愈创灵软膏在混合痔术后创面应用的疗效观察

发布时间：2018-11-10 12:18

【摘要】：目的:混合痔是肛肠疾病中的难治性较高的一种,内痔III度以上的混合痔最佳的治疗方式是手术治疗。根据Thomson的“肛垫”学说和丁泽民的分段齿形结扎术思想而创立的TST术,是目前混合痔手术中损伤最少的术式。TST术后剩余的外痔采用小“V”切口切除,能够进一步缩小了术后的创面。但由于肛门的生理特殊性,使肛门周围容易滋生细菌,并且肛周末梢神经丰富,炎症刺激引起的术后创面水肿、疼痛等症状对患者造成的影响较大,严重影响了患者对治疗的满意度。本课题通过观察愈创灵软膏在混合痔术后对创面的抑菌消炎、消肿止痛及促进创面愈合的治疗效果,为混合痔术后提供一种能够有效减轻患者症状的外用药膏。方法:将84例来自广西中医药大学附属瑞康医院并符合纳入标准的患者,按随机数字表法随机分为治疗组42例和对照组42例。治疗组:患者术后每日坐浴完予生理盐水常规清洁肛门后,应用愈创灵软膏涂抹于创面,每次3g,范围以肛缘为中心直径约3cm,加无菌纱布覆盖并予胶布固定,每日2次;对照组:患者术后每日坐浴完予生理盐水常规清洁肛门后,应用美宝湿润烧伤膏涂抹于创面,每次3g,范围以肛缘为中心直径约3cm,加无菌纱布覆盖并予胶布固定,每日2次。两组的临床用药及其他处理措施皆相同。观察并记录患者术后第1、3、5、7天换药后的疼痛情况,采用长海痛尺进行评分;记录术后第1、3、5、7天第一次换药前的创面菌落计数情况,根据培养皿中细菌生长所占面积无、达到1/4、达到1/2、达到3/4、达到全部按0分、1分、2分、3分、4分进行统计,同时观察术后第1、3、5、7天创面的肉芽生长、创面水肿、创面渗液情况,并根据其症状无、轻、中、重的程度按0分、1分、2分、3分进行统计,再根据患者随诊和回访情况记录创面完全愈合时间,对比分析两组患者的临床疗效差异。结果:根据统计结果表明,两组患者的总体疗效具有显著性差异(P0.05)。治疗组在术后第1、3、5、7天治疗组的创面疼痛、创面细菌计数、创面肉芽生长、创面切缘水肿、创面渗液积分均优于对照组,存在统计学差异(P0.05)。治疗组在创面完全愈合时间上也明显短于对照组,差异具有统计学意义(P0.05)。两组患者均未发生药物不良反应。结论:通过临床观察发现,愈创灵软膏在混合痔术后创面上应用,能够有效地抑菌、消肿止痛及促进创面肉芽生长,缩短愈合时间,疗效明显优于美宝湿润烧伤膏,且安全无毒副作用,可在混合痔术后应用。
[Abstract]:Objective: mixed hemorrhoids is a refractory type of anorectal diseases. Surgical treatment is the best treatment for mixed hemorrhoids with III degree. According to Thomson's theory of "anal pad" and Ding Zemin's idea of segmental tooth ligation, TST procedure is the least injuried procedure in mixed hemorrhoidectomy at present. The remaining external hemorrhoids after TST are resected by small "V" incision. Can further reduce the postoperative wound. However, because of the physiological particularity of the anus, bacteria can easily breed around the anus, and the perianal peripheral nerves are abundant, and the symptoms of postoperative wound edema and pain caused by inflammatory stimulation have a great influence on the patients. It severely affects the patient's satisfaction with the treatment. By observing the effect of Yuchuangling ointment on inhibiting bacteria and inflammation, reducing swelling and relieving pain and promoting wound healing after mixed hemorrhoids operation, this paper provides an effective external ointment for relieving symptoms of patients after mixed hemorrhoids operation. Methods: 84 patients from Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine were randomly divided into treatment group (n = 42) and control group (n = 42). In the treatment group, after daily sitting bath and routine cleaning of anus with normal saline, the patients were smeared with Yuchuangling ointment on the wound surface for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. Control group: after routine cleaning of anus with normal saline, the patients were smeared with MEBO burn ointment for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. The clinical medication and other treatment measures were the same in both groups. The pain was observed and recorded on the 1st day, 3rd day, 5th day after the operation, and the pain was scored by the Changhai pain ruler. The count of wound colonies before the first dressing change 7 days after operation was recorded. According to the area occupied by bacteria growth in the petri dish, it reached 1 / 4, reached 1 / 2, reached 3 / 4, and reached 0, 1, 2, 3 points. At the same time, the granulation growth, edema and exudation of the wound were observed on the 1st, 3rd, 5th and 7th day after operation, and the statistics were made according to the degree of no, light, moderate and severe symptoms, according to 0, 1, 2, 3 points. The time of complete wound healing was recorded according to the follow-up and return visit of the patients, and the difference of clinical efficacy between the two groups was analyzed. Results: according to the statistical results, there was a significant difference between the two groups (P0.05). The treatment group was superior to the control group in wound pain, bacterial count, granulation growth, edematous wound margin and wound exudate score on the 1st day and 5th day after operation (P0.05). Treatment group in the wound healing time was significantly shorter than the control group, the difference was statistically significant (P0.05). There were no adverse drug reactions in both groups. Conclusion: the clinical observation shows that the application of Yuchuangling ointment on the wounds of mixed hemorrhoids can effectively inhibit bacteria, reduce swelling and pain, promote the growth of granulation, shorten the healing time, and the curative effect is obviously better than MEBO. And safe and no side effects, can be used in mixed hemorrhoids after surgery.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R266

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