复方硝苯地平软膏在肛门部手术后的临床应用研究

Clinical Application of Nifedipine Compound Ointment in the Postoperative Management of Anal Disease

为研究复方硝苯地平软膏在肛门部手术后的临床应用效果，将166例肛门部手术后患者按随机数字表法分为3组，即治疗组（56例）、对照组（59例）和空白组（51例），分别给予复方硝苯地平软膏、消炎祛腐生肌膏、凡士林软膏换药，观察3组患者术后平均疼痛指数、排便疼痛指数、创面愈合时间、创面出血、创面水肿、肛门控便能力、心血管副作用、肛管动力学变化、肛门肌电图、住院时间等指标。结果显示，治疗组平均疼痛指数、排便疼痛指数低于对照组和空白组（P〈0．05），3组患者出血症状、肛门控便能力、住院时间差异无统计学意义（P〉0．05）。空白组创面水肿发生率高于治疗组和对照组（P〈0．05）。治疗组创面愈合时间短于对照组和空白组（P〈0．05）。肛管动力学变化：治疗组术后肛管静息压低于对照组和空白组（P〈0．05）；3组患者肛管收缩压差异无统计学意义（P〉0．05）。肛门肌电图检测：3组患者术后检测静息相及缩肛相的运动单位电位（MUP）分析显示，治疗组静息相MUP波幅（Am）、面积／波幅（Ar／Am）与对照组和空白组差异有统计学意义（P〈0．05），3组患者缩肛相MUPAm、面积（Ar）、Ar／Am、频率（Freq）的差异无统计学意义（P〉0．05）。心血管副作用：治疗组有5例（8．9％）出现头晕或头痛、面色潮红等反应，未予干预处理，其中4例为复杂性肛瘘患者，术后创面较大。空白组没有发现心血管相关反应。结果表明，复方硝苯地平软膏能有效减轻肛门部手术后疼痛，加快创面愈合，不良反应少，但在较大创口中应用，不良反应可能增加。

The objective of the study was to observe the therapeutic efficacy of nifedipine compound ointment（NCO） in the postoperative management of anal disease. One hundred and sixty-six patients who had undergone anal operation were randomized into three groups. Patients in the treatment group（ n =56） re ceived NCO for dressing change, patients in the control group received the ointment of XiaoYan QuFu ShengJi （a traditional herbal drug oinment,THDO） for dressing change,and patients in the blank control group received vaseline oinment for dressing change, and to observe the average pain index, pain index at defecation, the wound healing time, bleeding and edema, defecation control, cardiovascular adverse reaction, the changes of anal dynamics, anal electromyogram,hospital stay among the three groups. As results, the average pain index and pain index at defecation in the treatment group were lower than that in the control and blank control groups（ P 〈0.05）,there was no statistical difference in bleeding,defecation control and hospital stay among the three groups（ P 〈0.05）. The incidence of edema at wound was higher in the blank control group than that in the treatment and control groups（ P 〈0.05）. The wound healing time was shorter in the treatment group than that in the another two groups（ P 〈0.05）. Anal rest pressure was lower in the treatment group than that in the control and blank control groups（ P 〈0.05） ,there was no statistical difference in anal contraction pressure among the three groups（ P 〈0.05）. There was statistical difference in amplitude（Am） ,area/amplitude（Ar/Am） at rest phase motor unit potential（MUP） between the study group and the control ＆blank control groups（ P d0.05） ,while there was no statistical difference in Am, area（Ar） ,Ar/Am and frequency（Freq） at anal contraction phase MUP（ P 〉0.05）. Dizziness or headache and facial flush occurred in 5 case in the treatment group（4 of whom had larger surgical wounds due to the complex anal fistula） ,while no cardiovascular adverse reaction was found in the blank control group. It is concluded that NCO can effectively relieve postoperative pain of anal disease,accelerate wound healing and reduce adverse reactions, while some adverse reactions could occur when the surgical wound is larger.