臺灣博碩士論文加值系統

中醫臨床上常用的促進傷口癒合的外用藥生肌玉紅膏，其直接針對燙傷創口外敷的促進傷面癒合效果如何，且與西醫慣用處理方式之治療效果相較何如，實有進一步探討之必要。因此本研究採用豬的深度燙傷模型，共三隻豬，每隻豬左、右背部各三個創面，將燙傷創面分為對照組、西藥外敷組及中藥外敷組等三組，並利用重複拉丁方陣設計（repeated Latin-square design）方法進行實驗設計與分組。於第一、二、三、四週時，描繪傷口未癒合之面積，以變異數分析法進行統計分析。同時於第三天及第一、二、四週時，進行切片採樣，藉此觀察不同用藥處理對組織癒合之影響。
研究結果顯示，外敷中藥玉紅膏對於豬深度燙傷的創面癒合，在燙傷後第三週時較不敷藥與外敷西藥Silver sulfadiazine有顯著的促創面癒合作用。在組織病理觀察上外敷中藥玉紅膏有下列幾個特點：1.無顯著的促痂皮崩解作用；2.對燙傷創面後期癒合上，可以促進表皮再生的生長線位移，亦可促進過度增生的細胞趨於成熟化；3.對燙傷創面後期癒合上，可以降低纖維母細胞浸潤程度；4.在組織修復過程有顯著促進血管新生的作用；5.可以減輕燙傷創面的炎症反應。

For assessing and comparing the effect of Yu-Hong-Gao(玉紅膏) and western medicine on wound healing of deep degree burn, a deep degree porcine burn model with repeated Latin-square design experiment method was used. Three burns were inflicted on both the flanks of the three pigs used in the present study. These burn wounds were divided into a control group, a western medicine group and a Chinese medicine group. Rate of reepithelialization was calculated at 7, 14, 21, 28 postburn days. Full thickness biopsies were taken at 3,7,14 and 28 postburn days for histopathological evaluation.
As a result, the rate of reepithelialization of burn wounds which were treated with Yu-Hong-Gao was significantly increased as compared to that of the control group as well as the western medicine group at 21 postburn days. Comparing the Yu-Hong-Gao-treated burns and Silver Sulfadiazine-treated burns, we concluded that 1.) Both Yu-Hong-Gao and Silver Sulfadiazine could not improve the disintegration of the crust; 2.) Yu-Hong-Gao could promote the epidermal regeneration at late phase of wound healing; 3.) Yu-Hong-Gao could reduce the degree of fibroblast infiltration at late phase of wound healing; 4.) Yu-Hong-Gao could enhance the neovascularization of the wounded area during the process of wound healing; 5.) Yu-Hong-Gao could the reaction of inflammation.

第一章 前言 1
第二章 文獻探討 3
第一節 　燒燙傷後的病理變化 3
一、皮膚燒傷時微循環的變化 3
二、皮膚燒傷程度的分類及其形態變化 5
三、皮膚燒傷後的瘢痕組織 9
第二節　西醫對燒燙傷創面的局部處理11
第三節　歷代中醫對燒燙傷的看法及處理方法14
第四節　燒傷中醫外治法－燒燙傷後中藥外敷的使用17
第五節　燒燙傷研究之動物模型19
第六節　本研究使用中藥藥膏的背景21
第三章 材料與方法27
一、實驗設計方法27
二、實驗對象27
三、實驗時間與地點27
四、實驗材料27
五、實驗分組28
六、燙傷模型29
七、實驗流程29
八、換藥時間29
九、豬成長效應的觀測30
十、病理切片30
十一、評估指標30
十二、統計方法31
第四章 結果32
第一節　豬隻之基本資料32
第二節　創面癒合率之變化與比較33
第三節　創面組織切片一般光學病理組織鏡檢之結果39
第五章 討論60
一、玉紅膏對豬深度燙傷促創面癒合之效應60
二、玉紅膏對豬深度燙傷促創面癒合之組織病理變化62
三、結語67
第六章結論69
參考文獻70
英文摘要82

