臺灣博碩士論文加值系統

中文摘要
雲南白藥為坊間普遍流傳的外傷用藥，其主要功效為止血癒傷為主。根據文獻指出，犬隻以warfarin 殺鼠劑誘導犬隻急慢性中毒後，以維生素K1治療犬隻，其效果十分顯著。
本論文實驗設計係以warfarin 殺鼠劑誘導犬隻慢性中毒後，分別給予不同劑量雲白藥和維生素K1治療中毒犬隻，檢驗相關的凝血時間等，目的在評估雲南白藥和維生素K1其止血作用的差異。血液凝固檢查的項目：包括凝血酶原時間(prothrombin time：PT)、活化部分凝血活酶時間(activated partial thromboplastin time：APTT)、凝血酶凝固時間(thrombin clotting time：TCT)、纖維素原(fibrinogen)、血小板數目的變化、血漿鈣離子濃度及出血時間(bleeding time：BT)。
在warfarin殺鼠劑誘導犬隻慢性中毒的模式下，不做任何治療的犬隻，於中毒後4天內，全數死亡；而以雲南白藥治療犬隻，則全數存活，足以初步判定雲南白藥確有止血功效。至於實驗的結果，在血液凝固項目 (凝血酶原時間、活化部分凝血活酶時間、凝血酶凝固時間、纖維素原) 檢查方面，雲南白藥的治療效果雖無維生素K1顯著，但仍有療效；在血小板與止血作用相關的檢驗項目(血小板數量、出血時間)方面，雲南白藥組的治療效果，則較維生素K1顯著；在血漿鈣離子濃度檢查，各組之間並無顯著差異。
經由實驗證實，雲南白藥確實具有促進微血管收縮，降低微血管的通透性，減少炎症滲出液；增進血小板數量、活化血小板的功能；輔助肝臟合成維生素K依賴型凝固因子II、VII、IX、X的功效，進而達到顯著止血效果。在warfarin殺鼠劑誘導犬隻慢性中毒的模式下，雲南白藥具有顯著療效，因此臨床上可使用雲南白藥於 warfarin殺鼠劑中毒的治療及車禍等外科手術的止血。
未來將可進一步研究，究竟雲南白藥是透過何種機制來輔助肝臟合成凝固因子、促進血小板增生及活化血小板。此外，也可以進一步分析，究竟雲南白藥中，何種成份參與止血作用，且其具有較顯著的效果。

Abstract
Yunnan Baiyao is one of the most popular Chinese traditional medicine which is very useful to stop external bleeding and help wound healing . It has been reported that Vitamin K1 is helpful to treat warfarin toxicated dogs.
The goal of our experiments is to determine whether Yunnan Baiyao has the same function as Vitamin K1 to stop internal bleeding in warfarin toxicated dogs . By observing and comparing the prothrombin time (PT) , activated partial thromboplastin time (APTT) , thrombin clotting time (TCT) , fibrinogen concentrations , platelet numbers , plasma calcium concentrations and the bleeding time of both Yunnan Baiyao and Vitamin K1 treated warfarin toxicated (treated)dogs , the relative difference between Yunnan Baiyao and Vitamin K1 in anti-bleeding function can be determined .
In our expeniments , without any treatment , all warfarin treaded dogs died in four days , however , every dogs in the Yunnan Baiyao treated group survived. This result indicated that Yunnan Baiyao has a significant effect in reversing the toxicity of warfarin . Our results indicated that Yunnan Baiyao has better performance than Vitamin K1 in increasing the number of platelet and decreasing the bleeding time . It also acted well but not as good as Vitmin K1 in the items of PT , APTT , TCT , and fibrinogen . Finally , they had the same effects in increasing blood calcium .
Our observations prove that Yunnan Baiyao does has anti-bleeding function by increasing vascular contraction , decreasing vascular permeability , reducing inflammatory exudates , increasing platelet activation and its number , and increasing synthesis of coagulative factor I , VII , IX , and X in the liver . Therefore , we suggest that Yunnan Baaiyao can be adopted in treating warfarin toxication and accidental truma bleeding .
According to our results , it is interesting to understand why Yunnan Baiyao can improve the synthesis of coagulative factors in the liver, increase the number and activation of platelet . We can also see the future direction in determining the actual components which participate in the coagulative cascade .

目錄·························································Ⅰ
附圖目錄·····················································Ⅳ
附表目錄·····················································Ⅶ
中文摘要·····················································Ⅸ
英文摘要·····················································Ⅹ
第一章 緒言··················································1
第二章 文獻探討··············································3
第一節 雲南白藥·············································3
一、雲南白藥的由來············································3
二、雲南白藥的成分············································3
三、雲南白藥的功效與主治·····································12
四、雲南白藥的性狀與劑型·····································12
五、雲南白藥的規格···········································12
六、雲南白藥的用法與用量·····································12
七、雲南白藥的副作用與注意事項·······························12
八、雲南白藥的臨床驗證·······································13
第二節 維生素 K1···········································18
一、維生素K1 的由來··········································18
二、維生素K1 的構造··········································18
三、維生素K1 的作用機序······································18
四、維生素K1 的需求量········································19
第三節 Warfarin············································21
一、Warfarin的由來···········································21
二、Warfarin的構造···········································21
三、Warfarin的作用機制·······································21
四、Warfarin 的代謝··········································23
五、Warfarin 中毒的臨床症狀··································25
第四節 血液凝固相關檢查····································26
一、止血機制·················································26
二、凝血酶原時間(Prothrombin time)···························28
三、活化部分凝血活酶時間(Activated partialthromboplastintime)29
四凝血酶凝固時間(Thrombin clotting time)·····················30
五、纖維素原(Fibrinogen)·····································31
六、出血時間(Bleeding time)··································32
七、血小板數量···············································33
7-1.血小板的構造·········································33
7-2.血小板的作用·········································34
7-3.血小板減少的原因 ········· ··························35
八、血漿鈣離子···············································36
第三章 實驗材料與方法·······································38
第一節 實驗材料··············································38
一、實驗動物·············································38
二、儀器·············································38
三、試劑及藥品·······································38
第二節 實驗方法··············································39
一、實驗分組·········································40
二、凝血酶原時間測定·································40
三、活化部分凝血活酶時間測定·································41
四、凝血酶凝固時間測定·······························42
五、纖維素原測定·····································42
六、出血時間測定·····································43
七、血小板數量測定···································43
八、血漿鈣離子·······································43
九、資料分析·········································43
第三節 實驗設計··············································44
一、 雲南白藥的劑量······································44
二、 實驗流程圖··········································51
第四章 結果·················································52
第一節 凝血酶原時間實驗結果··································52
第二節 活化部分凝血活酶時間實驗結果··························58
第三節 凝血酶凝固時間實驗結果································63
第四節 纖維素原實驗結果········ ····························69
第五節 出血時間實驗結果······································75
第六節 血小板數量實驗結果····································81
第六節 血漿鈣離子實驗結果····································85
第五章 討論·················································89
參考文獻·····················································91
····························································100

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