如意金黃膏外用治療闌尾周圍膿腫的臨床觀察與研究
發(fā)布時間：2019-03-19 13:58
【摘要】：闌尾周圍膿腫是一種臨床常見的急腹癥,繼發(fā)于急性闌尾炎,屬于急性闌尾炎較為嚴重的臨床病理類型之一,屬中醫(yī)學“腸癰”范疇。典型的闌尾周圍膿腫癥狀上多表現(xiàn)為轉移性右下腹痛,疼痛持續(xù)難緩解,發(fā)熱,可伴有惡心、腹脹、腹瀉等消化道癥狀,多強迫屈身體位,情緒焦慮。查體：右下腹局限性肌緊張,麥氏點壓痛、反跳痛陽性,右下腹深壓或可觸及包塊、壓痛強陽性,移動性濁音陰性,結腸充氣試驗、閉孔肌試驗均陽性。實驗室檢查外周血白細胞計數(shù)(WBC)和中性粒細胞百分比(NE%)均顯著升高；B超下闌尾區(qū)可見大小不等、形態(tài)欠規(guī)則且邊界欠清晰的混合回聲區(qū)。傳統(tǒng)觀念認為,闌尾周圍膿腫Ⅰ期手術分離病灶難度大、易損傷,應首選非手術治療,在非手術治療痊愈后3-6個月再擇期行闌尾切除術。故臨床上,闌尾周圍膿腫的治療周期較長,癥狀恢復較慢。如今,雖有眾多國內外學者在不斷創(chuàng)新、探索著闌尾周圍膿腫的Ⅰ期手術治療,但因技術和技巧等原因,并未廣泛推廣于臨床。而隨著祖國醫(yī)學與現(xiàn)代醫(yī)學的融會貫通,中西醫(yī)結合治療已逐漸成為目前臨床上治療闌尾周圍膿腫的一大趨勢。目的：觀察如意金黃膏外敷結合西醫(yī)抗炎治療闌尾周圍膿腫與單純西醫(yī)抗炎治療闌尾周圍膿腫的臨床療效差異,探討其可能的作用機制,以豐富中西醫(yī)結合治療在普外科應用的推廣方法：2011年9月-2014年12月間,于北京中醫(yī)藥大學第一臨床醫(yī)學院普通外科病房收治闌尾周圍膿腫患者74例。完全隨機分為觀察組和對照組各37例,對照組采用西醫(yī)常規(guī)抗炎、對癥治療加生理鹽水濕敷,治療組采用西醫(yī)常規(guī)抗炎、對癥治療加如意金黃膏外敷。7天1療程,觀察期為2療程。觀察受試者體溫恢復正常時間、腹痛消失時間、及1療程和2療程治療結束后(或出院時)血常規(guī)、包塊大小等情況,比較組內和組間差異。結果：1.治療組在體溫恢復時間、腹痛消失時間及包塊消散時間上均較對照組短,經(jīng)統(tǒng)計學處理,均有顯著性差異(P0.05)。2.治療組與對照組在恢復受試者外周血白細胞和中性粒細胞百分比方面療效相當,經(jīng)統(tǒng)計學處理,無顯著性差異(P0.05)。結論：在西醫(yī)抗炎治療基礎上,局部外敷如意金黃膏治療闌尾周圍膿腫,可有效緩解患者腹痛和發(fā)熱癥狀,縮短包塊消散和膿腫吸收的時間,療效肯定,無明顯毒副作用,值得臨床推廣應用。同時,在此基礎上應進一步研究促進外敷中藥透皮吸收的方法和機制,以期在中西醫(yī)結合治療外科疾病中取得更好療效。
[Abstract]:Periappendiceal abscess is a common acute abdominal disease, secondary to acute appendicitis, belongs to one of the more serious clinical pathological types of acute appendicitis, belongs to the traditional Chinese medicine "intestinal carbuncle" category. The typical symptoms of periappendiceal abscess were metastatic right lower abdominal pain, persistent pain, fever, nausea, abdominal distension, diarrhea and other digestive tract symptoms, multiple forced body flexion and emotional anxiety. Physical examination: local muscle tension of right lower abdomen, slight tenderness, rebound pain positive, deep pressure of right lower abdomen or palpable mass, positive tenderness, negative mobility voiced, inflatable colon test and obturator muscle test were all positive in the right lower abdominal pressure or palpable mass, tenderness positive, mobility voiced negative, colon inflatable test, obturator muscle test positive. The peripheral blood leukocyte count (WBC) and neutrophil percentage (NE%) increased significantly in laboratory examination, and the mixed echo area with irregular shape and unclear boundary was found in the appendiceal area under B-ultrasound. The traditional idea is that it is difficult and easy to dissect the foci of periappendiceal abscess in the first stage. Non-operative treatment should be the first choice, and appendectomy should be performed at 3 months and 6 months after non-operative treatment. Therefore, the treatment period of periappendiceal abscess is longer and the recovery of symptoms is slower. Nowadays, although many scholars at home and abroad have been making innovations to explore the first stage surgical treatment of periappendiceal abscess, they have not been widely used in clinical practice for reasons such as technology and skills. With the integration of Chinese medicine and modern medicine, integrated treatment of traditional Chinese medicine and western medicine has gradually become a major trend in clinical treatment of periappendiceal abscess. Objective: to observe the difference of curative effect between Ruyi Jinhuang ointment and western medicine in treating periappendiceal abscess and simple western medicine in treating periappendiceal abscess, and to explore the possible mechanism of action of Ruyi Jinhuang ointment in treating periappendiceal abscess. From September 2011 to December 2014, 74 patients with periappendiceal abscess were treated in the general surgical ward of the first Clinical Medical College of Beijing University of traditional Chinese Medicine. The patients in the control group were divided into observation group and control group, 37 cases in each group. The control group was treated with western medicine routine anti-inflammatory therapy and normal saline wet compress, the treatment group was treated with western medicine routine anti-inflammatory therapy, and the treatment group was treated with Ruyi Jinhuang ointment. 7 days a course of treatment. The observation period was 2 courses. The recovery time of body temperature, the disappearance time of abdominal pain, the blood routine and the size of lumps after one and two courses of treatment were observed, and the differences between the two groups were compared. Results: 1. In the treatment group, the recovery time of body temperature, the disappearance time of abdominal pain and the dissipation time of lumps were shorter than those of the control group, and there was significant difference between the treatment group and the control group (P0.05). Treatment group and control group in the recovery of peripheral blood leukocyte and neutrophil percentage of the same, after statistical treatment, there was no significant difference (P0.05). Conclusion: on the basis of anti-inflammatory treatment of western medicine, local application of Ruyi Jinhuang ointment to treat periappendiceal abscess can effectively relieve abdominal pain and fever, shorten the time of mass dissipation and abscess absorption, and has no obvious toxic and side effects. It is worth popularizing and applying in clinic. At the same time, on this basis, we should further study the methods and mechanisms of promoting external application of traditional Chinese medicine transdermal absorption, in order to achieve better curative effect in the treatment of surgical diseases by combination of traditional Chinese and western medicine.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656.8
