五味消毒饮热奄联合芒硝分层外治干预急性炎症型乳痈随机对照研究

A Randomized Controlled Study on Layered External Treatment with Wuwei Xiaodu Decoction Hot Compress Combined with Mirabilite for Acute Inflammatory Mastitis

摘要: 目的：对比在专业通乳的基础上，联合中药分层外敷方案与联合头孢类抗菌药方案对急性炎症型哺乳期乳痈的临床干预效果，为轻症乳痈不使用抗生素、维持持续母乳喂养提供临床依据。方法：选取2023年6月至2025年5月本院乳腺多学科门诊收治的90例未化脓哺乳期乳腺炎患者，采用随机数字表划分成两组，各45例。两组均接受标准化专业循经通乳与母乳喂养宣教，对照组在此基础上采用头孢曲松静脉输注抗感染配合通乳，治疗阶段停止哺乳，依靠吸乳器定时排空乳汁；试验组在此基础上采用五味消毒饮序贯芒硝外敷联合专业循经排乳、母乳健康宣教全程纯中医干预，不使用任何全身抗菌药物，鼓励母乳喂养，两组均以5天作为完整治疗周期。对比两组治疗前后乳房局部症状积分、视觉模拟疼痛评分、白细胞、C反应蛋白水平，同时记录体温恢复时长、乳房包块完全吸收时间、产后3个月持续哺乳比例及各类不良刺激反应。结果：综合症状积分、临床疗效、血清炎症指标、母乳喂养随访四项观察结果可见，试验组可更显著降低乳房肿块、胀痛、乳汁不畅单项及总症状积分，整体临床总有效率更高，能更快下调外周血WBC、CRP炎性水平，且产后远期纯母乳喂养成功率显著提升；该方案在专业通乳基础上联合中药分层外治，无需全身使用抗生素、无需中断母乳喂养，疗效较对照组明显，差异有统计学意义(P < 0.01)。结论：在专业通乳的基础上，联合使用五味消毒饮和芒硝外敷可能比联合使用抗生素更能改善急性炎症型哺乳期乳腺炎的临床结局，可快速控制全身与局部炎性反应，无需中断哺乳，短期用药安全性佳，适合乳腺多学科门诊作为首诊方案参考。

Abstract: Objective: To compare the clinical efficacy of combined traditional Chinese medicine (TCM) layered external application versus combined cephalosporin antibiotic therapy, both on the basis of professional lactation promotion, for acute inflammatory lactation mastitis, and to provide clinical evidence for non-antibiotic treatment and maintenance of continuous breastfeeding in mild cases. Methods: A total of 90 non-abscess lactating mastitis patients admitted to our multidisciplinary breast clinic from June 2023 to May 2025 were randomly divided into two groups (n = 45 each). Both groups received standardized professional meridian-based lactation promotion and breastfeeding health education. The control group received intravenous ceftriaxone anti-infection on this basis, stopping breastfeeding during treatment and using electric breast pump to empty milk regularly. The test group received sequential external application of Wuwei Xiaodu Decoction hot compress and mirabilite on this basis, without any systemic antibiotics, and breastfeeding was encouraged. Both groups had a 5-day treatment course. Breast local symptom scores, visual analogue pain scores, white blood cell count, C-reactive protein levels, fever resolution time, breast mass absorption time, and breastfeeding success rate at 3 months postpartum were compared. Results: The test group significantly reduced breast mass, pain, milk stasis and total symptom scores, achieved higher overall effective rate, faster reduction of peripheral WBC and CRP, and significantly higher long-term exclusive breastfeeding rate. The TCM layered regimen combined with professional lactation promotion required no systemic antibiotics and no breastfeeding interruption, with superior efficacy compared to the control group (P < 0.01). Conclusion: On the basis of professional lactation promotion, combined external application of Wuwei Xiaodu Decoction and mirabilite may improve clinical outcomes of acute inflammatory lactation mastitis better than combined antibiotic therapy. It can rapidly control systemic and local inflammatory reactions without interrupting breastfeeding, with favorable short-term safety, and is suitable for promotion as a first-visit regimen in multidisciplinary breast clinics.