金银花黄芪汤联合中药熏洗对肛瘘术后患者肛门功能及炎症因子的影响

Effect of Shuanghua Huangqi Decoction(金银花黄芪汤)Combined with Traditional Chinese Medicine Fumigation on Anal Function and Inflammatory Factors in Patients after Anal Fistula Operation

目的探讨金银花黄芪汤联合中药熏洗对肛瘘术后患者肛门功能及炎症因子的影响。方法选择如皋市中医院肛肠外科2020年5月—2021年6月经肛瘘切除术治疗的肛瘘患者162例的病例资料,按随机对照临床研究原则,分对照组(81例)和治疗组(81例),两组均予以肛瘘切除术治疗。术后对照组采用术后温水熏洗疗法;治疗组采用金银花黄芪汤联合中药熏洗治疗,治疗前后观察并记录视觉模拟(visual analog scale,VAS)评分、大便失禁严重程度(fecal incontinence severity index,FISI)、渗液程度积分,测定肛门功能指标,治疗后采血测定血清白细胞介素族(interleukin,IL)及β内啡肽(β-endorphin,β-EP)含量,同时对比临床疗效和并发症状况。结果与手术前比较,两组患者治疗后VAS评分、FISI评分、渗液程度积分降低,治疗后肛管最大收缩压(anal maximum contraction pressure,AMCP)、肛管最长收缩时间(anal longest contraction time,ALCT)升高,直肠静息压(rectal resting pressure,RRP)、肛管静息压(anal resting pressure,ARP)降低,治疗后血清IL-4、IL-6、IL-10以及β-EP含量升高(P<0.05);与对照组比较,治疗组治疗后VAS评分、FISI、渗液程度积分较低,ALCT较低,RRP、ARP较高,血清IL-4、IL-6、IL-10以及β-EP含量较低(P<0.05);对照组创口愈合时间和住院时间(22.16±3.21)d、(20.04±2.69)d与治疗组(17.25±2.69)d、(15.92±2.34)d,差异有统计学意义(P<0.05);对照组有效率为72.84%(59/81),治疗组有效率为90.12%(73/81),治疗组高于对照组(P<0.05)。结论金银花黄芪汤联合中药熏洗对肛瘘术后患者疗效显著,较好的保护患者肛门功能,降低疼痛应激及炎症反应,值得在临床上推广应用。

Objective To investigate the effect of Shuanghua Huangqi Decoction(金银花黄芪汤)combined with traditional Chinese medicine fumigation on anal function and inflammatory factors in patients after anal fistula.Methods A hundred and sixty-two patients with anal fistula treated by anal fistula resection from May 2020 to June 2021 were selected.According to the principle of randomized controlled clinical study,they were divided into the control group(81 cases)and the treatment group(81 cases).Both groups were treated with anal fistula resection,and the control group was treated with warm water fumigation therapy after operation.Visual analog scale(VAS)score,fecal incontinence severity index(FISI)and exudation degree score were observed and recorded before and after treatment,and anal function indexes were measured.Blood samples were collected after treatment to measure serum interleukin(IL)andβ-endorphin(β-EP)content,and clinical efficacy and complications were compared.Results Compared with those before operation,VAS score,FISI and exudation degree score were decreased,the values of anal maximum contraction pressure(AMCP)and anal longest contraction time(ALCT)were increased,the values of rectal resting pressure(RRP)and anal resting pressure(ARP)were decreased,the levels of serum IL-4,IL-6,IL-10 andβ-EP were increased after treatment in the two groups(P<0.05).Compared with those of the control group,the VAS score,FISI and exudation degree score were lower,the value of ALCT was lower,the valuues of RRP and ARP were higher,and the levels of serum IL-4,IL-6,IL-10 andβ-EP were lower in the treatment group after treatment(P<0.05).The wound healing time and hospital stay in the control group were(22.16±3.21)d and(20.04±2.69)d,and those in the treatment group were(17.25±2.69)d and(15.92±2.34)d.There were differences(P<0.05).The effective rate of the control group was 72.84%(59/81),and that of the treatment group was 90.12%(73/81),which was higher than that of the control group(P<0.05).Conclusion Shuanghua Huangqi Decoction combined with traditional Chinese medicine fumigation and washing has a significant effect on patients after anal fistula surgery,which can better protect the anal function of patients,reduce pain stress and inflammatory reaction,and is worthy of clinical application.