愈創(chuàng)靈軟膏在混合痔術(shù)后創(chuàng)面應(yīng)用的療效觀察
發(fā)布時間：2018-11-10 12:18
【摘要】：目的:混合痔是肛腸疾病中的難治性較高的一種,內(nèi)痔III度以上的混合痔最佳的治療方式是手術(shù)治療。根據(jù)Thomson的“肛墊”學說和丁澤民的分段齒形結(jié)扎術(shù)思想而創(chuàng)立的TST術(shù),是目前混合痔手術(shù)中損傷最少的術(shù)式。TST術(shù)后剩余的外痔采用小“V”切口切除,能夠進一步縮小了術(shù)后的創(chuàng)面。但由于肛門的生理特殊性,使肛門周圍容易滋生細菌,并且肛周末梢神經(jīng)豐富,炎癥刺激引起的術(shù)后創(chuàng)面水腫、疼痛等癥狀對患者造成的影響較大,嚴重影響了患者對治療的滿意度。本課題通過觀察愈創(chuàng)靈軟膏在混合痔術(shù)后對創(chuàng)面的抑菌消炎、消腫止痛及促進創(chuàng)面愈合的治療效果,為混合痔術(shù)后提供一種能夠有效減輕患者癥狀的外用藥膏。方法:將84例來自廣西中醫(yī)藥大學附屬瑞康醫(yī)院并符合納入標準的患者,按隨機數(shù)字表法隨機分為治療組42例和對照組42例。治療組:患者術(shù)后每日坐浴完予生理鹽水常規(guī)清潔肛門后,應(yīng)用愈創(chuàng)靈軟膏涂抹于創(chuàng)面,每次3g,范圍以肛緣為中心直徑約3cm,加無菌紗布覆蓋并予膠布固定,每日2次;對照組:患者術(shù)后每日坐浴完予生理鹽水常規(guī)清潔肛門后,應(yīng)用美寶濕潤燒傷膏涂抹于創(chuàng)面,每次3g,范圍以肛緣為中心直徑約3cm,加無菌紗布覆蓋并予膠布固定,每日2次。兩組的臨床用藥及其他處理措施皆相同。觀察并記錄患者術(shù)后第1、3、5、7天換藥后的疼痛情況,采用長海痛尺進行評分;記錄術(shù)后第1、3、5、7天第一次換藥前的創(chuàng)面菌落計數(shù)情況,根據(jù)培養(yǎng)皿中細菌生長所占面積無、達到1/4、達到1/2、達到3/4、達到全部按0分、1分、2分、3分、4分進行統(tǒng)計,同時觀察術(shù)后第1、3、5、7天創(chuàng)面的肉芽生長、創(chuàng)面水腫、創(chuàng)面滲液情況,并根據(jù)其癥狀無、輕、中、重的程度按0分、1分、2分、3分進行統(tǒng)計,再根據(jù)患者隨診和回訪情況記錄創(chuàng)面完全愈合時間,對比分析兩組患者的臨床療效差異。結(jié)果:根據(jù)統(tǒng)計結(jié)果表明,兩組患者的總體療效具有顯著性差異(P0.05)。治療組在術(shù)后第1、3、5、7天治療組的創(chuàng)面疼痛、創(chuàng)面細菌計數(shù)、創(chuàng)面肉芽生長、創(chuàng)面切緣水腫、創(chuàng)面滲液積分均優(yōu)于對照組,存在統(tǒng)計學差異(P0.05)。治療組在創(chuàng)面完全愈合時間上也明顯短于對照組,差異具有統(tǒng)計學意義(P0.05)。兩組患者均未發(fā)生藥物不良反應(yīng)。結(jié)論:通過臨床觀察發(fā)現(xiàn),愈創(chuàng)靈軟膏在混合痔術(shù)后創(chuàng)面上應(yīng)用,能夠有效地抑菌、消腫止痛及促進創(chuàng)面肉芽生長,縮短愈合時間,療效明顯優(yōu)于美寶濕潤燒傷膏,且安全無毒副作用,可在混合痔術(shù)后應(yīng)用。
[Abstract]:Objective: mixed hemorrhoids is a refractory type of anorectal diseases. Surgical treatment is the best treatment for mixed hemorrhoids with III degree. According to Thomson's theory of "anal pad" and Ding Zemin's idea of segmental tooth ligation, TST procedure is the least injuried procedure in mixed hemorrhoidectomy at present. The remaining external hemorrhoids after TST are resected by small "V" incision. Can further reduce the postoperative wound. However, because of the physiological particularity of the anus, bacteria can easily breed around the anus, and the perianal peripheral nerves are abundant, and the symptoms of postoperative wound edema and pain caused by inflammatory stimulation have a great influence on the patients. It severely affects the patient's satisfaction with the treatment. By observing the effect of Yuchuangling ointment on inhibiting bacteria and inflammation, reducing swelling and relieving pain and promoting wound healing after mixed hemorrhoids operation, this paper provides an effective external ointment for relieving symptoms of patients after mixed hemorrhoids operation. Methods: 84 patients from Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine were randomly divided into treatment group (n = 42) and control group (n = 42). In the treatment group, after daily sitting bath and routine cleaning of anus with normal saline, the patients were smeared with Yuchuangling ointment on the wound surface for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. Control group: after routine cleaning of anus with normal saline, the patients were smeared with MEBO burn ointment for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. The clinical medication and other treatment measures were the same in both groups. The pain was observed and recorded on the 1st day, 3rd day, 5th day after the operation, and the pain was scored by the Changhai pain ruler. The count of wound colonies before the first dressing change 7 days after operation was recorded. According to the area occupied by bacteria growth in the petri dish, it reached 1 / 4, reached 1 / 2, reached 3 / 4, and reached 0, 1, 2, 3 points. At the same time, the granulation growth, edema and exudation of the wound were observed on the 1st, 3rd, 5th and 7th day after operation, and the statistics were made according to the degree of no, light, moderate and severe symptoms, according to 0, 1, 2, 3 points. The time of complete wound healing was recorded according to the follow-up and return visit of the patients, and the difference of clinical efficacy between the two groups was analyzed. Results: according to the statistical results, there was a significant difference between the two groups (P0.05). The treatment group was superior to the control group in wound pain, bacterial count, granulation growth, edematous wound margin and wound exudate score on the 1st day and 5th day after operation (P0.05). Treatment group in the wound healing time was significantly shorter than the control group, the difference was statistically significant (P0.05). There were no adverse drug reactions in both groups. Conclusion: the clinical observation shows that the application of Yuchuangling ointment on the wounds of mixed hemorrhoids can effectively inhibit bacteria, reduce swelling and pain, promote the growth of granulation, shorten the healing time, and the curative effect is obviously better than MEBO. And safe and no side effects, can be used in mixed hemorrhoids after surgery.