自拟“养阴清热、和血解毒”方加减对肛瘘患者术后创面愈合的影响

Effect of Self-made Modified Yangyin Qingre Hexue Jiedu Decoction on Postoperative Wound Healing for Patients with Anal Fistula

目的:观察自拟“养阴清热、和血解毒”方加减对肛瘘患者术后创面愈合的影响。方法:将2020年5月~2021年5月于我院治疗的94例肛瘘术后(阴虚内热证)患者作为分析对象,按照随机数字表法分为观察组与对照组各47例。两组均给予术后常规处理,对照组给予维生素C口服治疗,观察组给予自拟“养阴清热、和血解毒”方加减内服治疗,两组均治疗2周。治疗2周后,统计两组临床疗效及创面愈合情况,比较治疗后第1d(T0)、治疗2周后(T1)两组临床症状评分(疼痛程度、分泌物、肉芽形态)、肛肠动力学指标[直肠静息压(RRP)、肛管最大收缩压(AMCP)、肛管最长收缩时间(ALCT)、肛管静息压(ARP)]及创面组织[转化生长因子β1(TGF-β1)、血管生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)]变化情况。结果:两组临床总有效率比较差异无统计学意义(P>0.05),但观察组治愈比例明显高于对照组(P<0.05)。观察组切口渗液时间、切口腐肉脱落时间、新生上皮出现时间、切口愈合时间均短于对照组(P<0.05)。T1时,两组临床症状评分(VAS、分泌物及肉芽形态)低于T0时,观察组低于对照组(P<0.05)。T1时,两组肛肠动力学RRP、ARP均低于T0时,观察组低于对照组(P<0.05);两组ALCT、AMCP均高于T0时,但两组间比较差异无统计学意义(P>0.05),两组创面组织TGF-β1、VEGF、bFGF水平均高于T0时,观察组高于对照组(P<0.05)。结论:自拟“养阴清热、和血解毒”方加减对肛瘘患者术后创面愈合效果显著,能促进创面愈合,减轻术后疼痛等临床症状,恢复肛肠动力学,对创面恢复具有积极的促进作用。

Objective:To observe the influence of Self-made Modified Yangyin Qingre Hexue Jiedu Decoction on postoperative wound healing for patients with anal fistula.Methods:94 patients with postoperative anal fistula(Yin deficiency and internal heat syndrome)who were treated in the hospital between May 2020 and May 2021 were selected as the analysis subjects,and they were divided into an observation group and a controlled group with 47 cases in each group according to the random number table method.Both groups were given routine postoperative treatment,and the controlled group was given oral vitamin C therapy while the observation group was given oral administration of Self-made Modified Yangyin Qingre Hexue Jiedu Decoction.Both groups were treated for 2 weeks.After 2 weeks of treatment,the clinical efficacy and wound healing of the two groups were statistically analyzed.The scores of clinical symptoms(pain level,secretion,granulation morphology),anorectal dynamics indicators[rectal resting pressure(RRP),anal maximum contraction pressure(AMCP),anal longest contraction time(ALCT),anal resting pressure(ARP)]and wound tissues indicators[transforming growth factorβ1(TGF-β1),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)]were compared between the two groups on the 1stday after treatment(T0)and after 2 weeks of treatment(T1).Results:There was no statistical significance in the total clinical effective rate between the two groups(P>0.05),but the cure rate in the observation group was significantly higher than that in the controlled group(P<0.05).The time of incision exudation,incision slough shedding time,new epithelium appearance time and incision healing time were shorter in the observation group than those in the controlled group(P<0.05).At T1,the scores clinical symptoms(VAS,secretion and granulation morphology)of the two groups were lower than that at T0,and the scores in the observation group were lower compared to the controlled group(P<0.05).At T1,the anorectal dynamics RRP and ARP in the two groups were lower than those at T0,and the two indicators in the observation group were lower than those in the controlled group(P<0.05).The ALCT and AMCP in both groups were higher than those at T0,but there were no statistical differences between the two groups(P>0.05),and the levels of TGF-β1,VEGF and bFGF in the wound tissues of the two groups were higher than those at T0,and the levels were higher in the observation group compared to the controlled group(P<0.05).Conclusion:Self-made Modified Yangyin Qingre,Hexue Jiedu Decoction has significant effect on postoperative wound healing in patients with anal fistula,and it can promote the wound healing,relieve the postoperative pain and other clinical symptoms,restore the anorectal dynamics,and positively promote the wound recovery.