愈创生肌汤联合中药外熏洗治疗肛瘘术后湿热下注证临床研究

Clinical Study on Yuchuang Shengji Decoction Combined with External Fumigation and Washing of Chinese Medicine for Damp-Heat Pouring Downward Syndrome After Surgery for Anal Fistula

目的:观察愈创生肌汤联合中药外熏洗治疗肛瘘术后湿热下注证的疗效。方法:选择205例肛瘘手术患者,按随机数字表法分为高锰酸钾组52例、愈创生肌汤组50例、中药外熏洗组51例、联合组52例。术后高锰酸钾组给予高锰酸钾溶液熏洗,愈创生肌汤组给予愈创生肌汤口服,中药外熏洗组给予中药外熏洗治疗,联合组给予愈创生肌汤联合中药外熏洗治疗。4组均连续治疗21 d。比较4组临床疗效及创面愈合情况,比较4组术后、术后21 d创面症状评分、炎性因子[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]、血管内皮生长因子(VEGF)水平及安全性指标值的变化。结果:联合组总有效率为96.15%,高锰酸钾组、愈创生肌汤组和中药外熏洗组临床疗效分别为84.62%、82.00%、82.35%(P<0.05)。术后当天,4组中医证候积分比较,差异无统计学意义(P>0.05)。术后21 d,4组中医证候积分均较术后当天下降(P<0.05),联合组中医证候积分低于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05)。术后7 d,4组创面愈合率比较,差异无统计学意义(P>0.05)。术后14 d、术后21 d,联合组创面愈合率高于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05);联合组创面渗液时间、创面愈合时间均短于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05)。术后当天,4组水肿、肉芽、疼痛创面症状评分比较,差异无统计学意义(P>0.05)。术后21 d,4组水肿、肉芽、疼痛创面症状评分均较术后当天下降(P<0.05),联合组均低于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05)。联合组肉芽组织水肿发生率、肉芽组织溃疡发生率均低于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05)。术后21 d,4组TNF-α、hs-CRP水平均较术后当天下降(P<0.05),VEGF水平均较术后当天上升(P<0.05);联合组TNF-α、hs-CRP水平均低于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05),VEGF水平高于高锰酸钾组、愈创生肌汤组、中药外熏洗组(P<0.05)。联合组创口感染发生率、尿潴留发生率、便秘发生率与其他3组比较,差异均无统计学意义(P>0.05)。结论:愈创生肌汤联合外熏洗治疗肛瘘术后湿热下注证疗效较好,可促进术后创面愈合,提升创面愈合质量,减轻创面症状。

Objective: To observe the curative effect of Yuchuang Shengji Decoction combined with external fumigation and washing of Chinese medicine on damp-heat pouring downward syndrome after surgery for anal fistula. Methods:A total of 205 cases of patients underwent surgery for anal fistula were selected and divided into the Potassium Permanganate group,the Yuchuang Shengji Decoction group,the external fumigation and washing of Chinese medicine group and the combination group according to the random number table method,with 52,50,51 and 52 cases in each group respectively. After surgery,the Potassium Permanganate group was treated with fumigation and washing with Potassium Permanganate solution, the Yuchuang Shengji Decoction group was given the oral administration of Yuchuang Shengji Decoction,the external fumigation and washing of Chinese medicine group was treated with external fumigation and washing of Chinese medicine,and the combination group was treated with Yuchuang Shengji Decoction combined with external fumigation and washing of Chinese medicine. All the groups were treated for 21 days. The clinical effects and wound healing were compared among the four groups. The changes in wound symptom scores,inflammatory factors [hypersensitive C-reactive protein(hs-CRP), and tumor necrosis factor-α(TNF-α)], vascular endothelial growth factor(VEGF) levels and safety indexes after surgery and in 21 days after surgery were compared among the four groups. Results:The total effective rate was 96.15% in the combination group, 84.62% in the Potassium Permanganate group, 82.00% in the Yuzhuang Shengji Decoction group and 82.35% in the external fumigation and washing of Chinese medicine group(P<0.05). On the day after surgery,there was no significant difference being found in the comparison of traditional Chinese medicine(TCM) syndrome scores among the four groups(P>0.05). On the day 21 after surgery,TCM syndrome scores in the four groups were decreased when compared with those on the day after surgery(P<0.05),and the score in the combination group was lower than those in the other three groups(P<0.05). On the day 7 after surgery,there was no significant difference being found in the comparison of wound healing rates among the four groups(P>0.05). On the days 14 and 21 after surgery,the wound healing rates in the combination group were higher than those in the other three groups(P<0.05),and the wound exudate time and healing time in the combination group were shorter than those in the other three groups(P<0.05). On the day after surgery, there was no significant difference being found in the comparison of the scores of wound symptoms like edema,granulation and pain among the four groups(P>0.05). On the day 21 after surgery,the scores of wound symptoms like edema,granulation and pain in the four groups were decreased when compared with those on the day after surgery(P<0.05),and the scores in the combination groups were lower than those in the other three groups(P<0.05). The incidence of granulation tissue edema and granulation tissue ulcer in the combination group was lower than those in the other three groups(P<0.05). On the day 21 after surgery,the levels of TNF-α and hs-CRP in the four groups were decreased when compared with those on the day after surgery(P<0.05), and VEGF levels were increased when compared with those on the day after surgery(P<0.05);the levels of TNF-α and hs-CRP in the combination group were lower than those in the other three groups(P<0.05),and the level of VEGF was higher than those in the other three groups(P<0.05). There was no significant difference being found in the comparison of the incidence of wound infection,urinary retention and constipation between the combination group and the other 3 groups(P>0.05). Conclusion:Yuchuang Shengji Decoction combined with external fumigation and washing has a good curative effect on damp-heat pouring downward syndrome after surgery for anal fistula, which can promote postoperative wound healing,improve wound healing quality and alleviate wound symptoms.