加减内托生肌散促进肛瘘术后创面愈合的临床观察

发布时间：2018-09-05 15:45

【摘要】：目的：本研究针对正虚邪恋型肛瘘术后气虚血瘀的特点,运用导师临床经验方加减内托生肌散内服,评价此方改善肛瘘术后并发症及促进创面愈合的临床疗效。方法：本研究观察的60例正虚邪恋型低位单纯性肛瘘术后患者为福建中医药大学附属人民医院肛肠科2013年2月至2013年12月住院病人。其中男性39例,女性21例,年龄18～60岁,所有受试者按随机数字表随机分为治疗组30例和对照组30例。两组患者均在局部浸润麻醉下行肛瘘切除术,术后均按常规治疗。治疗组在常规治疗的基础上术后第2天开始口服加减内托生肌散治疗,对照组无口服给药。两组各种辅助治疗均相同。分别在术后第2天、第4天、第6天、第8天观察创面分泌物情况并对患者疼痛情况进行评分；比较两组患者术后第2天、第16天、第25天创面面积及创面愈合率；记录两组患者术后创面完全愈合天数。客观评价各指标,计量资料描述将采用X±S,两样本间采取两独立样本t检验,计数资料采用卡方检验,等级资料采用Ridit分析。数据采用统计软件SPSS18.0处理对结果进行分析。结果：治疗前对两组病例的性别、年龄、病程、创面分泌物情况、疼痛情况、创面愈合时间等进行均衡性比较,差异均无统计学意义,组间基线一致。研究结果分析如下： (1)创面分泌物、疼痛：两组术后第2天创面分泌物比较,差异无统计学意义(P0.05)。两组术后第4天、第6天、第8天创面分泌物比较,差异有统计学意义(P0.05),治疗组在早期减少创面分泌物方面优于对照组。两组术后第2天疼痛评分比较,差异无统计学意义(P0.05)。两组术后第4天、第6天、第8天疼痛评分比较,差异有统计学意义(P0.05),治疗组在减轻术后疼痛方面优于对照组。 (2)创面面积和创面愈合率：术后第16天对照组创面面积为(8.37±0.11)cm2,治疗组创面面积为(7.07±0.20)cm2；术后第25天对照组创面面积为(3.47±0.31)cm2,治疗组为(2.40±0.25)cm2。两组创面面积比较,差异有统计学意义(P0.05)。两组术后创面愈合率比较,术后第16天对照组创面愈合率平均为72.40%,治疗组平均为84.53%,两组创面愈合率比较,经秩和检验,P=0.000(P0.05),差异有统计学意义。术后第25天对照组创面愈合率平均为96.70%,治疗组平均为100%,两组创面愈合率比较,经秩和检验,P=0.000(P0.05),差异有统计学意义。说明治疗组在促进创面愈合,缩小创面面积方面均优于对照组。 (3)总疗效和创面愈合时间：两组治疗后症状、体征均消失,两组临床总疗效均为100%。对照组创面愈合时间为(18～29)天,平均创面愈合时间为(23.00±0.53)天；治疗组创面愈合时间为(17～25)天,平均创面愈合时间为(21.33±0.44)天。两组平均创面愈合时间比较差异有统计学意义(P0.05),治疗组优于对照组。结论：治疗组比对照组更有效的减轻肛瘘术后并发症、促进肛瘘术后创面愈合,说明加减内托生肌散口服能有效减少术后创面分泌物,减轻术后疼痛,从而促进创面愈合,且无明显毒副作用,安全性较好,值得临床推广应用。
[Abstract]:Objective: According to the characteristics of qi deficiency and blood stasis after operation of anal fistula of Zheng deficiency and evil Love type, this study used the tutor's clinical experience prescription to add or subtract the Internal Torsheng Muscle Powder to take orally, and evaluated the clinical effect of this prescription on improving the postoperative complications of anal fistula and promoting wound healing.
Methods: 60 cases of low simple anal fistula with positive deficiency and evil love were observed from February 2013 to December 2013 in the Anorectal Department of People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine. Among them, 39 were male and 21 were female, aged 18-60. All the subjects were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group began to take orally modified Nato Sheng Ji San on the second day after operation, while the control group did not take orally. All the adjuvant treatments were the same in the two groups. The wound area and wound healing rate were compared between the two groups on the 2nd day, the 16th day and the 25th day after operation, and the days of complete wound healing were recorded. Hierarchical data were analyzed by Ridit. Data were analyzed by statistical software SPSS18.0.
Results: There was no significant difference in gender, age, course of disease, wound secretion, pain and wound healing time between the two groups before treatment. The results were as follows:
(1) Wound secretion, pain: There was no significant difference between the two groups on the 2nd day after operation (P 0.05). There was significant difference between the two groups on the 4th, 6th and 8th day after operation (P 0.05). The treatment group was superior to the control group in reducing wound secretion in the early stage. The pain scores of the two groups on the 4th, 6th and 8th day after operation were statistically significant (P 0.05). The treatment group was superior to the control group in relieving postoperative pain.
(2) Wound area and wound healing rate: on the 16th day after operation, the wound area of the control group was (8.37 [0.11] cm 2, the wound area of the treatment group was (7.07 [0.20] cm 2, and on the 25th day after operation, the wound area of the control group was (3.47 [0.31] cm 2, and the treatment group was (2.40 [0.25] cm 2). There was a significant difference in the wound healing rate between the two groups (P 0.05). The average wound healing rate was 72.40% in the control group and 84.53% in the treatment group on the 16th day after operation. The difference was statistically significant between the two groups by rank sum test (P = 0.000 (P 0.05). The average wound healing rate was 96.70% in the control group and 100% in the treatment group on the 25th day after operation. The difference was statistically significant (P 0.05), indicating that the treatment group was superior to the control group in promoting wound healing and reducing wound area.
(3) Total curative effect and wound healing time: After treatment, symptoms and signs disappeared in both groups, and the total clinical curative effect was 100%. The wound healing time in control group was (18-29) days, the average wound healing time was (23.00 (0.53) days; the wound healing time in treatment group was (17-25) days, the average wound healing time was (21.33 (0.44) days. There was a significant difference in healing time between the two groups (P0.05), and the treatment group was better than the control group.
Conclusion: The treatment group is more effective than the control group in reducing the postoperative complications of anal fistula, promoting wound healing after anal fistula surgery, indicating that oral administration of modified Nato Sheng Ji Powder can effectively reduce postoperative wound secretion, relieve postoperative pain, thus promoting wound healing, without obvious toxic and side effects, and is safe and worthy of clinical application.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R266

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