中药熏洗坐浴联合针刺治疗肛肠术后疼痛的疗效及分析对血清TNF-α、IL-6、IL-1β、VEGF水平的影响

Efficacy of traditional Chinese medicine fumigation and sitz bath combined with acupuncture in the treatment of pain after anorectal surgery and its influence on serum TNF-α,IL-6,IL-1β and VEGF levels

目的 研究中药熏洗坐浴联合针刺治疗肛肠术后疼痛的疗效及对血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、血管内皮生长因子(VEGF)水平的影响。方法 130例肛肠术后疼痛患者,按照随机数字表法分为对照组及观察组,每组65例。两组患者均接受常规抗感染治疗,创面定期换药并使用碘伏消毒杀菌。在此基础上,对照组术后实施高锰酸钾溶液坐浴,观察组术后实施中药熏洗坐浴联合针刺。比较两组术后临床症状(肛门疼痛、肛缘水肿、创面渗液)评分,术后疼痛数字评分法(NRS)评分,术后血清指标(TNF-α、IL-6、IL-1β、VEGF)水平,治疗相关指标(水肿消失时间、疼痛消失时间、渗出物消失时间、创面愈合时间),临床疗效,不良反应发生情况。结果 术后7 d,两组患者的肛门疼痛评分、肛缘水肿评分、创面渗液评分均低于本组术后1 d,且观察组患者的肛门疼痛评分、肛缘水肿评分、创面渗液评分均低于对照组,差异具有统计学意义(P<0.05)。观察组术后12、24、48 h时的NRS评分分别为(3.70±0.68)、(3.05±0.57)、(1.41±0.30)分,均低于对照组的(5.45±1.01)、(4.20±0.79)、(3.17±0.59)分,差异具有统计学意义(P<0.05)。术后7 d,两组TNF-α、IL-6、IL-1β水平均低于本组术后1 d, VEGF水平均高于本组术后1 d,且观察组TNF-α(100.11±13.25)ng/L、IL-6(16.04±3.57)ng/L、IL-1β(5.17±0.64)ng/L均低于对照组的(122.76±20.06)、(24.13±5.61)、(7.34±0.88)ng/L, VEGF(4.69±0.86)ng/L高于对照组的(3.46±0.78)ng/L,差异具有统计学意义(P<0.05)。观察组水肿消失时间、疼痛消失时间、渗出物消失时间、创面愈合时间均短于对照组,差异具有统计学意义(P<0.05)。观察组临床总有效率95.38%高于对照组的78.46%,差异具有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 对肛肠术后疼痛患者实施中药熏洗坐浴联合针刺治疗安全有效,可有效改善疼痛等临床症状,减轻炎症反应,加快创面愈合速度。

Objective To study the efficacy of traditional Chinese medicine fumigation and sitz bath combined with acupuncture in the treatment of pain after anorectal surgery and its influence on serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1β(IL-1β),vascular endothelial growth factor(VEGF)levels.Methods A total of 130 patients with pain after anorectal surgery were divided into control group and observation group according to the random numerical table,with 65 cases in each group.Patients in both groups received conventional anti-infection treatment,regular dressing changes and disinfection and sterilization with iodophor on the trauma surface.On this basis,the control group received a sitz bath with potassium permanganate solution after surgery,and the observation group received a traditional Chinese medicine fumigation and washing sitz bath combined with acupuncture after surgery.Both groups were compared in terms of postoperative clinical symptoms(anal pain,anal margin edema,wound exudate)scores,numerical rating scale(NRS)score,postoperative serum indexes(TNF-α,IL-6,IL-1β,VEGF),treatment-related indicators(disappearance time of edema,pain,exudate and wound healing time),clinical efficacy,and occurrence of adverse reactions.Results At 7 d after surgery,the anal pain score,anal margin edema score and wound exudate score of the two groups were lower than those of this group at 1 d after surgery;the anal pain score,anal margin edema score and wound exudate score of the observation group were lower than those of the control group;all the differences were statistically significant(P<0.05).The NRS scores of the observation group at 12,24,and 48 h after surgery were(3.70±0.68),(3.05±0.57),and(1.41±0.30)points,which were lower than(5.45±1.01),(4.20±0.79),and(3.17±0.59)points of the control group,and the differences were statistically significant(P<0.05).At 7 d after surgery,the levels of TNF-α,IL-6 and IL-1βin the two groups were lower than those at 1 d after surgery in this group,and the VEGF level were higher than that at 1 d after surgery in this group;the TNF-α(100.11±13.25)ng/L,IL-6(16.04±3.57)ng/L,IL-1β(5.17±0.64)ng/L in the observation group were lower than(122.76±20.06),(24.13±5.61),(7.34±0.88)ng/L in the control group,and the VEGF(4.69±0.86)ng/L was higher than(3.46±0.78)ng/L in the control group;all the difference was statistically significant(P<0.05).The disappearance time of edema,pain,exudate and wound healing time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The total clinical effective rate of the observation group was 95.38%,which was higher than 78.46%of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Traditional Chinese medicine fumigation and sitz bath combined with acupuncture is safe and effective in the treatment of pain after anorectal surgery,and can effectively improve clinical symptoms such as pain,reduce inflammatory reaction and accelerate wound healing.