基于快速康复外科理念的中医特色疗法预防混合痔术后尿潴留的价值研究

Role of Traditional Chinese Medicine Characteristic Therapy Based on Enhanced Recovery After Surgery in Preventing Urinary Retention after Mixed Hemorrhoid Operation

目的探讨基于快速康复外科理念(ERAS)的中医特色疗法预防混合痔术后尿潴留的价值。方法选取2021年7月—2022年7月于惠州市中医医院肛肠科收治的100例混合痔手术患者作为研究对象,按照随机数字表法分成两组,对照组(50例)采用物理疗法,观察组(50例)则采用中医特色疗法,比较两组尿潴留发生率、自主排尿情况,于术前、术后1d、术后3 d时检测两组患者血液中C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平变化。结果观察组患者治疗总有效率为98%,对照组患者治疗总有效率为80%,两者的治疗效果比较差异有统计学意义(P<0.05)。观察组首次排尿所需时间、排尿顺畅度、小腹膨满胀痛及膀胱充盈度评分均低于对照组(P<0.05);两组患者术后首次排尿时间无明显差异(P>0.05)。术后1 d时两组患者主症、次症及中医证候总积分差异无统计学意义(P>0.05);术后3 d时观察组主症、次症及中医证候总积分均显著低于对照组(P<0.01)。术后即刻两组患者VAS评分差异无统计学意义(P>0.05);术后6 h及24 h时观察组患者VAS评分均显著低于对照组(P<0.01)。术后1d两组患者血清IL-6、CRP水平无明显差异(P>0.05);术后3 d时观察组血清IL-6、CRP水平均低于对照组(P<0.01)。观察组有1例穴位注射后膝关节麻木感,自行缓解,两组患者均无严重不良反应情况。结论基于快速康复外科理念的中医特色疗法可有效预防混合痔术后尿潴留的发生,减轻患者因排尿困难带来的痛苦,加速患者术后康复。

Objective To investigate the value of traditional Chinese medicine(TCM)therapy based on enhanced recovery after surgery(ERAS)in preventing postoperative urinary retention in patients undergoing mixed hemorrhoid surgery.Methods From July 2021 to July 2022,100 patients who underwent mixed hemorrhoid surgery at the Proctology Department of Huizhou Hospital of Traditional Chinese Medicine were selected and randomly divided into two groups using a random number table method.The control group(50 cases)received physical therapy,while the observation group(50 cases)received TCM therapy.The incidence of urinary retention and the status of spontaneous urination were compared between the two groups.Changes in blood levels of C-reactive protein(CRP)and interleukin-6(IL-6)were measured preoperatively,on the first day postoperatively,and on the third day postoperatively.Results The total effective rate of treatment in the observation group was 98%,significantly higher than 80%in the control group(P<0.05).The observation group had lower scores for the time required for the first urination,ease of urination,lower abdominal distension and pain,and bladder fullness than the control group(P<0.05).There was no significant difference in the time of the first urination postoperatively between the two groups(P>0.05).On the first day postoperatively,there was no significant difference in the main symptoms,secondary symptoms,and total TCM syndrome scores between the two groups(P>0.05).On the third day postoperatively,the observation group had significantly lower scores for the main symptoms,secondary symptoms,and total TCM syndrome scores than the control group(P<0.01).There was no significant difference in VAS scores between the two groups immediately after surgery(P>0.05).However,at 6 and 24 hours postoperatively,the observation group had significantly lower VAS scores than the control group(P<0.01).On the first day postoperatively,there was no significant difference in serum IL-6 and CRP levels between the two groups(P>0.05).On the third day postoperatively,the observation group had lower serum IL-6 and CRP levels than the control group(P<0.01).In the observation group,there was one case of knee joint numbness after acupoint injection,which resolved on its own.There were no serious adverse reactions in either group.Conclusion TCM therapy based on the ERAS can effectively prevent postoperative urinary retention in patients undergoing mixed hemorrhoid surgery,alleviate the pain caused by urination difficulties,and accelerate postoperative recovery.