【摘要】：目的：本研究針對(duì)正虛邪戀型肛瘺術(shù)后氣虛血瘀的特點(diǎn),運(yùn)用導(dǎo)師臨床經(jīng)驗(yàn)方加減內(nèi)托生肌散內(nèi)服,評(píng)價(jià)此方改善肛瘺術(shù)后并發(fā)癥及促進(jìn)創(chuàng)面愈合的臨床療效。 方法：本研究觀(guān)察的60例正虛邪戀型低位單純性肛瘺術(shù)后患者為福建中醫(yī)藥大學(xué)附屬人民醫(yī)院肛腸科2013年2月至2013年12月住院病人。其中男性39例,女性21例,年齡18～60歲,所有受試者按隨機(jī)數(shù)字表隨機(jī)分為治療組30例和對(duì)照組30例。兩組患者均在局部浸潤(rùn)麻醉下行肛瘺切除術(shù),術(shù)后均按常規(guī)治療。治療組在常規(guī)治療的基礎(chǔ)上術(shù)后第2天開(kāi)始口服加減內(nèi)托生肌散治療,對(duì)照組無(wú)口服給藥。兩組各種輔助治療均相同。分別在術(shù)后第2天、第4天、第6天、第8天觀(guān)察創(chuàng)面分泌物情況并對(duì)患者疼痛情況進(jìn)行評(píng)分；比較兩組患者術(shù)后第2天、第16天、第25天創(chuàng)面面積及創(chuàng)面愈合率；記錄兩組患者術(shù)后創(chuàng)面完全愈合天數(shù)�？陀^(guān)評(píng)價(jià)各指標(biāo),計(jì)量資料描述將采用X±S,兩樣本間采取兩獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),等級(jí)資料采用Ridit分析。數(shù)據(jù)采用統(tǒng)計(jì)軟件SPSS18.0處理對(duì)結(jié)果進(jìn)行分析。 結(jié)果：治療前對(duì)兩組病例的性別、年齡、病程、創(chuàng)面分泌物情況、疼痛情況、創(chuàng)面愈合時(shí)間等進(jìn)行均衡性比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義,組間基線(xiàn)一致。研究結(jié)果分析如下： (1)創(chuàng)面分泌物、疼痛：兩組術(shù)后第2天創(chuàng)面分泌物比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后第4天、第6天、第8天創(chuàng)面分泌物比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組在早期減少創(chuàng)面分泌物方面優(yōu)于對(duì)照組。兩組術(shù)后第2天疼痛評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后第4天、第6天、第8天疼痛評(píng)分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組在減輕術(shù)后疼痛方面優(yōu)于對(duì)照組。 (2)創(chuàng)面面積和創(chuàng)面愈合率：術(shù)后第16天對(duì)照組創(chuàng)面面積為(8.37±0.11)cm2,治療組創(chuàng)面面積為(7.07±0.20)cm2；術(shù)后第25天對(duì)照組創(chuàng)面面積為(3.47±0.31)cm2,治療組為(2.40±0.25)cm2。兩組創(chuàng)面面積比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后創(chuàng)面愈合率比較,術(shù)后第16天對(duì)照組創(chuàng)面愈合率平均為72.40%,治療組平均為84.53%,兩組創(chuàng)面愈合率比較,經(jīng)秩和檢驗(yàn),P=0.000(P0.05),差異有統(tǒng)計(jì)學(xué)意義。術(shù)后第25天對(duì)照組創(chuàng)面愈合率平均為96.70%,治療組平均為100%,兩組創(chuàng)面愈合率比較,經(jīng)秩和檢驗(yàn),P=0.000(P0.05),差異有統(tǒng)計(jì)學(xué)意義。說(shuō)明治療組在促進(jìn)創(chuàng)面愈合,縮小創(chuàng)面面積方面均優(yōu)于對(duì)照組。 (3)總療效和創(chuàng)面愈合時(shí)間：兩組治療后癥狀、體征均消失,兩組臨床總療效均為100%。對(duì)照組創(chuàng)面愈合時(shí)間為(18～29)天,平均創(chuàng)面愈合時(shí)間為(23.00±0.53)天；治療組創(chuàng)面愈合時(shí)間為(17～25)天,平均創(chuàng)面愈合時(shí)間為(21.33±0.44)天。兩組平均創(chuàng)面愈合時(shí)間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對(duì)照組。 結(jié)論：治療組比對(duì)照組更有效的減輕肛瘺術(shù)后并發(fā)癥、促進(jìn)肛瘺術(shù)后創(chuàng)面愈合,說(shuō)明加減內(nèi)托生肌散口服能有效減少術(shù)后創(chuàng)面分泌物,減輕術(shù)后疼痛,從而促進(jìn)創(chuàng)面愈合,且無(wú)明顯毒副作用,安全性較好,值得臨床推廣應(yīng)用。
[Abstract]:Objective: According to the characteristics of qi deficiency and blood stasis after operation of anal fistula of Zheng deficiency and evil Love type, this study used the tutor's clinical experience prescription to add or subtract the Internal Torsheng Muscle Powder to take orally, and evaluated the clinical effect of this prescription on improving the postoperative complications of anal fistula and promoting wound healing.
