The effect of Xuebijing on burn patients and its effect on pain and wound healing

2021-01-04LeGuanBaoGuoChenHuiFengSongNingKangYanWu

Journal of Hainan Medical College 2020年22期

Le Guan, Bao-Guo Chen, Hui-Feng Song, Ning Kang, Yan Wu

1.Beijing Jingcheng Skin Hospital, Chaoyang District of Beijing City 100085, China

2.Five Burn and plastic department of the First affiliated hospital of the general hospital of the Chinese people's liberation army, Haidian district of Beijing city 100048, China

3.Plastic surgery hospital, Chinese academy of medical sciences, Shijingshan district, Beijing 100144, China

4.Peking university first hospital Xicheng district, Beijing 100034, China

Keywords:Xuebijing Burn Pain Wound healing

ABSTRACT Objective: To explore the therapeutic effect of Xuebijing on burn patients and its effect on pain and wound healing. Methods: The burn patients treated in our hospital were selected and divided into two groups according to single and double numbers. The first group, the conventional treatment group (CT group): take conventional treatment to treat this group of burn patients; the second group, Xuebijing group (BWN group): take the CT group + Xuebijing combination treatment of this group of burn patients , 37 cases in each group. There was no difference in general data between CT group and BWN group. To explore the differences between prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), pain, secondary effects, and wound healing in CT group and BWN group The therapeutic effect of the patient and its effect on pain and wound healing. Results: Examination showed that the coagulation indexes of patients in CT group were 26.34 ± 4.25, 17.69 ± 4.12, 2.01 ± 0.78, the coagulation indexes of patients in BWN group were 17.49 ± 3.56, 11.07 ± 2.39, 3.56 ± 1.14, compared with CT group and BWN group In the CT group, the prothrombin time (PT) and thrombin time (TT) indicators were higher than those in the BWN group, but fibrinogen (FIB) was significantly lower than that in the BWN group (p ＜0.05). It can be seen from the table that before treatment, the visual analogue scoring (VAS) scores of patients in CT group and BWN group were 6.64 ± 1.12 and 6.98 ± 1.08, respectively, with a small difference (p＞ 0.05). After treatment, CT group and BWN group scores They were 4.56 ± 1.16 and 2.12 ± 0.97 respectively. Compared with CT group and BWN group, the VAS score of CT group was significantly higher than that of BWN group (p ＜0.05). After treatment, the number of wound healing days in the BWN group (20.68 ± 3.14d) was less than that in the CT group (32.89 ± 4.25d) (P ＜0.05), but the wound healing rate (96.48 ± 6.89%) was significantly higher than the CT group (81.17 ± 5.74%) (P ＜0.05). In the CT group, 3 patients had blood accumulation, 2 infections, and 3 effusions. In the BWN group, there were 0 blood accumulations, 1 infection, and 2 effusions. Compared with the CT group and the BWN group, the number and incidence of the BWN group (8.12% ) Are less than CT group (21.62%) (p ＜0.05). The patient's leg suffered third-degree burns. After 5 weeks of treatment, the edge of the allogeneic skin on the CT group began to peel off and the epidermis fell off. Rejection. Conclusion: Conventional treatment + Xuebijing treatment, its curative effect is significant, can significantly accelerate the wound healing rate, and at the same time, reduce the incidence of secondary effects.

1. Introduction

Burn generally refers to the damage of skin tissue caused by boiling water, steam, flame, etc. [1]. Burn is a common type of emergency trauma in clinic. Burn is usually divided into shallow, deep, severe and so on [2]. The burn was characterized by pain, redness, and severe erythema, blister or eschar. When burns occur, first aid should be given as soon as possible. Early treatment plays an important role. Improper treatment will lead to wound ulceration and even life-threatening, and hinder the follow-up treatment. Early treatment is the basis of follow-up treatment for burn patients [3]. In the body of severely burned patients, infection is easy to occur, which destroys the physiological balance of the patients, and eventually leads to the disease characterized by persistent excessive inflammation and immunosuppression [4-5]. In the patients with deep burn, the vast majority of patients suffer from sepsis, and further development of sepsis can lead to circulatory system failure, MODS, MOF and even death [6-7]. The reason is that the skin surface of the patient is damaged, a large number of necrotic skin on the burn wound is not removed in time, which makes the skin lose its defense function. The occurrence of the disease is characterized by fierce and rapid onset, and the disease changes indefinitely [8]. Therefore, wound repair plays an important role in the treatment of burn. Some studies have proved that Xuebijing is a common method in clinical emergency treatment of pediatric burns [9]. Blood will net is A clear brown liquid, and its main component is safflor yellow pigment a, etc. It is one of the commonly used drugs in the treatment of burn related complications in traditional Chinese medicine. It has the functions of activating blood circulation and removing blood stasis, clearing channels and collaterals, and dispersing toxin and evil [10]. There are many literatures about the effect of Xuebijing Injection on burn patients. This article not only analyzes the clinical effect of Xuebijing injection, but also studies the specific mechanism of action of Xuebijing on patients. Therefore, this article analyzes the differences of coagulation index, pain, secondary effect and wound healing between CT group and BWN group to explore the therapeutic effect of Xuebijing on burn patients and its influence on pain and wound healing.

