中西医结合分阶段治疗肛周坏死性筋膜炎疗效观察

Observation on the curative effect of stage treatment with integrated traditional Chinese and western medicine on perianal necrotizing fasciitis

目的探讨中西医结合分阶段治疗肛周坏死性筋膜炎的临床效果。方法选取2017年1月—2019年6月石家庄市中医院及合作医院收治的肛周坏死性筋膜炎患者106例,利用随机数字表法分为对照组和观察组各53例,2组均给予手术治疗+抗炎对症治疗+营养支持治疗。在此基础上,对照组采用碘伏液灌洗创面+碘伏纱条创面覆盖治疗;观察组采用清热解毒联合益气养阴法分阶段治疗,即早期患者热毒炽盛,应用复方黄柏液灌洗创面+复方黄柏液纱条创面覆盖+黄连解毒汤口服,后期患者气阴两虚,应用复方黄柏液灌洗创面+复方黄柏液纱条创面覆盖+八珍汤加减口服;2组均治疗4周。观察2组治疗前后肛周疼痛程度VAS评分、理化指标[超敏C反应蛋白(hs-CRP)、白细胞(WBC)、血红蛋白(Hb)、白细胞介素-8(IL-8)、白细胞介素-13(IL-13)]变化,统计2组肛周水肿情况、临床疗效及创面愈合时间。结果治疗后,2组VAS评分及血WBC、hs-CRP、IL-8水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);治疗后,2组Hb、IL-13水平均明显升高(P均<0.05),且观察组均明显高于对照组(P均<0.05)。治疗4周后,观察组肛周水肿明显轻于对照组(P<0.05);观察组和对照组治疗总有效率分别为94.3%(50/53)和81.1%(43/53),观察组明显高于对照组(P<0.05);观察组患者腐肉脱落时间、创面愈合时间、住院时间均明显短于对照组(P均<0.05)。结论采取中西医结合分阶段治疗肛周坏死性筋膜炎可有效减轻患者肛周疼痛、水肿及炎症反应,改善贫血情况,缩短创面愈合时间,疗效更为确切。

Objective It is to explore the clinical effect of stage treatment with integrated traditional Chinese and western medicine on perianal necrotizing fasciitis.Methods A total of 106 patients with perianal necrotizing fasciitis admitted to Shijiazhuang Hospital of TCM and cooperative hospital from January 2017 to June 2019 were selected and divided into control group and observation group by a random number table method,with 53 cases in each group.Both groups were treated with surgery+anti-inflammatory and symptomatic treatment+nutritional support treatment.Additionally,the control group was treated with would lavage by iodophor+wound coverage with iodophor gauze;the observation group was treated with stage therpay for heat-clearing and detoxification combined with nourishing Qi and Yin,that is,the early patients with were intense heat toxin were treated with wound lavage by compound Huangbai liquid+wound coverage with compound Huangbai liquid gauze+oral administration of Huanglian Jiedu Decoction,the later patients with deficiency of both Qi and Yin were treated with wound lavage by compound Huangbai liquid+wound coverage with compound Huangbai liquid gauze+oral administration of modified Bazhen decoction,both groups were treated for 4 week.The changes of VAS scores of perianal pain and physical and chemical indicators[high-sensitivity C-reactive protein(hs-CRP),white blood cells(WBC),hemoglobin(Hb),interleukin-8(IL-8),interleukin-13(IL-13)]were observed before and after treatment in the two groups,the perianal edema,clinical efficacy and wound healing time in the 2 groups were evaluated.Results After treatment,the VAS scores and the levels of blood WBC,hs-CRP and IL-8 in the two groups were significantly reduced(all P<0.05),and the observation group was significantly lower than the control group(all P<0.05);after treatment,the levels of Hb and IL-13 in the two groups were significantly increased(both P<0.05),and the observation group was significantly higher than the control group(both P<0.05).After 4 weeks of treatment,the perianal edema of the observation group was significantly lighter than that of the control group(P<0.05);the total effective rates of the observation group and the control group were 94.3%(50/53)and 81.1%(43/53),respectively,the rate in the observation group was significantly higher than that of the control group(P<0.05);the time of carrion shedding,wound healing time,and hospital stay in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion The stage treatment with integrated traditional Chinese and western medicine can effectively relieve the perianal pain,edema and inflammation,improve anemia,shorten the wound healing time,and have a more accurate effect in the treatment of perianal necrotizing fasciitis.