三黄清热熏洗方联合中医旷置术治疗高位后马蹄形肛周脓肿的临床研究

Clinical study on Sanhuang Qingre Fuming and Washing Decoction combined with Chinese medical excision in the treatment of horseshoe perianal abscess after high position

目的评价三黄清热熏洗方联合中医旷置术治疗高位后马蹄形肛周脓肿的临床疗效,探讨其作用机制。方法随机对照试验研究。选取2020年4月-2021年2月本院外科患者60例作为观察对象,采用随机数字表法分为2组,每组30例。2组均施以中医旷置引流术,术后第2天起,对照组予以高锰酸钾坐浴熏洗,观察组予以三黄清热熏洗方坐浴熏洗。观察2组创面愈合时间,评价痊愈率。分别于术后第1、7 d采用ELISA法检测血清TNF-α、IL-1β、IL-6、VEGF、碱性成纤维细胞生长因子(bFGF)、表皮细胞生长因子(EGF)水平,化学发光法检测血清SOD水平,硫代巴比妥酸法检测血清MDA水平。结果观察组创面愈合时间短于对照组(t=3.37,P<0.01)。观察组痊愈率为93.3%(28/30)、对照组为76.7%(23/30),2组比较差异有统计学意义(χ^(2)=4.32,P=0.038)。术后7 d,观察组血清TNF-α、IL-1β、IL-6水平低于对照组(t值分别为2.01、2.05、4.88,P<0.05或P<0.01),SOD水平高于对照组(t=-2.13,P=0.038),MDA水平低于对照组(t=3.26,P=0.002),VEGF、bFGF、EGF水平高于对照组(t值分别为-2.02、-3.33、-3.77,P<0.05)。结论三黄清热熏洗方联合中医旷置术可缩短高位后马蹄形肛周脓肿患者的创面愈合时间,提高痊愈率,其作用机制可能与三黄清热熏洗方可减轻炎症反应及氧化应激损伤,提高生长因子水平,利于术后组织修复有关。

Objective To observe the clinical effect of Sanhuang Qingre Fuming and Washing Decoction combined with Chinese medical excision in the treatment of horseshoe-shaped perianal abscess after high position and to explore its mechanism of action.Methods Randomized controlled trial.Sixty surgical patients in our hospital from April 2020 to February 2021 were selected as observation objects.The patients were divided into two groups according to the random number table,with 30 patients in each group.Both groups were treated with Traditional Chinese Medicine drainage.On the second day after operation,the control group was treated with potassium permanganate sitz bath fumigation and washing,and the observation group was treated with Sanhuang Qingre Fuming and Washing Decoction.The wound healing time was observed in the two groups,serum TNF-α,IL-1β,IL-6,VEGF,bFGF,and EGF levels were detected by ELISA on the 1st and 7th d after operation,respectively.Serum SOD level was detected by the chemiluminescence method,and serum MDA level was detected by thiobarbituric acid method.Results The wound healing time in the observation group was shorter than that in the control group(t=3.37,P<0.01).The recovery rate was 93.3%(28/30)in the observation group and 76.7%(23/30)in the control group.The difference was statistically significant between the two groups(χ^(2)=4.32,P=0.038).Seven days after surgery,the levels of serum TNF-α,IL-1βand IL-6 in the observation group were significantly lower than those in the control group(t values were 2.01,2.05 and 4.88,respectively,P<0.05 or P<0.01),the level of SOD was significantly higher than that of the control group(t=-2.13,P=0.038),the level of MDA water was significantly lower than that of the control group(t=3.26,P=0.002),and the levels of VEGF,bFGF and EGF were significantly higher than those in the control group(t values were-2.02,-3.33,-3.77,respectively,P<0.05).Conclusion Sanhuang Qingre Tuming and Washing Decoction combined with Chinese medical excision in the treatment could shorten the healing time of the wound surface of horseshoe-shaped perianal abscess after high elevation and improve the recovery rate.The Sanhuang Qingre Fuming and Washing Decoction may reduce inflammatory reaction and oxidative stress damage,improve the level of growth factors and facilitate the postoperative tissue repair.