2. Data and methods

2.1 General information

74 burn patients (from January 2017 to June 2019) were divided into two groups according to single and double numbers. The first group, conventional treatment group (CT group): the burn patients in this group were treated with conventional treatment; the second group, Xuebijing group (BWN group): the burn patients in this group were treated with CT group + Xuebijing, 37 cases in each group. There was no difference in general data between CT group and BWN group.

Table 1 general information (example)

2.2 Inclusion and exclusion criteria

Inclusion criteria: ① all the family members were informed; ② before burn, all the patients had no major diseases; ③ no allergy to Xuebijing; ④ the patient's vital signs were stable and could receive corresponding treatment. Exclusion criteria: ① there were obvious exogenous pollutants in the burn wound; ② there was no reason to quit during the experiment; ③ the mental state was poor.

2.3 Treatment

CT group: routine treatment was adopted, and the scalded part was washed with normal saline for 10 minutes, and broadspectrum antibiotics were given to inhibit the growth of Gramnegative bacteria and other bacteria. The skin was disinfected with Iodophor disinfectant, mopirosin ointment was applied externally, the dressing was changed 3 times a day, and the wound was wet applied with gauze to prevent infection. At the same time, according to the burn condition and location of different patients, the most appropriate treatment scheme is selected, such as surgical resection, escharectomy and skin grafting.

BWN group: on the basis of the treatment of CT group, Xuebijing injection was given. Xuebijing was injected intravenously twice a day for 100 ml for one week.

2.4 Observation indicators

① The changes of coagulation indexes in CT group and BWN group after treatment were analyzed and compared. The changes were detected by CA-7000 automatic hemagglutination analyzer, including prothrombin time (PT), thrombin time (TT), fibrinogen (FIB). ② the pain of CT group and BWN group before and after treatment was observed and compared. The higher the score, the more pain The stronger the sensation, the total score was 10 points; ③ after treatment, the secondary effects of CT group and BWN group, including wound infection, wound area blood, wound area fluid, etc.; ④ observe and record the wound healing of CT group and BWN group.

2.5 Statistical analysis

SPSS 22.0 statistical analysis was used to observe the differences of recovery time, extubation time, secondary effect and hemodynamic parameters between RM group and SA group during the operation. T-test was used, P ＜ 0.05.

3. Results

3.1 Comparison of coagulation indexes between 1ct group and BWN group

The results showed that the coagulation indexes in CT group were 26.34 ± 4.25, 17.69 ± 4.12 and 2.01 ± 0.78, respectively, and those in BWN group were 17.49 ± 3.56, 11.07 ± 2.39 and 3.56 ± 1.14, respectively. Compared with BWN group, TT and Pt indexes in CT group were higher than those in BWN group, but FIB was significantly lower (P ＜ 0.05). The results are shown in Table 2.

Table 2 Comparison of coagulation indexes between T group and BWN group( ±s )

#Compared with CT group p＜0.05

group n TT（s） PT（s） FIB(g/L)CTgroup 37 26.34±4.25 17.69±4.12 2.01±0.78 BWNgroup 37 17.49±3.56# 11.07±2.39# 3.56±1.14#t 9.710 8.454 6.826 p＜0.001 ＜0.001 ＜0.001

3.2 Comparison of pain between 2ct group and BWN group

According to the table, before treatment, the VAS scores of CT group and BWN group were 6.64 ± 1.12 and 6.98 ± 1.08, respectively, with little difference (P ＞ 0.05). After treatment, the scores of CT group and BWN group were 4.56 ± 1.16 and 2.12 ± 0.97, respectively. Compared with BWN group, the VAS scores of CT group were significantly higher than those of BWN group (P ＜ 0.05). The results are shown in Table 3.