1. Sabiston JL. Sabiston Essentials of Surgery, W. B. Saunders Company, Philadelphia, Pennsylvania. 1994: 131.
2. Dziewulski P. Burn wound healing. James Ellsworth Laing Memorial Essay for 1991. Burns 1992; 18(6): 466-478.
3. Jackson DM. The diagnosis of the depth of burning. Br J Surg 1953; 40: 558-596.
4. Gretchen J. Carrougher, Burn care and therapy. Mosby, Missouri 1998: 9-10.
5. Zawacki B. The local effects of burn injury. In Boswick, J ed.: The art and science of burn care. Aspen, Rockville 1987: 25-32.
6. 常致德，張明良，孫永華，沈祖堯，曹大鑫，張仲明，燕鳳芝，韓巽：燒傷創面修復與全身治療，北京出版社，北京，1993: 18.
7. Bauer JA, Sauer T. Cutaneous 10MH2 ultrasound B scan allows the quantitative assessment burn depth. Burns 1989; 15(1): 49-51.
8. .Gatti JE, La RD, Silverman DG, Hartford CE. Evaluation of the burn wound with perfusion fluorometry. J Trauma 23:202, 1983.
9. 常致德，張明良，孫永華，沈祖堯，曹大鑫，張仲明，燕鳳芝，韓巽：燒傷創面修復與全身治療，北京出版社，北京，1993: 19.
10. 密磊、史濟湘、徐惠貞、金再敏、邵炳榮、王鐘晶：燒傷後花生四烯酸途徑代謝狀態的改變及其意義。中華整形燒傷外科雜誌　1993；9(3)：189-191.
11. 常致德，張明良，孫永華，沈祖堯，曹大鑫，張仲明，燕鳳芝，韓巽：燒傷創面修復與全身治療，北京出版社，北京，1993: 22-23.
12. 梁勇才編：中國燒傷大全，學苑出版社，北京　　1998;3-5.
13. Seymour IS. Principles of Surgery Companion 6E Handbook. McGraw-Hill Int''l Enterprises Inc., Lodon 1994: 101.
14. 甘忠毅：燒傷分度及分度形態改變的研討。中華外科雜誌 1965；13；469.
15. Artz CP. Depth of the burn. The treatment of burns. W. B. Saunders Comp, Philadelphia and London 1957: 5l.
16. Munster AM. Classification, natural history and prognosis. Burn Care for the house officer. William & Wilkins Bartimore, London 1986: 3.
17. 顧伯康：中醫外科學，知音出版社，台北　1994, 408.
18. 徐莉萍，張家憲，柯哲銘，莊榮彬，黃千祝，劉俊人編譯：Ross組織學，台北　1991; 5: 108.
19. Hackett MEJ. The use of thermograph in the assessment of depth of burn and blood supply of flaps, with preliminary reports on its use in Dupuytren''s contrature and treatment varicose ulcers. Br J Plast Surg 1974; 27(4): 311-317.
20. Kalus AM. Application of ultrasound in assessing burn depth. Lancet 8109:188, 1979.
21. McManus AT, Kim SH, McManus WF, Mason AD Jr, Pruitt BA Jr. Comparison of quantitative microbiology and histopathology in divided burn-wound biopsy specimens. Arch Surg 122(1): 74, 1987.
22. 常致德，張明良，孫永華，沈祖堯，曹大鑫，張仲明，燕鳳芝，韓巽：燒傷創面修復與全身治療，北京出版社，北京，1993: 20-21.
23. .Milchell V, Galizia JP, Fournier L. Precise diagnosis of infection in burn wound biopsy specimens. J Burn Care Rehabil 10(3): 195-202 1989.
24. Munster AM. Classification, natural history and prognosis. Burn Care for the house officer. William & Wilkins Bartimore, London 1986: 2.
25. Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma Injury Infect Criti Care 1970; 10(12): 1103-1108.
