中西医结合分阶段治疗肛周坏死性筋膜炎疗效观察  

Observation on the curative effect of stage treatment with integrated traditional Chinese and western medicine on perianal necrotizing fasciitis

作　　者：宋金忠[1] 魏少兴 李青 葛焱 王书奇[1] 马晓波 李凤燕[1] 许建成[5] 赵鹏飞[1] 张天朋 梅宁宁 SONG Jinzhong;WEI Shaoxing;LI Qing;GE Yan;WANG Shuqi;MA Xiaobo;LI Fengyan;XU Jiancheng;ZHAO Pengfei;ZHANG Tianpeng;MEI Ningning(Shijiazhuang Hospital of TCM,Shijiazhuang 050051,Hebei,China;The People’s Hospital of Xingtai,Xingtai 054000,Hebei,China;Yiling Hospital,Shijiazhuang 050091,Hebei,China;Hospital of Chang’an District,Shijiazhuang 050011,Hebei,China;Hebei Provincial Hospital of TCM,Shijiazhuang 050011,Hebei,China)

机构地区：[1]河北省石家庄市中医院,河北石家庄050051 [2]邢台市人民医院,河北邢台054000 [3]河北以岭医院,河北石家庄050091 [4]石家庄市长安区医院,河北石家庄050011 [5]河北省中医院,河北石家庄050011

出　　处：《现代中西医结合杂志》2021年第10期1056-1060,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省中医药管理局2017年度中医药类科研计划项目(2017109)。

摘　　要：目的探讨中西医结合分阶段治疗肛周坏死性筋膜炎的临床效果。方法选取2017年1月—2019年6月石家庄市中医院及合作医院收治的肛周坏死性筋膜炎患者106例,利用随机数字表法分为对照组和观察组各53例,2组均给予手术治疗+抗炎对症治疗+营养支持治疗。在此基础上,对照组采用碘伏液灌洗创面+碘伏纱条创面覆盖治疗;观察组采用清热解毒联合益气养阴法分阶段治疗,即早期患者热毒炽盛,应用复方黄柏液灌洗创面+复方黄柏液纱条创面覆盖+黄连解毒汤口服,后期患者气阴两虚,应用复方黄柏液灌洗创面+复方黄柏液纱条创面覆盖+八珍汤加减口服;2组均治疗4周。观察2组治疗前后肛周疼痛程度VAS评分、理化指标[超敏C反应蛋白(hs-CRP)、白细胞(WBC)、血红蛋白(Hb)、白细胞介素-8(IL-8)、白细胞介素-13(IL-13)]变化,统计2组肛周水肿情况、临床疗效及创面愈合时间。结果治疗后,2组VAS评分及血WBC、hs-CRP、IL-8水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);治疗后,2组Hb、IL-13水平均明显升高(P均<0.05),且观察组均明显高于对照组(P均<0.05)。治疗4周后,观察组肛周水肿明显轻于对照组(P<0.05);观察组和对照组治疗总有效率分别为94.3%(50/53)和81.1%(43/53),观察组明显高于对照组(P<0.05);观察组患者腐肉脱落时间、创面愈合时间、住院时间均明显短于对照组(P均<0.05)。结论采取中西医结合分阶段治疗肛周坏死性筋膜炎可有效减轻患者肛周疼痛、水肿及炎症反应,改善贫血情况,缩短创面愈合时间,疗效更为确切。Objective It is to explore the clinical effect of stage treatment with integrated traditional Chinese and western medicine on perianal necrotizing fasciitis.Methods A total of 106 patients with perianal necrotizing fasciitis admitted to Shijiazhuang Hospital of TCM and cooperative hospital from January 2017 to June 2019 were selected and divided into control group and observation group by a random number table method,with 53 cases in each group.Both groups were treated with surgery+anti-inflammatory and symptomatic treatment+nutritional support treatment.Additionally,the control group was treated with would lavage by iodophor+wound coverage with iodophor gauze;the observation group was treated with stage therpay for heat-clearing and detoxification combined with nourishing Qi and Yin,that is,the early patients with were intense heat toxin were treated with wound lavage by compound Huangbai liquid+wound coverage with compound Huangbai liquid gauze+oral administration of Huanglian Jiedu Decoction,the later patients with deficiency of both Qi and Yin were treated with wound lavage by compound Huangbai liquid+wound coverage with compound Huangbai liquid gauze+oral administration of modified Bazhen decoction,both groups were treated for 4 week.The changes of VAS scores of perianal pain and physical and chemical indicators[high-sensitivity C-reactive protein(hs-CRP),white blood cells(WBC),hemoglobin(Hb),interleukin-8(IL-8),interleukin-13(IL-13)]were observed before and after treatment in the two groups,the perianal edema,clinical efficacy and wound healing time in the 2 groups were evaluated.Results After treatment,the VAS scores and the levels of blood WBC,hs-CRP and IL-8 in the two groups were significantly reduced(all P<0.05),and the observation group was significantly lower than the control group(all P<0.05);after treatment,the levels of Hb and IL-13 in the two groups were significantly increased(both P<0.05),and the observation group was significantly higher than the control group(both P<0.05).After 4 weeks of tre

关 键 词：肛周坏死性筋膜炎 清热解毒法 益气养阴法 中西医结合疗法 分阶段治疗 

分 类 号：R574.8[医药卫生—消化系统]