实秘方治疗伴有便秘的混合痔围手术期患者的疗效及对血清MTL、VIP、SP的影响

Efficacy of Shimi Formula in treating perioperative patients of mixed hemorrhoids with constipation and its influence on serum MTL,VIP and SP

目的:观察实秘方治疗伴有便秘的混合痔围手术期患者的临床疗效及对血清胃动素(MTL)、血管活性肠肽(VIP)、P物质(SP)水平的影响。方法:纳入96例伴有便秘的混合痔患者,按随机数字表分为中药组48例和西药组48例。中药组患者给予实秘方口服治疗,西药组患者给予乳果糖口服治疗,服药7 d后,所有患者均行混合痔外剥内扎术,术后继续服药4周。于用药前及用药7、14、21、35 d后,评价并比较两组患者的排便情况各项指标评分;于用药前及用药14、35 d后,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价患者的焦虑、抑郁情绪状态;于术后当天及第3、7、14天,评价并比较两组患者的术后并发症(包括疼痛、出血、水肿、尿潴留)评分;记录并比较两组患者的创面愈合时间;于用药前及用药35 d后,检测所有患者的血清MTL、VIP、SP水平;用药35 d后,比较两组患者的临床疗效。结果:①用药后,两组患者的排便情况较用药前均明显改善(P<0.05,P<0.01),且中药组患者的改善情况明显优于西药组(P<0.05,P<0.01)。②用药后,两组患者的SAS、SDS评分较用药前均明显降低(P<0.01),且中药组患者的评分明显低于西药组(P<0.01)。③术后,中药组患者的疼痛、出血、水肿评分均低于西药组(P<0.05,P<0.01)。④两组患者的创面愈合时间比较,差异无统计学意义(P>0.05)。⑤用药35 d后,两组患者的MTL、VIP水平显著下降(P<0.01),SP水平显著上升(P<0.05),且中药组患者的MTL、VIP水平低于西药组(P<0.05),SP水平高于西药组(P<0.05)。⑥用药后,中药组患者的临床总有效率为87.50%,西药组为66.67%,中药组的疗效优于西药组(P<0.05)。结论:实秘方用于伴有便秘的混合痔围手术期患者,可明显缓解患者的排便困难,减轻其焦虑、抑郁情绪,减少术后并发症,并可调节血清胃肠激素水平,具有较好的治疗效果。

Objective:To observe the clinical efficacy of Shimi Formula in treating perioperative patients of mixed hemorrhoids with constipation and its influence on the levels of serum motilin(MTL),vasoactive intestinal peptide(VIP)and substance P(SP).Methods:Ninety-six patients of mixed hemorrhoids with constipation were included and divided into the Chinese medicine group(48 cases)and western medicine group(48 cases)according to the random number table.The patients in the Chinese medicine group were orally treated with Shimi Formula and the patients in the western medicine group were orally treated with lactulose.After 7 days of medication,all the patients were given Milligan-Morgan hemorrhoidectomy and continued to take medication for 4 weeks after surgery.Before medication and after 7,14,21 and 35 days of medication,the scores of defecation condition indexes of the two groups were evaluated and compared.Before medication and after 14 and 35 days of medication,the anxiety and depression of the patients were evaluated by self-rating anxiety scale(SAS)and self-rating depression scale(SDS).On the day and the 3rd,7th and 14th days after surgery,the scores of postoperative complication(including pain,bleeding,edema,and urinary retention)in the two groups were evaluated and compared.The wound healing time of the two groups were recorded and compared.Before medication and after 35 days of medication,the levels of serum MTL,VIP and SP were detected.After 35 days of medication,the clinical efficacy of the two groups was compared.Results:①After medication,the defecation condition of the two groups were significantly improved compared with that before medication(P<0.05,P<0.01),and the improvement of the Chinese medicine group was obviously superior to the western medicine group(P<0.05,P<0.01).②After medication,the scores of SAS and SDS in the two groups were significantly decreased compared with those before medication(P<0.01),and the scores of the Chinese medicine group were obviously lower than those of the western medicine group(P<0.01).③After surgery,the scores of pain,bleeding and edema in the Chinese medicine group were lower than those in the western medicine group(P<0.05,P<0.01).④There was no statistically significant difference on the wound healing time between the two groups(P>0.05).⑤After 35 days of medication,the levels of MTL and VIP in the two groups were significantly decreased(P<0.01),the level of SP was significantly increased(P<0.05),and the levels of MTL and VIP in the Chinese medicine group were lower than those in the western medicine group(P<0.05),the level of SP was higher than that in the western medicine group(P<0.05).⑥After medication,the total clinical effective rate was 87.50%in the Chinese medicine group and 66.67%in the western medicine group,and the effect of the Chinese medicine group was superior to the western medicine group(P<0.05).Conclusion:Shimi Formula can significantly relieve the defecation difficulty,alliviate the anxiety and depression,reduce the postoperative complications,and regulate the serum gastrointestinal hormone levels in treating perioperative patients of mixed hemorrhoids with constipation,which has better therapeutic effects.