如意金黄膏外用治疗阑尾周围脓肿的临床观察与研究

发布时间：2019-03-19 13:58

【摘要】：阑尾周围脓肿是一种临床常见的急腹症,继发于急性阑尾炎,属于急性阑尾炎较为严重的临床病理类型之一,属中医学“肠痈”范畴。典型的阑尾周围脓肿症状上多表现为转移性右下腹痛,疼痛持续难缓解,发热,可伴有恶心、腹胀、腹泻等消化道症状,多强迫屈身体位,情绪焦虑。查体：右下腹局限性肌紧张,麦氏点压痛、反跳痛阳性,右下腹深压或可触及包块、压痛强阳性,移动性浊音阴性,结肠充气试验、闭孔肌试验均阳性。实验室检查外周血白细胞计数(WBC)和中性粒细胞百分比(NE%)均显著升高；B超下阑尾区可见大小不等、形态欠规则且边界欠清晰的混合回声区。传统观念认为,阑尾周围脓肿Ⅰ期手术分离病灶难度大、易损伤,应首选非手术治疗,在非手术治疗痊愈后3-6个月再择期行阑尾切除术。故临床上,阑尾周围脓肿的治疗周期较长,症状恢复较慢。如今,虽有众多国内外学者在不断创新、探索着阑尾周围脓肿的Ⅰ期手术治疗,但因技术和技巧等原因,并未广泛推广于临床。而随着祖国医学与现代医学的融会贯通,中西医结合治疗已逐渐成为目前临床上治疗阑尾周围脓肿的一大趋势。目的：观察如意金黄膏外敷结合西医抗炎治疗阑尾周围脓肿与单纯西医抗炎治疗阑尾周围脓肿的临床疗效差异,探讨其可能的作用机制,以丰富中西医结合治疗在普外科应用的推广方法：2011年9月-2014年12月间,于北京中医药大学第一临床医学院普通外科病房收治阑尾周围脓肿患者74例。完全随机分为观察组和对照组各37例,对照组采用西医常规抗炎、对症治疗加生理盐水湿敷,治疗组采用西医常规抗炎、对症治疗加如意金黄膏外敷。7天1疗程,观察期为2疗程。观察受试者体温恢复正常时间、腹痛消失时间、及1疗程和2疗程治疗结束后(或出院时)血常规、包块大小等情况,比较组内和组间差异。结果：1.治疗组在体温恢复时间、腹痛消失时间及包块消散时间上均较对照组短,经统计学处理,均有显著性差异(P0.05)。2.治疗组与对照组在恢复受试者外周血白细胞和中性粒细胞百分比方面疗效相当,经统计学处理,无显著性差异(P0.05)。结论：在西医抗炎治疗基础上,局部外敷如意金黄膏治疗阑尾周围脓肿,可有效缓解患者腹痛和发热症状,缩短包块消散和脓肿吸收的时间,疗效肯定,无明显毒副作用,值得临床推广应用。同时,在此基础上应进一步研究促进外敷中药透皮吸收的方法和机制,以期在中西医结合治疗外科疾病中取得更好疗效。
[Abstract]:Periappendiceal abscess is a common acute abdominal disease, secondary to acute appendicitis, belongs to one of the more serious clinical pathological types of acute appendicitis, belongs to the traditional Chinese medicine "intestinal carbuncle" category. The typical symptoms of periappendiceal abscess were metastatic right lower abdominal pain, persistent pain, fever, nausea, abdominal distension, diarrhea and other digestive tract symptoms, multiple forced body flexion and emotional anxiety. Physical examination: local muscle tension of right lower abdomen, slight tenderness, rebound pain positive, deep pressure of right lower abdomen or palpable mass, positive tenderness, negative mobility voiced, inflatable colon test and obturator muscle test were all positive in the right lower abdominal pressure or palpable mass, tenderness positive, mobility voiced negative, colon inflatable test, obturator muscle test positive. The peripheral blood leukocyte count (WBC) and neutrophil percentage (NE%) increased significantly in laboratory examination, and the mixed echo area with irregular shape and unclear boundary was found in the appendiceal area under B-ultrasound. The traditional idea is that it is difficult and easy to dissect the foci of periappendiceal abscess in the first stage. Non-operative treatment should be the first choice, and appendectomy should be performed at 3 months and 6 months after non-operative treatment. Therefore, the treatment period of periappendiceal abscess is longer and the recovery of symptoms is slower. Nowadays, although many scholars at home and abroad have been making innovations to explore the first stage surgical treatment of periappendiceal abscess, they have not been widely used in clinical practice for reasons such as technology and skills. With the integration of Chinese medicine and modern medicine, integrated treatment of traditional Chinese medicine and western medicine has gradually become a major trend in clinical treatment of periappendiceal abscess. Objective: to observe the difference of curative effect between Ruyi Jinhuang ointment and western medicine in treating periappendiceal abscess and simple western medicine in treating periappendiceal abscess, and to explore the possible mechanism of action of Ruyi Jinhuang ointment in treating periappendiceal abscess. From September 2011 to December 2014, 74 patients with periappendiceal abscess were treated in the general surgical ward of the first Clinical Medical College of Beijing University of traditional Chinese Medicine. The patients in the control group were divided into observation group and control group, 37 cases in each group. The control group was treated with western medicine routine anti-inflammatory therapy and normal saline wet compress, the treatment group was treated with western medicine routine anti-inflammatory therapy, and the treatment group was treated with Ruyi Jinhuang ointment. 7 days a course of treatment. The observation period was 2 courses. The recovery time of body temperature, the disappearance time of abdominal pain, the blood routine and the size of lumps after one and two courses of treatment were observed, and the differences between the two groups were compared. Results: 1. In the treatment group, the recovery time of body temperature, the disappearance time of abdominal pain and the dissipation time of lumps were shorter than those of the control group, and there was significant difference between the treatment group and the control group (P0.05). Treatment group and control group in the recovery of peripheral blood leukocyte and neutrophil percentage of the same, after statistical treatment, there was no significant difference (P0.05). Conclusion: on the basis of anti-inflammatory treatment of western medicine, local application of Ruyi Jinhuang ointment to treat periappendiceal abscess can effectively relieve abdominal pain and fever, shorten the time of mass dissipation and abscess absorption, and has no obvious toxic and side effects. It is worth popularizing and applying in clinic. At the same time, on this basis, we should further study the methods and mechanisms of promoting external application of traditional Chinese medicine transdermal absorption, in order to achieve better curative effect in the treatment of surgical diseases by combination of traditional Chinese and western medicine.
【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】：2015
【分类号】：R656.8

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