Table 3 C VAS scores of patients in T group and BWN group（±s）

*Compared with the pre-treatment group, P ＜ 0.05, compared with the CT group, P ＜ 0.05

group n Before treatment Before treatment t p CTgroup 37 6.64±1.12 4.56±1.16* 7.847 ＜0.001 BWNgroup 37 6.98±1.08 2.12±0.97*# 20.364 ＜0.001 t 1.329 9.815 p 0.188 ＜0.001

3.3 Wound healing in 3CT group and BWN group

After treatment, the number of wound healing days in BWN group (20.68 ± 3.14 days) was less than that in CT group (32.89 ± 4.25 days), but the wound healing rate (96.48 ± 6.89%) was significantly higher than that in CT group (81.17 ± 5.74%). The results are shown in Table 4.

Table 4 Comparison of wound healing between group 4CT and group BWN（±s）

#Compared with CT group, P ＜ 0.05

group n Days of wound healing（d） Days of wound healing(%)CTgroup 37 32.89±4.25 81.17±5.74 BWNgroup 37 20.68±3.14# 96.48±6.89#t 18.262 56.884 p＜0.001 ＜0.001

3.4 Comparison of secondary effects between 4CT group and BWN group

Compared with BWN group, the number and incidence of secondary effect in BWN group (8.12%) were lower than those in CT group (21.62%), and the difference between the two groups was significant (P ＜ 0.05).

3.5 analysis of typical cases of two groups of patients

After 5 weeks of treatment, the edge of allograft skin began to exfoliate and large area of epidermis in CT group. In BWN group, the self eschar was dry and intact, close to the wound surface, and no dissolution or exfoliation was found. The results are shown in Figure 1.

Figure 1 Typical cases

4. Discussion

Burn is a more common form of injury in life, including flame burn and scald [11]. In medicine, the burns are divided into I-IV degree burns, I degree burns represent the lightest burn, only the surface of the skin can be healed within one week, IV degree burns represent severe burns, the bones and even the internal organs of the patients have different degrees of damage, the treatment depends on surgery, and the severe ones need amputation [12]. At the same time, there are shallow and deep burns, usually with the healing time as the boundary, greater than 21 days as the depth, otherwise, it is shallow [13]. Burn will not only give patients surface pain but also bring other diseases, such as sepsis, bacterial infection and so on. Further aggravate the disease, bring more pain to the patients. In this regard, the early emergency treatment for burns is particularly important. In case of burns, leave the site quickly, apply ice or wash with cold water, and send to the hospital as soon as possible [14].

Compared with BWN group, TT and Pt of CT group were higher than BWN group, but FIB was significantly lower than BWN group. It can be seen from the table that before treatment, there was little difference in VAS score between CT group and BWN group. After treatment, compared with BWN group, the VAS score of CT group was significantly higher than BWN group. After treatment, the wound healing days of BWN group were less than that of CT group, but the wound healing rate was significantly higher than that of CT group. There were 3 hematocele, 2 infection and 3 effusion in CT group, 0 hematocele, 1 infection and 2 effusion in BWN group. Compared with BWN group, the number and incidence of BWN group were less than CT group. The literature shows that after the burn, the injured skin should be treated in time, the damaged skin on the surface of the patient's skin should be removed, and the deep nerves of the skin should be prevented from being seriously damaged, so as to deepen the depth of the wound. If the patients are not treated in a timely and scientific way, the burn wound may be infected and suppurated, which may lead to other complications [15]. A large number of studies show that sepsis will lead to the increase of inflammatory factors in patients, and then lead to other diseases, increasing the difficulty of treatment. Therefore, it is particularly important to prevent the occurrence of complications in the process of burn treatment [16]. Research shows that iodophor is a commonly used disinfectant in medicine. Iodophor has less irritation to skin wound and mucous membrane, but has significant bactericidal effect on pathogenic bacteria and common bacteria of iatrogenic infection. Routine disinfection with Iodophor and antibiotics, followed by corresponding surgical treatment, to reduce the risk of infection [17]. The experimental results show that the coagulation mechanism of most burn patients will be abnormal, but the side effects of conventional treatment drugs on the patients are large, but the traditional Chinese medicine preparation is mild, which can not only effectively improve the patients' symptoms, but also reduce the secondary effects. Xuebijing, a traditional Chinese medicine, has the functions of protecting the vascular endothelial cells of burn patients, regulating the immune response of patients and improving the microcirculation in shock state [18]. Through data analysis, it can be seen that Xuebijing has better clinical treatment results for burn patients, can effectively inhibit the occurrence and development of sepsis, and can be safely applied in clinical [19]. The results of this study are consistent with the above results.

To sum up: routine treatment + Xuebijing treatment, the curative effect is significant, can significantly accelerate the wound healing rate, at the same time, reduce the incidence of secondary effects.