白及对混合痔术后创面疼痛及愈合的临床观察

发布时间：2018-12-10 23:20

【摘要】：目的:手术是治疗中、重度混合痔的常见干预手段,外剥内扎术是主要术式之一。术后往往因术者、术式不同,出现肛门疼痛、创面愈合迟缓等并发症,常导致治疗效果的降低、住院时间的延长、医疗支出的增加,以及有限医疗资源的浪费。能有效地控制术后并发症,将有助于提高手术的疗效及增加患者的满意度。因此,减少术后并发症发生频率与降低并发症程度是目前临床工作的重要课题。本研究意在探讨白及制剂对混合痔术后并发症的治疗效果,将分别观察肛门疼痛与创面愈合两种并发症。方法:收集自2016年1月1日至2017年2月28日于北京中医药大学东直门医院肛肠科行混合痔外剥内扎术治疗并出现术后肛门疼痛的80例住院患者。剔除包含排除标准的患者,将同意入组且符合诊断、纳入标准的病患纳入研究。采取随机分配隐藏方案的方法,按区组随机法编制80张随机卡片标明组号、序号,装入不透明的信封中封存。按住院手术顺序抽取卡片得到相关治疗方案。治疗组及对照组,共计4组,治疗组包括白及粉组、白及多糖组各20例,共计40例;对照组包括凡士林组、云南白药组各20例,共计40例。术后其他干预措施相同,于术后第一次换药开始按方案用药,白及粉组、白及多糖组、云南白药组换药后均予凡士林纱布及干纱布外敷,胶布固定,凡士林纱条组仅用凡士林纱条换药,换药完毕以干纱布外敷,胶条固定。每日用药一次,疗程21天。分别于第1天至第7天、第14天、第21天换药前,换药后立即及换药后2小时对患者进行疼痛评分,采用视觉模拟评分法进行疼痛评分,同时换药前对患者的术后创面进行评分,出院后按照术后第14天及第21天与患者预约换药并记录其创面愈合时间。将记录的相关数据包括四组疼痛评分、创面愈合时间整理后进行组间对比研究。采用Stata12.0统计软件进行统计分析,统计数据均经正态检验,计数资料行卡方检验,计量资料行单变量检验,即分组均值t检验,具体方法为:对所有换药前、换药后立即及换药后2小时疼痛评分求和后组间分别求平均值差值并行t检验。结果:本实验共收入有效患者76例,其中实验组37人,男性共18人,女性19人、其中白及粉组19人,白及多糖组18人;采用双对照组,共计39人,其中凡士林组19人,云南白药组20人,男性共23人,女性16人。实验组中白及粉组患者年龄在18到63岁之间,平均年龄44.26± 14.11岁,白及多糖组患者年龄在24-64岁之间,平均年龄42.50± 12.47岁;对照组中凡士林组患者年龄在28-77岁之间,平均年龄46.79土15.64岁,云南白药组中患者年龄在27-66岁之间,平均年龄43.82±14.15岁。两组患者的性别、年龄经比较,无统计学差异(P0.05),两组患者具有可比性。各组疼痛评分经统计学方法处理,证实四种药物均能有效缓解混合痔术后疼痛,白及多糖组与其他各组间在换药后立即比较换药前VAS评分方面具有显著差异(P0.05),提示白及多糖瞬时止痛效果优于其他各组;白及粉组与白及多糖、凡士林组在换药后2h对比换药前VAS评分对比方面具有显著差异性,提示白及粉持续止痛效果与云南白药相当(P0.05),优于其他分组,但刺激性最强。在促创面愈合方面,白及粉组效果优于白及多糖组,凡士林组效果最佳,各组比较不具有统计学差异(P0.05)。结论:经临床研究证实白及可有效缓解混合痔术后疼痛,其中白及多糖粉瞬时止痛效果优于白及粉,白及粉维持止痛效果优于白及多糖组。同时,白及粉及白及多糖粉制剂未见明显促进创面愈合功能。白及治疗混合痔术后并发症过程中未见明显毒副作用及皮肤过敏等不良反应。
[Abstract]:Objective: The operation is one of the common methods of intervention in the treatment of severe mixed hemorrhoid. The postoperative complications such as anal pain and delayed wound healing often result in the reduction of the treatment effect, the extension of the hospitalization time, the increase of the medical expenditure, and the waste of the limited medical resources. The effective control of postoperative complications will help to improve the efficacy of the operation and to increase the patient's satisfaction. Therefore, it is an important task to reduce the frequency of postoperative complications and to reduce the degree of complication. The purpose of this study is to study the effect of the white and the preparation on the postoperative complications of mixed hemorrhoid, and to observe the two complications of anal pain and wound healing, respectively. Methods: From January 1, 2016 to Feb. 28, 2017, 80 patients with anal pain and 80 cases of post-operative anal pain were treated with external and internal ligation of the anorectal section of the Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine. Patients who have excluded the exclusion criteria will agree to the group and meet the criteria for inclusion in the study. The method of random allocation of hidden scheme shall be adopted, and 80 random cards shall be marked with the group number and serial number according to the random method of the zone group, and sealed in an opaque envelope. The relevant treatment plan was obtained by taking the card in the procedure of hospitalization. In the treatment group and the control group, a total of 4 groups were treated. The treatment group included 20 cases of white and powder group, 20 cases of white and polysaccharide group and 40 cases. The control group included the vaseline group and 20 cases of the Yunnan Baiyao group, and the total was 40 cases. the other intervention measures after the operation are the same, the first medicine change after the operation is started according to the scheme, the white and the powder groups, the white and the polysaccharide groups, the Yunnan white medicine group is changed, the vaseline gauze and the dry gauze are applied for external application, the adhesive tape is fixed, the vaseline gauze strip group is only changed with the Vaseline gauze, After the medicine is changed, the dry gauze is applied for external application, and the adhesive tape is fixed. once a day, the course of treatment is 21 days. The pain scores