Clinical And Experimental Study On The Effects Of Clearing Away The Heat. Prompting Blood Flow, Tonifying Qi On Wound Tissue Repair

Perioperation stage is one of the hot issues in surgery,which is increasingly considered.The purpose of repair in trauma is changing from speed to quality in healing.The connotation of repair in trauma is expanding expressed with the study from the body surface to inside,from local area to all over the body,from macroscopic to microcosmic.It is believed by the modern medicine:there are not only changes in morphology but also in biochemics in repair in trauma.In the later one,growth factor and collagen such as FGF, typeⅠ,Ⅲcollagen play important roles during the repair.In traditional Chinese medicine(TCM),it is thought that the forein coup result in Qi and blood stagnation,stagnation of Yingqi,meridian blocking, disorder between viscera and organs after trauma which lead to heat,stagnated blood,deficency of healthy Qi and so on consequently.Reparative process after surgical trauma showed obvious different properties in the different stages. During the early stage,the patients are mostly manifested with pyretic syndrome and syndrome of blood stasis;during the intermediate stage,they are mostly manifested with deficient syndrome and syndrome of blood stasis; during the stage of postoperative rehabilitation,they are always with deficient syndrome.The previous studies indicated that the traditional Chinese medicine can produce marked effects through multiple targets and links during repair in trauma,while the effects and mechanisms of TCM are not clear in the process of the wound repair yet.With the guidance of the TCM theory,this study considered the regularity of wound repair in toto;analysized and summarized the effects of promoting blood flow,tonifying Qi,clearing away heat on the different stages in wound repair in clinic.On the other hand,the basic fibroblast growth factor(bFGF) and typeⅠ,Ⅲcollagen in granulation tissues were detected in the early stage during wound repair in rat,in order to observe the effects of the treatment of promoting blood flow,tonifying Qi,clearing away heat on the wound repair in rat and to approach the mechanisms.Part one:clinical studyPatients after open cystectomy were selected and divided into 2 groups in random.There are no obvious differences between groups in the sex,age, operation time,anaesth time,volume of bleeding,bile bacteria culture.The control group was treated with common practice;the treatment group was treated according to the rules of TCM above:in addition to common practice,the patients were i.v administrated with Qingkailing injection(to clear away the heat)and Danshen injection(to promoting the blood flow)at the operation day and 1-3 days after operation,with Shenmailing injection(to tonify the Qi)and Danshen injection at the 4-7 days after operation.The body temperature recovery time,wound repair information,white blood cells(WBC)recovery time, the recovery time of gastrointestinal functions,body weigh,complications, length of stay in hospital,cost of hospitalization were observed and investigated.It was found that the treatment group was better than the control groups in the following items such as body temperature recovery time,WBC recovery time,time of passage of gas by anus,first defecation time after operation,the time to take out stitches,body weight lessening and so on (P＜0.05);the incidence of complications(pulmonary infection,urinary system infection,split of the infected wound)in treatment group was lower than control group.The treatment group did not add the cost of hospitalization compared with the control group.Part two:experimental studySD rats were divided to several groups:model group,clearing away heat +promoting the blood flow treatment group,tonifying Qi+promoting the blood flow treatment group.Rats in each group were killed at day 3 or 7 to take the neogenetic granulation tissue on the wound surface to observe bFGF mRNA expression by quantities PCR,pathological changes by HE stain,typeⅠ,Ⅲcollagen production by immunohistochemistry methods.The basic information such as food-intake,loss of body weight was also observed after operation.The results showed that the food-intake and the loss of body weight were improved from day 1-3 after operation in Danshen+Qingkailing group compared with model group;improved from day 4-7 in Danshen+Shenmai group compared with model group.In Qingkailing +Danshen group,it was seen that the granulation tissue grew red and the wound surface diminished obviously at day 3.In addition, the blood scabs formation with oozy fluid and inflammation cells under it, repair hyperplasia could beobserved by HE stain;immunohistochemistry results showed that the low to medium amounts of typeⅠcollagen expressed and low amount of typeⅢcollagen expressed in this group;the bFGF mRNA expression increased compared with the model group.At day 7,the food-intake and the activity gradually recovered;the granulation tissues proliferated with afferent,clumping and neoplastic characters which covered the wound surface completely and the tissue was not smooth.In HE stain,there were still blood scabs formation under which small amounts of oozy fluid and inflammation cells were seen,the repair hyperplasia was obvious.TypeⅠ,Ⅲcollagen expression were similar to day 3,while the bFGF mRNA increased compared with day 3.At day 3 post operation in Shenmai+Danshen group,it was seen that the granulation tissue grew evenly and the wound surface diminished obviously. In HE stain,the granulation tissue hyperplasia with more inflammatory cell infiltration;immunohistochemistry results showed there are weak expression of typeⅠ,Ⅲcollagen in this group;the bFGF mRNA expression increased compared with the model group.At day 7,the neoplastic granulation tissues were smooth and part of the wound had been repaired.In HE stain,there were many neoplastic granulation tissues which was similar to day 3.The TypeⅠ,Ⅲcollagen expressions were stronger than day 3,while the bFGF mRNA reduced obviously compared with day 3.This study partly confirmed that to prompt the blood flow,tonify Qi,clear away heat could improve would repair,which may partly due to the effects on the bFGF and typeⅠ,Ⅲcollagen production in the early and intermediate stage during wound repair.Discussions:It was concluded that to prompt the blood flow,tonify Qi,clear away heat could improve would repair according to the results in clinical study and experimental study.To prompt the blood flow played important rules in the treatment of wound which may reduce the scar formation and could be used in the whole stage;To clear away heat was more important at the early stage; to tonify Qi could prompt the growth of the granulation tissues which may lead to repair the wound as early as possible and improve the healing quality.To differentiation of symptoms and signs according to the different stage in per operation stage could guide on the recovery postoperation.The TCM showed advantages in wound repair while the mechanisms need ho be further investigated.