益气活血方对混合痔术后创面愈合的干预作用及对肉芽组织成纤维细胞的影响

Intervention of Yiqi Huoxue Formula on wound healing after mixed hemorrhoid surgery and its effects on granulation tissue fibroblasts

目的探讨混合痔术后内服中药益气活血方促进创面愈合的临床效果。方法选择儋州市中医医院肛肠科收治的接受手术治疗的混合痔患者120例,按照随机数字表法分为治疗组和对照组,每组60例。对照组术后予以换药、中药外洗等常规治疗,治疗组在对照组治疗的基础上予以中药益气活血方口服,疗程为14 d。比较两组术后第1、7、14天创面渗液评分、肉芽组织生长情况评分、创面疼痛评分,比较两组术后第7、14天创面愈合情况和第7天细菌阳性率,比较两组术后第1、14天血清可溶性细胞间黏附分子-1(soluble intercellular adhesion molecules-1,sICAM-1)、白细胞介素-1β(interleukin-1β,IL-1β)、IL-10、表皮生长因子(epidermal growth factor,EGF)、成纤维细胞生长因子-1(fibroblast growth factor-1,FGF-1)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平,并比较两组术后第3、7天肉芽组织成纤维细胞数。结果术后第7、14天,两组创面渗液评分、肉芽组织生长情况评分、创面疼痛评分低于术后第1天(P<0.01);治疗组上述各项评分低于对照组(P<0.01)。术后第7天,治疗组细菌阳性率低于对照组(P<0.05)。术后第14天,两组创面愈合率优于术后第7天(P<0.05);治疗组创面愈合情况优于对照组(P<0.05)。术后第14天,两组血清sICAM-1、IL-1β水平低于术后第1天(P<0.01),IL-10、EGF、FGF-1、VEGF水平高于术后第1天(P<0.01);治疗组血清sICAM-1、IL-1β水平低于对照组(P<0.01),IL-10、EGF、FGF-1、VEGF水平高于对照组(P<0.01)。术后第7天,两组肉芽组织成纤维细胞数多于第3天(P<0.01);术后第3、7天治疗组肉芽组织成纤维细胞多于对照组(P<0.01)。结论益气活血方可调节创面愈合相关因子含量,促进成纤维细胞增生,减轻机体炎症反应,抑制创面感染,加速混合痔术后创面愈合。

Objective To investigate the clinical effects of Yiqi Huoxue Formula(YQHXF)on wound healing after mixed hemorrhoid surgery.Methods A total of 120 patients with mixed hemorrhoids who underwent surgical treatments in the Anorectal Department at Danzhou Hospital of Chinese Medicine were assigned randomly into treatment and control groups by random number table method,with 60 cases in each group.The control group was given routine treatment such as dressing change and external washing of Chinese medicines after surgery,while the treatment group was given oral administration of YQHXF for 14 days based on the treatment of the control group.The wound exudation,granulation tissue growth,and wound pain scores of both groups on the 1st,7th,and 14th days after surgery were compared,and the wound healing on the 7th and 14th days and bacterial positive rate of the two groups on the 7th day after surgery were compared.The serum levels of soluble intercellular adhesion molecules-1(sICAM-1),interleukin-1β(IL-1β),IL-10,epidermal growth factor(EGF),fibroblast growth factor-1(FGF-1),and vascular endothelial growth factor(VEGF)on the 1st and 14th days after surgery were compared between the two groups,and the number of fibroblasts of granulation tissue of both groups on the 3rd and 7th days after surgery was compared.Results On the 7th and 14th days after surgery,the wound exudation,granulation tissue growth,and wound pain scores of both groups were lower than those on the 1st day after surgery(P<0.01);the above scores of the treatment group were lower than those of the control group(P<0.01).On the 7th day after surgery,the bacterial positivity rate of the treatment group was lower than that of the control group(P<0.05).On the 14th day after surgery,the wound healing rate of the two groups was better than that of the 7th day after surgery(P<0.05),and the wound healing status of the treatment group was better than that of the control group(P<0.05).On the 14th day after surgery,the levels of serum sICAM-1 and IL-1βof both groups were lower than the 1st day after surgery(P<0.01),while the levels of IL-10,EGF,FGF-1,and VEGF were higher than the 1st day after surgery(P<0.01).The levels of serum sICAM-1 and IL-1βof the treatment group were lower than those of the control group(P<0.01),while the levels of IL-10,EGF,FGF-1,and VEGF of the treatment group were higher than those of the control group(P<0.01).On the 7th day after surgery,the number of granulation tissue fibroblasts of both groups was higher than that of the 3rd day(P<0.01).On the 3rd and 7th days after surgery,the number of granulation tissue fibroblasts of the treatment group was higher than that of the control group(P<0.01).Conclusion YQHXF can regulate the content of wound healing-related factors,promote fibroblast proliferation,reduce inflammatory reaction,inhibit wound infection,and accelerate wound healing after mixed hemorrhoid surgery.