肛周脓肿一病两型分时诊疗的临床价值

Clinical Value of Time-sharing Diagnosis and Treatment Mode in One Disease and Two Types of Perianal Abscess

目的:探讨肛周脓肿一病两型分时诊疗的临床价值。方法:1)回顾性研究:随机选择2015年1月至2017年10月采用肛痈(热毒炽盛证)临床路径诊疗且诊疗有效的病例90例(对照组),2018年3月至2020年12月按肛周脓肿一病两型分时诊疗且治愈出院的高位肛周脓肿、低位肛周脓肿病例各90例(高位组、低位组)。比较3组患者住院时间、住院费用、抗生素DDD值、中医药费用占比情况。2)前瞻性研究:随机选取2019年10月至2021年10月高位肛周脓肿、低位肛周脓肿患者各90例,再进一步随机分为高位分时诊疗组、高位常规治疗组、低位分时诊疗组和低位常规治疗组,各45例。比较4组患者围术期症状评分及炎性指标水平。结果:1)回顾性研究:低位组患者住院时间、住院费用、抗生素DDD值均低于高位组和对照组(P<0.05);高位组患者中医药住院费用占比高于低位组和对照组(P<0.05),低位组中医药住院费用占比高于对照组(P<0.05)。2)前瞻性研究:与术前相比,4组患者术后第1天疼痛评分无明显变化(P>0.05),伴随症状评分均明显升高(P<0.05);组间比较,4组患者术后第1天疼痛及伴随症状评分比较均无统计学意义(P>0.05)。术后第5天4组患者疼痛及伴随症状评分均明显低于术后第1天和术前(P<0.05),组间比较,分时诊疗的两组患者疼痛及伴随症状评分均低于常规诊疗的两组(P<0.05)。与术前相比,4组患者术后第1天全血WBC、血清C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、血浆Fib水平均无明显变化(P>0.05),术后第5天均明显降低(P<0.05)。组间比较,术后第5天高位、低位分时诊疗组患者血清CRP、SAA水平明显低于相应常规治疗组(P<0.05)。结论:1)肛周脓肿一病两型分时诊疗模式在合理控制住院时间、住院费用及合理使用抗生素、提高中医药治疗占比方面具有地域运用前景。2)肛周脓肿一病两型分时诊疗模式有助于控制围术期症状,改善WBC、CRP、SAA、Fib指标。

Objective To investigate the clinical value of time-sharing diagnosis and treatment mode in one disease and two types of perianal abscess.Methods 1)Retrospective study:the 90 cases who underwent the clinical pathway of anal carbuncle(excessive heat toxin syndrome)from January 2015 to October 2017 effectively diagnosed and treated were randomly selected as control group(90 cases),the 90 cases of each of high and low perianal abscesses from March 2018 to December 2020 diagnosed and treated according to one disease and two types of perianal abscesses,cured and discharged were randomly selected as high-position group(90 cases)and low-position group(90 cases).Compared the hospitalization time,hospitali-zation cost,antibiotic DDD value,and proportion of TCM expenses among three groups of patients.2)Prospective study:the 90 cases of each of high and low perianal abscesses were randomly selected from October 2019 to October 2021,they were further randomly divided into high time-sharing diagnosis and treatment group(45 cases),high routine treatment group(45 cases),low time-sharing diagnosis and treatment group(45 cases),and low routine treatment group(45 cases).Compared the perioperative symptom scores and inflammatory index levels among four groups of patients.Results 1)Retrospective study:the hospitalization time,hospitalization cost,antibiotic DDD value in low-position group were all lower than those in high-position group and control group(P<o.05);The cost ratio of TCM in high-position group was higher than that in low-position group and control group(P<o.05).The cost ratio of TCM in low-position group was higher than that in control group(P<0.05).2)Prospective study:Compared with preoperative one,there was no significant change in pain scores on the first day after surgery in the four groups of patients(P>0.05),and the accompanying symptom scores were significantly increased(P<0.05);There was no statistically significant difference in pain and accompanying symptom scores among the four groups of patients on the first day after surgery(P>0.05).On the 5th day after surgery,the pain and accompanying symptom scores of the four groups of patients were significantly lower than those on the lst day after surgery and before surgery(P<0.05).Compared between groups,the pain and accompanying symptom scores of two groups of high time-sharing diagnosis and treatment group and low time-sharing diagnosis and treatment group were lower than those of the two groups of high routine treatment group and low routine treatment group(P<o.05).Compared with before surgery,there were no significant changes in the levels of whole blood WBC,serum C-reactive protein(CRP),serum amyloid A(SAA),and plasma Fib in the four groups of patients on the first day after surgery(P>0.05),but they all significantly decreased on the fifth day after surgery(P<0.05).Compared between groups,the serum CRP and SAA levels of patients in the two groups of high time-sharing diagnosis and treatment group and low time-sharing diagnosis and treatment group on the 5th day after surgery were significantly lower than those in the two groups of high routine treatment group and low routine treatment group(P<o.05).Conclusion 1)The time-sharing diagnosis and treatment mode in one disease and two types of perianal abscess has regional application prospect in reasonable control of hospitalization costs,hospitalization durtion,rational use of antibiotics and the improved proportion of TCM treatment.2)The time-sharing diagnosis and treatment mode in one disease and two types of perianal abscess effectively helps to control perioperative symptoms and improve WBC,CRP,SAA,and Fib indicators.