象皮粉对肛瘘手术患者术后创面愈合的效果及血清EGF和创面渗液VEGF、MMP-2和TIMP-1的影响

Effect of Xiangpi Shengji Ointment on wound healing after operation and serum EGF, VEGF, MMP-2 and TIMP-1 in patients with anal fistula operation

目的:探究象皮粉对肛瘘手术患者术后创面愈合的效果及血清表皮生长因子(EGF)和创面渗液血管内皮生长因子(VEGF)、基质金属蛋白酶(MMP)-2、基质金属蛋白酶组织抑制剂(TIMP)-1的影响.方法:选取2017年5月~2018年5月经本院收治的行肛瘘手术患者100例,根据随机数表法分为研究组和对照组,两组均为50例.对照组患者给予我院自制药液"坐浴三号"兑2000mL温开水熏洗坐浴治疗;研究组患者在对照组的基础上,坐浴后给予象皮粉外敷治疗.根据创面渗出情况,每天换药1~2次至创面愈合.采用疼痛视觉模拟评分法(VAS)和Wexner评分标准分别对患者疼痛和肛门功能进行评价.观察两组患者术后1d、7d、18d的EGF、VEGF、MMP-2及TIMP-1水平和术后7d、12d、18d的创面愈合率.比较两组创面愈合时间.结果:术后3d、7d、18d,研究组患者VAS评分显著低于对照组;术后7d、12d、18d,研究组患者愈合率均显著高于对照组;术后7d、18d,两组患者EGF、VEGF、TIMP-1水平显著高于术后1d,MMP-2水平显著低于术后1d,但研究组患者EGF、VEGF、TIMP-1水平显著高于对照组,MMP-2水平显著低于对照组;愈合时,两组患者Wexner评分均较术前显著升高,但研究组患者Wexner评分显著低于对照组;研究组患者创面愈合时间为(21.35±4.27)d显著短于对照组(27.43±5.46)d.结论:象皮生肌膏可上调肛瘘手术患者EGF、VEGF、TIMP-1并降低MMP-2水平,有效缓解患者伤口疼痛,促进术后创面的愈合.

Objective To investigate the effect of Xiangpishengji cream on postoperative wound healing and serum epidermal growth factor (EGF) and wound surface vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, tissue inhibitor of metalloproteinase (TIMP)-1 in patients with anal fistula. Methods A total of 100 patients with anal fistula surgery who were admitted to our hospital from October 2017 to October 2018 were enrolled. The patients were divided into study group and control group according to the random number table method, and 50 patients in both groups. The patients in the control group were treated with 1: 5000 potassium permanganate and 5000 ml warm water to wash the bath. The patients in the study group were given a topical application of XiangpiShengji Ointment after the bath. According to the exudation of the wound surface, the dressing was changed 1 to 2 times a day until the wound healed. Pain visual analog scale (VAS) and Wexner scoring criteria were used to evaluate pain and anal function, respectively. The levels of EGF, VEGF, MMP-2 and TIMP-1 at Id, 7d and 18d after operation and the wound healing rate at 7d, 12d and 18d after operation were observed. The wound healing time of the two groups was compared. Results At 3d, 7d and 18d, the VAS score of the study group was significantly lower than that of the control group;at 7d, 12d and 18d, the healing rate of the study group was significantly higher than that of the control group;at 7 and 18 days after operation, the levels of EGF, VEGF and TIMP-1 in the two groups were significantly higher than those at 1 day after operation, the level of MMP-2 was significantly lower than that at 1 day after surgery, but the levels of EGF, VEGF and TIMP-1 in the study group were significantly higher than those in the control group, the level of MMP-2 was significantly lower than that of the control group;at the time of healing, the Wexner scores of the two groups were significantly higher than those before surgery, but the Wexner score of the study group was significantly lower than that of the control group;the wound healing time of the study group was (21.35 ± 4.27) d significantly shorter than that of the control group (27.43 ± 5.46) d.Conclusion XiangpiShengji Ointment can up-regulate EGF, VEGF, TIMP-1 and reduce MMP-2 levels in patients with anal fistula surgery, effectively relieve wound pain and promote postoperative wound healing.