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R266
本文編號：2322455
[Abstract]:Objective: mixed hemorrhoids is a refractory type of anorectal diseases. Surgical treatment is the best treatment for mixed hemorrhoids with III degree. According to Thomson's theory of "anal pad" and Ding Zemin's idea of segmental tooth ligation, TST procedure is the least injuried procedure in mixed hemorrhoidectomy at present. The remaining external hemorrhoids after TST are resected by small "V" incision. Can further reduce the postoperative wound. However, because of the physiological particularity of the anus, bacteria can easily breed around the anus, and the perianal peripheral nerves are abundant, and the symptoms of postoperative wound edema and pain caused by inflammatory stimulation have a great influence on the patients. It severely affects the patient's satisfaction with the treatment. By observing the effect of Yuchuangling ointment on inhibiting bacteria and inflammation, reducing swelling and relieving pain and promoting wound healing after mixed hemorrhoids operation, this paper provides an effective external ointment for relieving symptoms of patients after mixed hemorrhoids operation. Methods: 84 patients from Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine were randomly divided into treatment group (n = 42) and control group (n = 42). In the treatment group, after daily sitting bath and routine cleaning of anus with normal saline, the patients were smeared with Yuchuangling ointment on the wound surface for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. Control group: after routine cleaning of anus with normal saline, the patients were smeared with MEBO burn ointment for 3 g each time, with the center diameter of anal margin being about 3 cm, covered with sterile gauze and fixed with plaster twice a day. The clinical medication and other treatment measures were the same in both groups. The pain was observed and recorded on the 1st day, 3rd day, 5th day after the operation, and the pain was scored by the Changhai pain ruler. The count of wound colonies before the first dressing change 7 days after operation was recorded. According to the area occupied by bacteria growth in the petri dish, it reached 1 / 4, reached 1 / 2, reached 3 / 4, and reached 0, 1, 2, 3 points. At the same time, the granulation growth, edema and exudation of the wound were observed on the 1st, 3rd, 5th and 7th day after operation, and the statistics were made according to the degree of no, light, moderate and severe symptoms, according to 0, 1, 2, 3 points. The time of complete wound healing was recorded according to the follow-up and return visit of the patients, and the difference of clinical efficacy between the two groups was analyzed. Results: according to the statistical results, there was a significant difference between the two groups (P0.05). The treatment group was superior to the control group in wound pain, bacterial count, granulation growth, edematous wound margin and wound exudate score on the 1st day and 5th day after operation (P0.05). Treatment group in the wound healing time was significantly shorter than the control group, the difference was statistically significant (P0.05). There were no adverse drug reactions in both groups. Conclusion: the clinical observation shows that the application of Yuchuangling ointment on the wounds of mixed hemorrhoids can effectively inhibit bacteria, reduce swelling and pain, promote the growth of granulation, shorten the healing time, and the curative effect is obviously better than MEBO. And safe and no side effects, can be used in mixed hemorrhoids after surgery.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R266
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