26. Zawacki BE. The natural history of reversible burn injury. Surg Gynec Obstet 1974; 139(6): 867-872.
27. Zawacki BE. Reversal of capillary stasis and prevention necrosis in burns. Ann Surg 1974, 180(1): 98-102.
28. Monafo W, Moyer CA. Effectiveness in dilute aqueous silver nitrate in the treatment of major burns. Arch of Surg 1965; 91: 200-210.
29. 常致德，張明良，孫永華，沈祖堯，曹大鑫，張仲明，燕鳳芝，韓巽：燒傷創面修復與全身治療，北京出版社，北京，1993: 31.
30. Charles LF. Topical therapy and the development of silver sulfadiazine. Surg Gynec Obstet 1983; 157: 82-88.
31. Sabiston, JL. Sabiston Essentials of Surgery, W. B. Saunders Company, Philadelphia, Pennsylvania. 1994: 133
32. Gilmann AG, Goodman LS, Gilman A. The pharmacological basis of therapeutics. New York, Macmillan Publishing Co Inc. 1980.
33. Sabiston, JL. Sabiston Essentials of Surgery, W. B. Saunders Company, Philadelphia, Pennsylvania. 1994: 134.
34. Fox CL Jr. Topical therapy and the development of silver sulfadiazine. Surg Gynec Obstet 1983; 157: 82-88.
35. Nangia AK, Hung CT, Lim JCK. Silver sulfadiazine in the management of burns: an update. Drugs of Today 1987; 23: 21-30.
36. 馮中明、董小青：小面積三度燒傷晚期創面幾種外用藥物療效觀察。中國中西醫結合雜誌　1996;16(4): 229-230.
37. McCauley RL, Linares HA, Pelligrini V, Herndon DN, Robson MC, and Heggers JP. In vivo toxocity of topical antimicrobial agents to human fibroblast. J Surg Res 1989; 46: 267-274.
38. Sawhney CP, Sharma RK, Rao KR, Kaushish R. Long-term experience with 1 per cent topical silver sulphadiazine cream in the management of burn wound. Burns 1989; 15(6): 403-406.
39. Coombs CJ, Wan AT, Masterton JP, Conyers RAJ, Pedersen J, and Cnina YT. Do burn patients have a silver lining? Burns 1992; 18: 179-182.
40. Chan CK, Jarrett F, Moylan JA. Acute leukopenia as an allergic reaction to silver sulfadiazine in burn patients. J Trauma 1976; 16: 395-396.
41. Fraser GL and Beaulieu JT. Leukopenia secondary to sulfadiazine silver. JAMA 1979; 241: 1928-1929.
42. Fraser-Moodie A and Nancarrow J. Neutropenia and thrombocytopenia in burns. Burns 1977; 3: 235.
43. Jarrett F, Ellerbe S and Demling R. Acute leukopenia during topical burn therapy with silver sulfadiazine. Am J Surg 1978; 135: 818-819.
44. Eldad A, Neuman A, Weinberg A, Benmeir P, Rotem M, and Wexler MR. Silver sulfadiazine-induced haemolyric anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient. Burns 1991; 17: 430-432.
45. 晉‧葛洪：補輯肘後方，安徽科學技術出版社，合肥　1996;353
46. 晉‧葛洪：補輯肘後方，安徽科學技術出版社，合肥　1996;351
47. 南北朝‧龔慶宣：劉涓子鬼遺方，東洋醫學善本叢書，大阪　1992; 5: 89.
48. 隋‧巢元方：諸病源候論，文光圖書有限公司，台北　1981; 35: 145.
49. 唐‧孫思邈：備急千金要方，人民衛生出版社，北京　1995; 459.
50. 宋‧趙佶編：聖濟總錄，人民衛生出版社，北京　1982: 2245.
51. 明‧薛己：正體類要，中國中醫藥出版社，北京　1997: 1232.
52. 明‧王肯堂：外科準繩，新文豐出版有限公司，台北　1974; 6: 37
53. 明‧陳實功：外科正宗，人民衛生出版社，北京　1979; 237.
54. 明‧汪機：外科理例，人民衛生出版社，北京　1963; 188.
55. 明‧汪機：外科理例，人民衛生出版社，北京　1963; 181.
