清解排脓汤联合清创引流术治疗肛周坏死性筋膜炎

Clinical observation of Qingjie-Painong decoction combined with debridement drainage in the treatment of perianal necrotizing fasciitis

目的 评价清解排脓汤联合清创引流术治疗肛周坏死性筋膜炎的疗效。方法 将符合入选标准的78例肛周坏死性筋膜炎（perianal necrotizing fasciitis, PNF）患者采用随机数字表法分为2组，每组39例。2组均给予抗感染等基础治疗，在此基础上对照组结合清创引流术，治疗组在对照组基础上加服清解排脓汤。2组均治疗14 d。治疗前后分别进行全身症状、病变范围及肛周疼痛评分；采用全自动血液流变测试仪检测WBC，采用ELISA法检测hs-CRP、IL-6、TNF-a，评价临床疗效。结果 治疗组总有效率为94.9%（37/39）、对照组为82.1%（32/39），2组比较差异有统计学意义（Z＝-2.099，P＝0.036）。治疗后，治疗组全身症状[（0.2±0.1）分比（1.0±0.2）分，t＝-2.601]、病变范围[（0.6±0.2）分比（1.1±0.4）分，t＝-2.270]、肛周疼痛 [（0.9±0.4）分比（1.8±0.5）分，t＝-3.493]评分均低于对照组（P＜0.05）；治疗组WBC[（6.25±2.08）×109/L比（10.98±2.72）×109/L，t＝-3.829]、hs-CRP[（11.20±2.41）mg/L比（23.34±4.39）mg/L，t＝-2.162]、IL-6[（13.03±3.36）pg/ml比（24.69±4.52）pg/ml，t＝-2.297]、TNF-a[（8.33± 3.16）ng/ml比（14.93±3.80）ng/ml，t＝-3.340]水平均低于对照组（P＜0.05）。结论 清解排脓汤联合清创引流术可降低PNF患者炎性细胞因子水平，改善全身症状，缩小病变范围，减轻肛周疼痛。

Objective To observe the clinical effect of Qingjie-Painong decoction combined with debridement drainage in the treatment of perianal necrotizing fasciitis. Methods A total of 78 patients with perianal necrosis fasciitis were randomly divided into two groups, 39 patients in each group. The two groups received the basic treatment of anti-infection, and the control group was treated with debridement drainage, and the treatment group applied the Qingjie-Painong decoction combined with debridement drainage treatment. Both groups were treated for 14 days. Before and after treatment, systemic symptom score, lesion range score, perianal pain score were assessed. The levels of WBC, hs-CRP, IL-6 and TNF-a were measured and the clinical efficacy was evaluated after treatment. Results The total effective rate was 94.88% （37/39） in the treatment group and 82.05% （32/39） in the control group. The total effective rate of the two groups was statistically significant （Z=-2.099, P=0.036）. After treatment, the Systemic symptom （0.21 ± 0.05 vs. 0.98 ± 0.17, t=-2.601）, Lesion range （0.57 ± 0.23 vs. 1.08 ± 0.40, t=-2.270）, Perianal pain （0.92 ± 0.35 vs. 1.77 ± 0.49, t=-3.493） in the treatment group were significantly lower than those in the control group （P〈0.05）. After treatment, the WBC （6.25 ×109/L ± 2.08 ×109/L vs. 10.98 ×109/L ± 2.72 ×109/L, t=-3.829）, CRP （11.20 ± 2.41 mg/L vs. 23.34 ± 4.39 mg/L, t=-2.162）, IL-6 （13.03 ± 3.36 pg/ml vs. 24.69 ± 4.52 pg/ml, t=-2.297）, TNF-a （8.33 ± 3.16 ng/ml vs. 14.93 ± 3.80 ng/ml, t=-3.340） in the treatment group were significantly lower than those in the control group （P〈0.05）. Conclusions The Qingjie-Painong decoction combined with debridement drainage in the treatment of perianal necrotizing fasciitis can significantly reduce the body＇s inflammatory status, improve systemic symptoms, reduce the scope of the lesion, reduce perianal pain, and improve clinical efficacy.