摘要
目的探讨祛瘀生肌散联合地奥司明对高位复杂性肛瘘(HCAF)术后患者创面愈合、肛门括约肌功能及细胞因子的影响,以期为HCAF患者术后恢复提供参考。方法选取2022年6月—2023年6月于石家庄市中医院接受治疗的96例HCAF术后患者,采用随机数字表法分为观察组与对照组,每组48例。对照组患者口服地奥司明,观察组患者在对照组基础上外用祛瘀生肌散,均治疗14 d。比较2组患者的临床疗效和创面愈合时间以及治疗前后创面渗液量和疼痛视觉模拟评分法(VAS)评分、创面症状评分、肛门括约肌功能和细胞因子水平。结果观察组患者的临床疗效优于对照组,差异有统计学意义(Z=2.155,P=0.031)。观察组患者创面愈合时间短于对照组,差异有统计学意义(t=5.929,P<0.001)。2组患者治疗前创面渗液量和VAS评分比较,差异均无统计学意义(P>0.05);2组患者治疗后创面渗液量和VAS评分均小于治疗前,且观察组均小于对照组,差异均有统计学意义(P<0.05)。2组患者治疗前瘙痒、水肿、渗出和疼痛4项创面症状评分比较,差异均无统计学意义(P>0.05);2组患者治疗后瘙痒、水肿、渗出和疼痛4项创面症状评分均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗前肛管最长收缩时间(ALCT)、肛管静息压(ARP)及直肠静息压(RRP)比较,差异均无统计学意义(P>0.05);2组患者治疗后ALCT均长于治疗前,ARP和RRP均低于治疗前,差异均有统计学意义(P<0.05);观察组患者治疗后ALCT长于对照组,ARP和RRP均高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗前血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及碱性成纤维细胞生长因子(b FGF)水平比较,差异均无统计学意义(P>0.05);2组患者治疗后血清TNF-α和IL-6水平均低于治疗前且观察组均低于对照组,血清b FGF水平均高于治疗前且观察组高于对照组,差异均有统计学意义(P<0.05)。结论HCAF术后患者应用祛瘀生肌散联合地奥司明治疗,有助于加快创面愈合,改善肛门括约肌功能,减轻炎症反应。
Objective To explore the impact of Quyu Shengji Powder combined with Diosmin on wound healing,anal sphincter function,and cytokines in patients with high-complex anal fistula(HCAF)after surgery,aiming to provide a reference for the postoperative recovery of these patients.Methods A total of 96 patients with HCAF after surgery who were treated at Shijiazhuang Hospital of Traditional Chinese Medicine from June 2022 to June 2023 were selected and assigned to an observation group and a control group using a random number table method,with 48 cases in each group.The control group received Diosmin orally,while the observation group received Quyu Shengji Powder topically on the basis of Diosmin,with a treatment duration of 14 days.The clinical efficacy,wound healing time,pre-and post-treatment wound exudate volume,pain visual analog scale(VAS)score,wound symptom score,anal sphincter function,and cytokine levels were compared between the two groups.Results The clinical efficacy of the observation group was significantly superior to that of the control group(Z=2.155,P=0.031).The wound healing time of the observation group was significantly shorter than that of the control group(t=5.929,P<0.001).Before treatment,no significant differences were noted in wound exudate volume and pain VAS score between the two groups(P>0.05);after treatment,the wound exudate volume and VAS score in both groups were decreased,and the observation group had lower scores than the control group,with statistically significant differences(P<0.05).Before treatment,no significant differences were observed in the four wound symptom scores of itching,edema,exudation,and pain between the two groups(P>0.05);after treatment,the four wound symptom scores in both groups were decreased,and the observation group had lower scores than the control group,with statistically signifi-cant differences(P<0.05).Before treatment,no significant differences were found in the anal longest contraction time(ALCT),anal resting pressure(ARP),and rectal resting pressure(RRP)between the two groups(P>0.05).After treatment,the ALCT in both groups was significantly longer than before treatment,and the ARP and RRP were significant-ly lower than before treatment(P<0.05);the ALCT in the observation group was significantly longer than that in the con-trol group,and the ARP and RRP were significantly higher than those in the control group(P<0.05).Before treatment,no significant differences were noted in the levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and basic fibroblast growth factor(bFGF)between the two groups(P>0.05).After treatment,the serum TNF-αand IL-6 levels in both groups were decreased,and the observation group had lower levels than the control group,while the serum bFGF lev-els were increased,and the observation group had higher levels than the control group,with statistically significant differ-ences(P<0.05).Conclusion The application of Quyu Shengji Powder combined with Diosmin in patients with HCAF af-ter surgery is beneficial to accelerate wound healing,strengthen anal sphincter function,and reduce inflammatory reactions.
作者
高晓楠
彭彪
鲍虎豹
王卫娜
周立茹
吴剑箫
杨乾
吴春晓
Gao Xiaonan;Peng Biao;Bao Hubao;Wang Weina;Zhou Liru;Wu Jianxiao;Yang Qian;Wu Chunxiao(The First Department of Coloproctology,Shijiazhuang Hospital of Traditional Chinese Medicine,Shijiazhuang 050000,China;Department of Anorectal Surgery,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050000,China)
出处
《保健医学研究与实践》
2024年第11期55-60,共6页
Health Medicine Research and Practice
基金
河北省中医药管理局科研计划项目(2023375)。