Methods: 60 cases of low simple anal fistula with positive deficiency and evil love were observed from February 2013 to December 2013 in the Anorectal Department of People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine. Among them, 39 were male and 21 were female, aged 18-60. All the subjects were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group began to take orally modified Nato Sheng Ji San on the second day after operation, while the control group did not take orally. All the adjuvant treatments were the same in the two groups. The wound area and wound healing rate were compared between the two groups on the 2nd day, the 16th day and the 25th day after operation, and the days of complete wound healing were recorded. Hierarchical data were analyzed by Ridit. Data were analyzed by statistical software SPSS18.0.
Results: There was no significant difference in gender, age, course of disease, wound secretion, pain and wound healing time between the two groups before treatment. The results were as follows:
(1) Wound secretion, pain: There was no significant difference between the two groups on the 2nd day after operation (P 0.05). There was significant difference between the two groups on the 4th, 6th and 8th day after operation (P 0.05). The treatment group was superior to the control group in reducing wound secretion in the early stage. The pain scores of the two groups on the 4th, 6th and 8th day after operation were statistically significant (P 0.05). The treatment group was superior to the control group in relieving postoperative pain.
(2) Wound area and wound healing rate: on the 16th day after operation, the wound area of the control group was (8.37 [0.11] cm 2, the wound area of the treatment group was (7.07 [0.20] cm 2, and on the 25th day after operation, the wound area of the control group was (3.47 [0.31] cm 2, and the treatment group was (2.40 [0.25] cm 2). There was a significant difference in the wound healing rate between the two groups (P 0.05). The average wound healing rate was 72.40% in the control group and 84.53% in the treatment group on the 16th day after operation. The difference was statistically significant between the two groups by rank sum test (P = 0.000 (P 0.05). The average wound healing rate was 96.70% in the control group and 100% in the treatment group on the 25th day after operation. The difference was statistically significant (P 0.05), indicating that the treatment group was superior to the control group in promoting wound healing and reducing wound area.
(3) Total curative effect and wound healing time: After treatment, symptoms and signs disappeared in both groups, and the total clinical curative effect was 100%. The wound healing time in control group was (18-29) days, the average wound healing time was (23.00 (0.53) days; the wound healing time in treatment group was (17-25) days, the average wound healing time was (21.33 (0.44) days. There was a significant difference in healing time between the two groups (P0.05), and the treatment group was better than the control group.
Conclusion: The treatment group is more effective than the control group in reducing the postoperative complications of anal fistula, promoting wound healing after anal fistula surgery, indicating that oral administration of modified Nato Sheng Ji Powder can effectively reduce postoperative wound secretion, relieve postoperative pain, thus promoting wound healing, without obvious toxic and side effects, and is safe and worthy of clinical application.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R266

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