本文編號：2443587
[Abstract]:Periappendiceal abscess is a common acute abdominal disease, secondary to acute appendicitis, belongs to one of the more serious clinical pathological types of acute appendicitis, belongs to the traditional Chinese medicine "intestinal carbuncle" category. The typical symptoms of periappendiceal abscess were metastatic right lower abdominal pain, persistent pain, fever, nausea, abdominal distension, diarrhea and other digestive tract symptoms, multiple forced body flexion and emotional anxiety. Physical examination: local muscle tension of right lower abdomen, slight tenderness, rebound pain positive, deep pressure of right lower abdomen or palpable mass, positive tenderness, negative mobility voiced, inflatable colon test and obturator muscle test were all positive in the right lower abdominal pressure or palpable mass, tenderness positive, mobility voiced negative, colon inflatable test, obturator muscle test positive. The peripheral blood leukocyte count (WBC) and neutrophil percentage (NE%) increased significantly in laboratory examination, and the mixed echo area with irregular shape and unclear boundary was found in the appendiceal area under B-ultrasound. The traditional idea is that it is difficult and easy to dissect the foci of periappendiceal abscess in the first stage. Non-operative treatment should be the first choice, and appendectomy should be performed at 3 months and 6 months after non-operative treatment. Therefore, the treatment period of periappendiceal abscess is longer and the recovery of symptoms is slower. Nowadays, although many scholars at home and abroad have been making innovations to explore the first stage surgical treatment of periappendiceal abscess, they have not been widely used in clinical practice for reasons such as technology and skills. With the integration of Chinese medicine and modern medicine, integrated treatment of traditional Chinese medicine and western medicine has gradually become a major trend in clinical treatment of periappendiceal abscess. Objective: to observe the difference of curative effect between Ruyi Jinhuang ointment and western medicine in treating periappendiceal abscess and simple western medicine in treating periappendiceal abscess, and to explore the possible mechanism of action of Ruyi Jinhuang ointment in treating periappendiceal abscess. From September 2011 to December 2014, 74 patients with periappendiceal abscess were treated in the general surgical ward of the first Clinical Medical College of Beijing University of traditional Chinese Medicine. The patients in the control group were divided into observation group and control group, 37 cases in each group. The control group was treated with western medicine routine anti-inflammatory therapy and normal saline wet compress, the treatment group was treated with western medicine routine anti-inflammatory therapy, and the treatment group was treated with Ruyi Jinhuang ointment. 7 days a course of treatment. The observation period was 2 courses. The recovery time of body temperature, the disappearance time of abdominal pain, the blood routine and the size of lumps after one and two courses of treatment were observed, and the differences between the two groups were compared. Results: 1. In the treatment group, the recovery time of body temperature, the disappearance time of abdominal pain and the dissipation time of lumps were shorter than those of the control group, and there was significant difference between the treatment group and the control group (P0.05). Treatment group and control group in the recovery of peripheral blood leukocyte and neutrophil percentage of the same, after statistical treatment, there was no significant difference (P0.05). Conclusion: on the basis of anti-inflammatory treatment of western medicine, local application of Ruyi Jinhuang ointment to treat periappendiceal abscess can effectively relieve abdominal pain and fever, shorten the time of mass dissipation and abscess absorption, and has no obvious toxic and side effects. It is worth popularizing and applying in clinic. At the same time, on this basis, we should further study the methods and mechanisms of promoting external application of traditional Chinese medicine transdermal absorption, in order to achieve better curative effect in the treatment of surgical diseases by combination of traditional Chinese and western medicine.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656.8
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