加味四黄汤内服外敷联合针刺对老年混合痔PPH术后疼痛的疗效及血清VEGF、IL-1β、IFN-γ的影响

Curative Effect of Internal and External Application of Modified Sihuang Tang Combined with Acupuncture on Senile Patients with Pain after PPH and Its Effect on VEGF,IL-1βand IFN-γin Serum

目的:观察加味四黄汤内服外敷联合针刺对老年混合痔吻合器痔上黏膜环形切除术(PPH)术后疼痛的临床疗效及血清血管内皮生长因子(VEGF)、白细胞介素-1β(IL-1β)、γ-干扰素(IFN-γ)的影响。方法:将老年混合痔PPH术后患者98例,根据治疗方法分为2组,每组49例。2组患者术后均给予常规处理,A组给予高锰酸钾溶液坐浴治疗,B组给予加味四黄汤内服外敷联合针刺治疗。记录2组治疗前后VEGF、IFN-γ、IL-1β、白细胞介素-6(IL-6)、创面毛细血管含量的变化,并比较2组疼痛程度、住院时间、疼痛消失时间、水肿消失时间、创面渗液消失时间、创口愈合时间及不良反应情况。结果:术后当天,2组疼痛评分组间比较,差异无统计学意义(P>0.05)。术后3 d、7 d,2组疼痛评分较术后当天下降(P<0.05),且B组疼痛评分低于A组(P<0.05)。B组住院时间、疼痛消失时间、水肿消失时间、创面渗液消失时间、创口愈合时间短于A组,差异有统计学意义(P<0.05)。术后当天,2组VEGF、IL-1β、IFN-γ、IL-6水平组间比较,差异无统计学意义(P>0.05)。术后7 d,2组VEGF、IFN-γ水平较术后当天上升,IL-1β、IL-6水平较术后当天下降,且B组VEGF、IFN-γ水平高于A组,IL-1β、IL-6水平低于A组(P<0.05)。术后3 d、7 d,2组创面毛细血管含量较术后当天上升,且B组创面毛细血管含量高于A组(P<0.05)。B组不良反应率(6.12%)与A组(10.20%)比较,差异无统计学意义(P>0.05)。结论:加味四黄汤内服外敷联合针刺用于老年混合痔PPH术后疼痛可有效减轻疼痛程度,促进恢复,调节相关细胞因子的表达。

Objective:To observe the curative effect of the therapy of internal and external application of modified Sihuang tang combined with acupuncture on senile patients with pain after procedure for prolapse and hemorrhoids(PPH)and its effect on vascular endothelial growth factor(VEGF),interleukin-1β(IL-1β)and interferon-γ(IFN-γ)in serum.Methods:A total of 98 cases of senile patients after PPH were divided into two groups according to treatment methods,49 cases in each group.Both groups were given routine treatment after surgery;Group A was additionally treated with sitting bath of potassium permanganate solution,and Group B was additionally treated with internal and external application of modified Sihuang tang combined with acupuncture.The changes of VEGF,IFN-γ,IL-1β,interleukin-6(IL-6)and the content of capillaries in wound were recorded before and after treatment,and the pain degree,hospitalization time,pain disappearance time,edema disappearance time,wound drainage disappearance time,wound healing time and adverse reactions were compared between the two groups.Results:There was no significant difference in the comparison of pain degree between the two groups on the day after surgery(P>0.05).On the third and seventh days after surgery,the pain scores in the two groups were decreased when compared with those on the day after surgery(P<0.05),and the pain score in Group B was lower than that in Group A(P<0.05).The hospitalization time,pain disappearance time,edema disappearance time and wound drainage disappearance time in Group B were shorter than those in Group A,the difference being significant(P<0.05).On the day after surgery,there was no significant difference in the comparison of the levels of VEGF,IFN-γ,IL-1βand IL-6 between the two groups(P>0.05).On the seventh day after surgery,the levels of VEGF and IFN-γin both groups were increased when compared with those on the day after surgery,while levels of IL-1βand IL-6 decreased;the levels of VEGF and IFN-γin Group B were higher than those in Group A,while levels of IL-1βand IL-6 lower(P<0.05).On the third and seventh days after surgery,the content of capillaries in wound in both groups were increased when compared with those on the day after surgery,and the content in Group B was more than that in Group A(P<0.05).There was no significant difference in the comparison of the incidence of adverse reactions between Group B(6.12%)and Group A(10.20%)(P>0.05).Conclusion:The therapy of internal and external application of modified Sihuang tang combined with acupuncture for senile patients with pain after PPH,can effectively reduce the pain degree,promote recovery and regulate the expression of related cytokines.