促愈汤对混合痔术后患者疼痛程度的影响及血清细胞因子变化研究

Study on the effects of Cuyu decoction on the degree of pain and the changes of serum cytokines in patients with mixed hemorrhoids after operation

目的探讨促愈汤对混合痔术后患者疼痛程度的影响及血清细胞因子变化情况。方法按随机数字表法分配原则将102例2020年12月-2022年5月上海中医药大学附属龙华医院肛肠科收治的混合痔术后患者分为对照组和治疗组,各51例。对照组常规专科换药,并给予注射用五水头孢唑林钠或甲硝唑氯化钠注射液进行抗感染治疗,治疗组在对照组专科换药及抗生素治疗的基础上加用促愈汤进行治疗,治疗组持续治疗2周,对照组持续抗感染治疗3 d,并同治疗组随访至治疗2周。比较2组治疗2周后的疗效,治疗前和治疗2周后的创面愈合情况、肛门直肠肌电测量指标、新生血管形成指标及炎症指标。结果治疗组治疗2周后的总有效率为94.12%,高于对照组的78.43%(P<0.05)。与治疗前比较,治疗2周后,2组创面疼痛、创面渗液、肛缘水肿、肉芽形态积分及血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均降低,治疗组低于对照组(P<0.05);2组肛管最大收缩压(MSP)、直肠最大耐受容量(MTV)、直肠静息压(RRP)及血清转化生长因子-β(TGF-β)、血管内皮细胞生长因子受体2(VEGFR-2)、血管内皮生长因子(VEGF)水平均升高,治疗组高于对照组(P<0.05)。结论促愈汤可有效调节混合痔术后患者血清细胞因子水平,改善血管内皮功能,减轻机体炎症,并可改善肛门直肠功能,缓解疼痛,进而可促进创面愈合,提高疗效。

Objective To explore the effects of the Cuyu decoction on the degree of pain and the changes of serum cytokines in patients with mixed hemorrhoids after operation.Methods A total of 102 patients with mixed hemorrhoids after operation admitted to the department of proctology of the Longhua Hospital Affi liated to Shanghai University of Traditional Chinese Medicine from December 2020 to May 2022 were divided into a control group(51 cases)and a treatment group(51 cases)according to the distribution principle of random number table.The control group received routine professional dressing changes and an anti-infection treatment with cefazolin sodium pentahydrate for injection or metronidazole sodium chloride injection,while the treatment group was treated with the Cuyu decoction on the basis of the control group.The treatment group was treated for two weeks,while the control group was given the antiinfection treatment for 3 days and was then followed up.The effects after 2 weeks of treatment,the including wound healing,anorectal electromyography indicators,neovascularization indicators and inflammation indicators before and after 2 weeks of treatment in the two groups were compared.Results The total eff ective rate of the treatment group after 2 weeks of treatment(94.12%)was higher than that in the control group(78.43%)(P<0.05).After 2 weeks of treatment,the scores of wound pain,wound exudation,anal border edema,granulation morphology and the levels of serum interleukin-1β(IL-1β),interleukin-6(IL-6),interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)in both groups were decreased,and the treatment group was lower than the control group(P<0.05).The anal maximum systolic pressure(MSP),rectal maximum tolerance volume(MTV),rectal resting pressure(RRP)and the levels of serum transforming growth factor-β(TGF-β),vascular endothelial growth factor receptor 2(VEGFR-2)and vascular endothelial growth factor(VEGF)in the two groups were increased,and the treatment group was higher than the control group(P<0.05).Conclusion The Cuyu decoction can effectively regulate the levels of serum cytokines in patients with mixed hemorrhoids after operation,improve the vascular endothelial function,reduce infl ammation,improve the anorectal function,relieve pains,and further promote the wound healing and improve the curative effect.