混合痔外剥内扎术后运用蒸发罨包疗法治疗混合痔的效果

Improvement of Technique of Evaporating Bag Therapy after External Stripping and Internal Ligation of Mixed Hemorrhoids

目的:探讨混合痔外剥内扎术后运用蒸发罨包疗法的技术要点改进,并观察其临床疗效。方法:选取2019年6月—2020年6月在上海中医药大学附属岳阳中西医结合医院肛肠科就诊的150例混合痔患者,术后按随机数字表法将患者分为红外线组(IR组)和实验组(L1h组、L4h组、H1h组和H4h组),每组30例。所有患者术后均进行基础治疗,换药后IR组采用红外线照射治疗,实验组则采用不同蒸发罨包起始温度和外敷时间进行干预,对比患者术后7 d内创面疼痛评分、肛缘水肿程度评分、创面渗液程度评分、创面愈合天数及湿疹发生情况。结果:在减轻创面疼痛方面,术后第1天,5组患者VAS评分差异无统计学意义(P>0.05),术后2~7 d,H1h组VAS评分均显著低于L1h组,H4h组VAS评分显著低于L4h组(P<0.05);在缓解肛缘水肿方面,术后1~5 d,5组患者肛缘水肿程度评分差异无统计学意义(P>0.05),术后6~7 d,H1h组肛缘水肿程度评分显著低于L1h组(P<0.05),术后7 d,H4h组肛缘水肿程度评分显著低于L1h组(P<0.05);在减少创面渗液方面,术后1~4 d,5组患者创面渗液程度评分差异无统计学意义(P>0.05),术后5~7 d,H1h组创面渗液评分显著低于L1h组,差异具有统计学意义(P<0.05)。在创面愈合天数方面,H组患者创面愈合天数均较L组减少,差异具有统计学意义(P<0.05),在术后湿疹发生率方面,各组患者差异无统计学意义(P>0.05)。结论:蒸发罨包疗法的起始温度为40℃,外敷时间为1 h的操作要点最利于缓解混合痔外剥内扎术后并发症及促进创面愈合,临床应用效果较好。

Objective To investigate the improvement of evaporative poultice therapy after external stripping and internal ligation of mixed hemorrhoids and to observe its clinical effect.Methods 150 mixed hemorrhoids patients undergoing external stripping and internal ligation were selected,patients were divided into infrared group(IR group)and experimental group(L1h group,L4h group,H1h group and H4h group)according to random number table.All patients were treated with basic treatment.The IR group was treated with infrared radiation after dressing change,and the experimental group was treated with different initial temperature and external application time.The wound pain score,the degree of anal edema,the degree of wound exudation score,the days of wound healing and the incidence of eczema were compared within 7 days after surgery.Results In terms of reducing wound pain,there was no significant difference in VAS scores between the five groups on the first day after surgery(P>0.05),and the VAS scores in the H1h group were significantly lower than those in the L1h group at2 to 7 days after surgery(P<0.05),and the VAS score of H4h group was significantly lower than that of L4h group(P<0.05).In terms of relieving anal marginal edema,there was no significant difference in the scores of the anal marginal edema in the five groups at 1 to 5 days after surgery(P>0.05).At 6 to 7 days postoperatively,the score of anal marginal edema in the H1h group was significantly lower than that in the L1h group(P<0.05).On the 7th postoperative day,the score of anal marginal edema in the H4h group was significantly lower than that in the L1h group(P<0.05).In terms of reducing wound exudate,there was no statistically significant difference in wound exudation scores between the five groups from 1 to 4 days after operation(P>0.05).After 5 to 7 days,the wound exudate score of H1h group was significantly lower than that of L1h group,which the difference was statistically significant(P<0.05).In terms of wound healing days,the number of wound healing days in group H reduced compared with that in group L,which the difference was statistically significant(P<0.05).In terms of the incidence of postoperative eczema,there was no statistically significant difference between the groups of patients(P>0.05).Conclusion The initial temperature of evaporative poultice therapy was 40℃and external application time was 1 hour.It was beneficial to relieve the complications after external stripping and internal binding of mixed hemorrhoids as well as promote wound healing.