperative wound healing, regulates the levels of VEGF, TGF-β1, and HIF-1α, and reduce complications in patients with ulcer-stage lower extremity varicose veins. -
Key words:
- Wet healing theory /
- Yanghe Decoction /
- Wet compress /
- Ulcer stage /
- Lower limb varicose veins /
- Wound healing
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表 1 2组溃疡期下肢静脉曲张患者一般资料比较
Table 1. Comparison of general information between two groups of patients with lower extremity varicose veins in the ulcer stage
组别 例数 性别(男性/女性，例) 年龄(x±s，岁) 静脉曲张部位(左下肢/右下肢，例) 下肢静脉曲张病程(x±s，年) 溃疡病程(x±s，月) 溃疡面积(x±s，cm2) 观察组 48 25/23 47.98±7.96 27/21 14.31±3.70 10.03±2.05 22.01±5.27 基线组 48 26/22 48.69±8.19 24/24 15.16±3.38 9.76±2.11 20.78±5.04 统计量 0.042a 0.431b 0.377a 1.175b 0.636b 1.169b P值 0.838 0.668 0.540 0.243 0.526 0.246 组别 例数 溃疡深度(x±s，mm) CEAP分级(C6级/C6r级，例) 长期吸烟史[例(%)] 长期饮酒史[例(%)] 糖尿病[例(%)] 创面感染[例(%)] 观察组 48 8.05±1.84 28/20 13(27.08) 15(31.25) 6(12.50) 18(37.50) 基线组 48 7.92±1.76 30/18 11(22.92) 13(27.08) 5(10.42) 20(41.67) 统计量 0.354b 0.174a 0.222a 0.202a 0.103a 0.174a P值 0.724 0.676 0.637 0.653 0.749 0.676 注：a为χ2值，b为t值。 
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表 2 2组溃疡期下肢静脉曲张患者疗效比较[例(%)]
Table 2. Comparison of curative effects pre- and post-treatment between two groups of patients with lower extremity varicose veins at ulcer stage[case (%)]
组别 例数 临床痊愈 显效 有效 无效 观察组 48 11(22.92) 24(50.00) 12(25.00) 1(2.08) 基线组 48 6(12.50) 13(27.08) 19(39.58) 10(20.83) 注：2组疗效比较，Z=3.197，P=0.001。
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表 3 2组溃疡期下肢静脉曲张患者治疗前后中医证候积分比较(x±s，分)
Table 3. Comparison of TCM syndrome scores before and after treatment between two groups of patients with lower extremity varicose veins at ulcer stage (x±s, points)
组别 例数 脓水清稀，淋漓不尽 创面肉色淡白或紫暗不鲜 创周肤色暗黑、板硬 总积分 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 48 4.00±1.02 2.02±0.41b 4.04±0.92 2.08±0.45b 4.17±0.89 2.13±0.44b 14.94±3.20 8.00±1.80b 基线组 48 4.13±0.99 2.31±0.50b 4.17±0.90 2.40±0.49b 4.08±0.91 2.35±0.48b 15.17±3.12 9.85±1.90b 统计量 0.634a 16.873c 0.700a 19.371c 0.490a 19.033c 0.357a 20.813c P值 0.528 ＜0.001 0.486 ＜0.001 0.625 ＜0.001 0.722 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 4 2组溃疡期下肢静脉曲张患者治疗前后溃疡面积、溃疡深度及创面愈合时间比较(x±s)
Table 4. Comparison of ulcer area, depth, and healing duration before and after treatment between two groups in patients with lower extremity varicose veins at ulcer stage (x±s, points)
组别 例数 溃疡面积(cm2) 溃疡深度(mm) 创面愈合时间(d) 治疗前 治疗后 治疗前 治疗后 观察组 48 22.01±5.27 7.77±1.32b 8.05±1.84 4.02±1.19b 28.33±4.08 基线组 48 20.78±5.04 8.52±1.53b 7.92±1.76 5.21±1.22b 30.25±4.14 统计量 1.169a 16.278c 0.354a 17.393c 2.289a P值 0.246 ＜0.001 0.724 ＜0.001 0.024 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 5 2组溃疡期下肢静脉曲张患者治疗前后血清VEGF、HIF-1α、TGF-β1水平比较(x±s，pg/mL)
Table 5. Comparison of serum levels of VEGF, HIF-1α, and TGF-β1 before and after treatment between two groups of patients with lower limb varicose veins (x±s, pg/mL)
组别 例数 VEGF HIF-1α TGF-β1 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 48 541.49±70.84 635.94±52.28b 178.23±34.28 123.72±20.15b 50.34±8.25 94.18±11.58b 基线组 48 528.60±65.71 604.71±53.19b 181.64±36.71 138.16±22.48b 52.07±8.89 86.28±10.33b 统计量 0.924a 20.389c 0.470a 19.845c 0.988a 19.036c P值 0.358 ＜0.001 0.639 ＜0.001 0.326 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 6 2组溃疡期下肢静脉曲张患者并发症发生率比较[例(%)]
Table 6. Comparison of the complication incidences between two groups of patients with lower extremity varicose veins at the ulcer stage[cases (%)]
组别 例数 血栓性浅静脉炎 穿刺点硬结 皮下局部红肿 创面感染 总发生 观察组 48 1(2.08) 1(2.08) 1(2.08) 0 3(6.25) 基线组 48 2(4.17) 2(4.17) 3(6.25) 3(6.25) 10(20.83) 注：2组并发症发生率比较，χ2=4.360，P=0.037。
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