were measured on the first day to the seventh day, the 14th day and the 21st day after the change of the medicine, immediately after the change of the medicine and 2 hours after the change of the medicine, the pain score was performed by the visual simulation scoring method, and the postoperative wound surface of the patient was scored before the change of the medicine, On the 14th and 21st days after the discharge, the patient was given an appointment and the healing time of the wound was recorded. The recorded related data included four groups of pain scores, and the group-to-group comparative study was performed after the wound healing time was finished. The statistical analysis is carried out by using the Staa12. 0 statistical software. The statistical data is verified by the positive-state test, the counting data line card-side test and the measurement data line single-variable test, that is, the grouping mean value t test, and the specific method is as follows: before all the medicines are changed, The average value difference and the parallel t-test were respectively obtained after the two-hour pain score after the change of the drug and the 2-hour pain score after the drug change. Results: In this experiment, 76 patients were treated with total income, including 37 in the experimental group, 18 in the male and 19 in the female group, 18 of the white and powder group, 18 in the white and the polysaccharide group, 19 in the group of the vaseline, 20 in the Yunnan Baiyao group and 23 in the male. 16 women. The age of the white and powder group in the experimental group was between 18 and 63 years, with a mean age of 44. 26 and 14. 11 years. The age of the white and polysaccharide group was between 24 and 64 years, with a mean age of 42. 50 and 12. 47 years; in the control group, the age of the patients in the vaseline group ranged from 28 to 77 years, with an average age of 46. 79 in the age of 15 to 64 years. The age of the patients in the Yunnan Baiyao group ranged from 27 to 66 years, with a mean age of 43. 82 to 14. 15 years. The sex and age of the two groups were compared, there was no statistical difference (P0.05), and the two groups were comparable. The pain scores of all groups were treated by the statistical method, and it was confirmed that the four drugs can effectively relieve the pain after the operation of the mixed hemorrhoids, and the white and the polysaccharide groups have a significant difference with the other groups immediately after the change of the medicine (P0.05). The results showed that the instantaneous analgesic effect of the white and the polysaccharides was superior to that of the other groups, the white and the powder groups and the white and the polysaccharides, the vaseline group had a significant difference in the comparison of the VAS scores before the change of the drug after the change of the drug, indicating that the effect of the continuous pain and pain of the white and the powder was comparable to that of the Yunnan white medicine (P0.05), which was superior to the other groups. but the stimulation is the strongest. In the aspect of promoting wound healing, the effect of white and powder group was superior to that of white and polysaccharide group, and the effect of vaseline group was the best, and there was no statistical difference between the groups (P0.05). Conclusion: The effect of white and multi-sugar powder on the pain of mixed hemorrhoid is better than that of white and white powder, and the effect of white and powder maintenance is better than that of white and polysaccharide. At the same time, the white powder and the white and the multi-sugar powder preparation are not found to promote the wound healing function. and no adverse effects such as obvious toxic and side effect, skin allergy and the like are seen in the process of the postoperative complications of the white and the treatment of the mixed hemorrhoid.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R266

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