56. 清‧陳士鋒：洞天奧旨，中國古籍出版社，北京　1992; 152.
57. 清‧陳士鋒：洞天奧旨，中國古籍出版社，北京　1992; 151.
58. 清‧陳士鋒：洞天奧旨，中國古籍出版社，北京　1992; 151-152.
59. 清‧吳謙：醫宗金鑑，中國中醫藥出版社，北京　1995; 877.
60. 清‧祁坤：外科大成，文光圖書有限公司，台北　1979; 348.
61. 馬王堆漢墓帛整理小組編：五十二病方，北京　1979; 103.
62. 唐‧王燾：外台祕要，人民衛生出版社，北京　1996;794.
63. 宋‧王懷隱編：太平聖惠方，人民衛生出版社，台北 　1980: 2135.
64. 明‧陳實功：外科正宗，人民衛生出版社，北京　1979; 237.
65. 明‧李梴：醫學入門，江西科學出版社，江西　1988; 1061.
66. 曾金鑒，戴海華，李克榮：清瘍散治療燒傷殘餘創面50例。中西醫結合雜誌　1991; 11(2): 115.
67. 林國福，徐學友，朱琦峰，王世娥，林國安，周義文，馬秉錄：複合燒傷油治療燒傷的臨床應用與實驗觀察。中華整形燒傷外科雜誌，1993; 2: 154.
68. Moserva J, Houskova E. The healing and treatment of skin defects. Basel: Karger, 1989: 39-46.
69. Moritz AR, Henriquez FC. Studies of thermal injury. II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Path 1947; 23: 695-720.
70. Davies JWL. Physiological responses to burning injury. London: Academic Press 1982: 9-44.
71. Randolph KC, Mark HL, Gail EB. A standardized model of partial thickness scald burns in mice. J Surg Res 1998; 80: 69-74.
72. Rosenthal, SM. Experimental chemotherapy of burns and shock. I. Methods. II. Effects of local therapy upon mortality from shock. Publ Heath Rep 1942; 57: 1923.
73. Rosenthal SR. Basket technique for producing standard thermal injury in mice. J Trauma 1961; 1: 560.
74. Balley BN, Lewis SR, Blocker TC Jr. Standardization of experimental burns in the laboratory rat. Texas Rep Biol Med 1962; 20: 20.
75. Arturson G. The infliction and healing of a large standard burn in rats. Acta Pathol Mirrobiol Scand 1964; 61: 353.
76. Walker HL, Mason AD Jr. A standard animal burn. J Trauma 1968; 8: 1049.
77. Ferrara JJ, Franklin EW, Choe EU, Taheri PA, Westervelt CL, Lippton HL. Serotonin receptors regulate canine regional vasodilator responses to burn. Crit Care Med 1995; 23: 1112.
78. Matsumura H, Yoshizawa N, Kimura T, Watanabe K, Gibran NS, ngrav LH. A burn wound healing model in the hairless descendant of the Mexican hairless dog. J Burn Care Rehabil 1997; 18: 306﹒
79. Bucky LP, Vedder NB, Hong HZ, Ehrlich HP, Winn RK, Harlan JM, May JW Jr. Reduction of burn injury by inhibiting CDl8-mediated leukocyte adherence in rabbits. Plast Reconstr Surg 1994; 93: 1473-1780.
80. Chu CS, McManus AT, Mason AD Jr, Okerberg CV, Pruitt BA Jr. Multiple graft harvesting from deep partial-thickness scald wounds healed under the influence of weak direct current. J Trauma 1990; 30: 1044.
81. Wang SL, Silberstein EB, Lukes S, Robb E, Zou WZ, Bruno L, Heyd TJ, Waymack JP, Alexander J W. The effect of the thromboxane synthetase inhibitor Dazmegrel (UK-38,485) on wound healing, dermal ink perfusion and skin blood flow measurements in deep partial thickness burns. Burns 1986; l2: 312.
82. Meyer W, Schwarz R, Neurand K. The skin of domestic mammals as a model for the human skin with special reference to the domestic pig. Curr Probl Dermatol 1978; 7: 39-52.
