“洗、吹、塞”三联合疗法在PPH术后伤口治疗中的应用效果

Application effect of triple therapy of “washing, blowing, and plugging” in wound treatment after PPH operation

目的探讨“洗、吹、塞”三联合疗法在吻合器痔上黏膜环切术(PPH)术后伤口治疗中的应用效果。方法选取河北省张家口市第五医院2017年6月至2018年9月期间接受PPH术治疗的204例中重度痔病患者作为研究对象,按随机数字表法随机分为2组,其中对照组于术后第2天采用盐水熏后坐浴及常规创面换药治疗方式,观察组则于术后第2天采用“洗、吹、塞”三联合疗法治疗并进行常规创面换药。对比2组的临床疗效、创面疼痛、创面渗出、皮缘水肿及出血状况,以及肉芽组织填平创面时间和创面完全愈合时间。结果观察组与对照组Ⅱ度痔患者的有效率比较差异无统计学意义(P>0.05),但Ⅲ度痔和Ⅳ度痔患者的有效率均较对照组高(P<0.05);术后2组的VAS评分、创面渗出、皮缘水肿及出血评分随时间延长而逐渐下降(P<0.05),且观察组术后各时间点的VAS、创面渗出、皮缘水肿及出血评分均较对照组低(P<0.05);观察组肉芽组织填平创面时间及创面完全愈合时间均较对照组短(P<0.05)。结论PPH术后应用“洗、吹、塞”三联合疗法的临床疗效确切,可显著改善创面疼痛、创面渗出、皮缘水肿及出血状况,能有效缩短创面愈合时间。

Objective To explore the effect of “washing, blowing and plugging” triple therapy on wound treatment after procedure for prolapse and hemorrhoids (PPH) operation. Methods Two hundreds and four patients with moderate to severe hemorrhoids treated by PPH from June 2017 to September 2018 in the Fifth Hospital of Zhangjiakou City of Hebei province were selected as study subjects and divided into two groups according to the random number table, the control group received saline fumigation followed by sitz bath and conventional wound dressing change on the second day after operation, the observation group were treated with “washing, blowing and plugging” triple therapy and routine wound dressing change on the 2nd day after operation. The clinical efficacy, wound pain, wound exudation, skin margin edema, hemorrhage, granulation tissue filling time and complete wound healing time were compared between the two groups. Results There was no significant difference in the effective rate between the observation group and the control group in degree Ⅱ hemorrhoids (P>0.05), while the effective rates of patients with degree Ⅲ and Ⅳ hemorrhoids were higher than those of the control group (P<0.05). The visual analogue scale (VAS), wound exudation, skin margin edema and hemorrhage scores of the two groups decreased gradually with time (P<0.05), meanwhile, the scores of VAS, wound exudation, skin margin edema and hemorrhage at each time point in the observation group were lower than those in the control group (P<0.05). The granulation tissue filling time and complete wound healing time in the observation group were shorter than those in the control group (P<0.05). Conclusions After PPH operation, the “washing, blowing and plugging” triple therapy has definite clinical effect, can significantly improve wound pain, wound exudation, skin margin edema and hemorrhage, and effectively shorten the wound healing time.