锡类散外用对低位单纯性肛瘘术后创面疼痛及瘢痕的影响  

Effects of Applying Xilei Powder Externally on Postoperative Wound Pain and Scarring in Patients with Low-level Simple Anal Fistula

作　　者：时宗保 石健[2] SHI Zongbao;SHI Jian(The First Clinical School,Anhui University of Traditional Chinese Medicine,Hefei 230038,China;Department of Colorectal SurgeryⅡ,the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一临床医学院,合肥230038 [2]安徽中医药大学第一附属医院肛肠二科,合肥230031

出　　处：《中西医结合研究》2024年第5期299-303,312,共6页Research of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨锡类散外用对低位单纯性肛瘘术后创面疼痛及瘢痕的影响。方法共纳入低位单纯性肛瘘患者60例,根据随机对照原则将其分为观察组和对照组,每组30例。2组患者均于腰麻下行低位肛瘘切除术和术后给予常规对症支持治疗。术后第1天开始换药,换药前予以痔瘘洗剂(院内制剂)坐浴熏洗,对照组使用凡士林纱条常规换药,观察组则使用锡类散纱条,直至创面愈合。比较2组患者术后8 h及术后1、2、3、7、14 d的创面静息疼痛评分,术后72 h内止痛药物使用率,术后1 d及术后14 d血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-6(interlukin-6,IL-6)水平,术后3、7、14 d创面渗液程度评分,创面愈合时间,术后14 w、18 w患者和观察者瘢痕评估量表(patient and observer scar assessment scale,POSAS)评分以及术后肉芽组织不良生长的发生率。结果治疗后,2组术后1、2、3、7、14 d的创面静息疼痛评分逐渐降低(P均<0.05),且观察组术后2、3、7、14 d的创面疼痛评分均低于对照组(P均<0.05)。术后72 h内,观察组止痛药物使用率为50.00%,明显低于对照组的80.00%(P<0.05)。术后14 d,2组血清TNF-α、IL-6的含量均低于术后1 d(P均<0.05),且观察组上述指标低于对照组(P均<0.05)。观察组术后7 d和14 d的创面渗液评分均低于对照组(P均<0.05)。观察组的创面愈合时间显著短于对照组(P<0.05)。术后18 w,2组POSAS评分均较术后14 w降低(P均<0.05),且观察组低于对照组(P<0.05)。不良反应方面,观察组术后肉芽组织不良生长的发生率低于对照组(P<0.05);在治疗过程中2组均未发生大出血、肛门失禁、肛周坏死等不良事件。结论锡类散外用可以减轻低位单纯性肛瘘患者术后的创面疼痛和瘢痕形成,减少术后创面渗液和肉芽组织的不良增生,缩短术后创面愈合时间。Objective To explore the effects of applying Xilei powder externally on postoperative wound pain and scarring in patients with low-level simple anal fistula.Methods Sixty patients with low-level simple anal fistula were included and randomly divided into the observation group and the control group according to the principle of randomized control,with 30 cases in each group.Both groups of patients underwent low anal fistula resection surgery under lumbar anesthesia and received routine symptomatic supportive treatmeat after surgery.On the first day after surgery,dressing changes were started.Before dressing changes,hemorrhoid and fistula cleaning agents(the hospital preparation)were used for sitz bath fumigation.The control group received routine dressing changes with vaseline gauze strips,while the observation group received Xilei powder gauze strips until the wound healed.The wound resting pain scores at 8 hours and 1,2,3,7 and 14 days postoperatively,analgesic drug usage rate within 72 hours,serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)at 1 and 14 days after surgery,wound exudation scores at 3,7 and 14 days after surgery,wound healing time,patient and observer scar assessment scale(POSAS)scores at 14 and 18 weeks after surgery,and the incidence rate of poor granulation tissue growth after surgery between the two groups were compared.Results After treatment,the wound resting pain scores in the two groups gradually decreased on postoperative days 1,2,3,7 and 14(all P<0.05),and the wound pain scores in the observation group were lower than those in the control group on postoperative days 2,3,7 and 14(all P<0.05).Within 72 hours after surgery,the usage rate of analgesic drug in the observation group was 50.00%,which was significantly lower than the 80.00%in the control group(P<0.05).On postoperative day 14,the serum levels of TNF-αand IL-6 in both groups were lower than those on postoperative day 1(all P<0.05),and the above indicators in the observation group were lower than those in the

关 键 词：锡类散 低位单纯性肛瘘 术后疼痛 术后瘢痕 创面愈合 

分 类 号：R266[医药卫生—中医外科学]