83. Winter GD. Epidermal regeneration studied in the domestic pig. Chicago. Medical Yearbook 1972; 4: 71-112.
84. Brans TA, Dutrieux RP, Hoekstra MJ, Kreis RW, Pont JS. Histopathological evaluation of scalds and contact burns in the pig model. Burns 1994; 20(1): S48-S51.
85. Weinstein GD. Comparison of turnover time and of keratinous protein fractions in swine and human epidermis. In: Bustad LK, McClellan RD, eds. Swine in biomedical research. Seattle: Frayn, 1966: 287-289.
86. Marcarian H, Calhoun ML. Microscopic anatomy of the integument of adult swine. Am J Vet Res 1966; 27: 765-772.
87. Carter HB. Variation in the hair follicle population of the mammalian skin. In: Lyne AG, Short BF, eds: Biology of skin and hair growth. New York: American Elsevier Publishing Company 1965: 25-33.
88. Forbes PD. Vascular supply of the skin and hair in swine. In: Montagna W, Dobson RL, eds. Hair Growth--advances in biology of skin. Oxford: Pergamon, l967: 419-32.
89. Ingram DL, Weaver ME. A quantitative study of the blood vessels of the pig''s skin and the influence of environmental temperature. Anat Rec 1969; 163: 517-524.
90. Mount LE. Adaptation to thermal environment. Baltimore: University Park Press, 1979: 182-207.
91. Archambeau JO. Histological parameters and elemental composition of skin of swine. J Invest Dermatol 1969; 52: 399-401.
92. Meyer W, Neurand K, Radke B. Elastic fibre arrangement in the skin of the pig. Arch Dermatol Res 1981; 270: 391.
93. Meyer W, Neurand K, Radke B. Collagen fibre arrangement in the skin of the pig. J Anat 1982; 134: 139-148.
94. Behounkova-Houskova E. and Moserova J. Histology of healing of deep dermal burns in pig. Scand J Plast Reconstr Surg 1979; 13: 57.
95. Lazare R, Watson PA, Winter GD. Distribution and excretion of silver sulphadiazine applied to scalds in the pig. Burns 1974; 1: 57.
96. Winter GD. Histological aspects of burn wound healing. Burns 1974; 11: 191-196.
97. Moritz A and Henriques FC. Studies of thermal injury. II. The relative mportance of time and surface temperature in the causation of cutaneous burns. Am J Path 1947; 23: 695-720.
98. 明‧陳實功：外科正宗，人民衛生出版社，北京　1979; 41.
99. 明‧陳實功：校正外科正宗，旋風出版社，台北　1976; 1: 11.
100. 王玉璽：實用中醫外科方劑大辭典，中國中醫藥出版社，北京　1993: 268.
101. 顧伯康主編：中醫外科學，上海科學技術出版社，上海　1986: 224.
102. 陳奇主編：中成藥名方藥理與臨床，人民衛生出版社，北京　1998；1039
103. 劉耀亮：玉紅膏治療燒傷的臨床應用。湖北中醫雜誌　1997; 19(1): 48.
104. 劉天驥、王淑平、呂洪范、閻國英、王景芝、關玉慧、王者香：中西醫結合治療燒傷160例。中國中西結合雜誌　1994; 8: 14.
105. 邱東文、呂麗：生肌玉紅膏治療燒傷後期殘餘創面43例。河南中醫　1998; 18(2): 47.
106. 趙伯文：生肌玉紅膏和虎地湯治療燒傷感染創面簡報。江西中醫藥　1989; (3): 35.
107. 錢小強，王厚澤：中西醫結合外治膿瘡38例。中國中西醫結合雜誌，1993, 13(1): 47.
108. 周麗：生肌玉紅膏治療帶狀皰疹。浙江中醫雜誌　1993; (6): 254.
109. 杜風霞、劉占春、孟祥啟：生肌玉紅膏治療手術切口癒合不良31例。河南中醫　1996; 16(5): 309.
110. 周玉祥，頤和熙：激光併中藥治療且門尖銳濕疣12例，江蘇中醫　1991, 12(7): 18.