八正散加减对痔瘘术后湿热下注型尿潴留患者排尿时间及自行排尿能力恢复的影响

目的:观察八正散加减对痔瘘术后湿热下注型尿潴留患者排尿时间及自行排尿能力恢复的影响,并探讨其作用机制。方法:选取106例痔瘘术后尿潴留患者,随机分成对照组和研究组,每组53例。两组均予听流水声诱导、心理疏导和膀胱区按摩等基础治疗,对照组予溴新斯的明口服,研究组予八正散加减。检测尿动力学,评价膀胱功能和中医主要症状评分,记录排尿情况,比较治疗效果。结果:与治疗前比较,治疗后两组尿动力学参数最大尿流量(Q-max),最大尿率时逼尿肌压(Pdet-Q-max)升高(P0.01),最大尿意膀胱容量(VMCC),残余尿量(PVR)降低(P0.01),逼尿肌受损、膀胱低顺应性和膀胱感觉缺失发生率降低(P0.05),排尿无力、小腹坠胀和倦怠乏力症状评分降低(P0.01);与对照组治疗后比较,研究组Q-max,Pdet-Q-max升高(P0.01),VMCC,PVR降低(P0.01),逼尿肌受损、膀胱低顺应性和膀胱感觉缺失发生率降低(P0.05),自行排尿、完全通畅排尿、排便、进食时间缩短(P0.01),排尿无力、小腹坠胀和倦怠乏力症状评分降低(P0.01),总有效率升高(P0.05)。结论:八正散加减可促进膀胱尿液排出,减少残余尿量,缩短自行排尿时间,提高自主排尿能力的恢复,有效治疗痔瘘术后湿热下注型尿潴留。

Effect of Modified Bazhengsan on Time of Urination and Ability Restoration of Self Urination in Patients with Damp-heat Pouring Downward Syndrome Type Urinary Retention After Anal Fistula Surgery

Objective: To investigate the effect of modified Bazhengsan on time of urination and ability restoration of self urination in patients with damp-heat pouring downward syndrome urinary retention after anal fistula surgery, and explore its action mechanism. Method: The 106 patients with urinary retention after anal fistula surgery were randomly divided into 2 groups, 53 cases in control group and 53 cases in treatment group.Patients in two groups were given with basic treatment such as listening to the sound of water induction, psychological counseling and bladder area massage therapy.Then patients in control group received neostigmine bromide by oral administration, and patients in treatment group received modified Bazhengsan.Urinary dynamics were detected; bladder function and the main traditional Chinese medicine (TCM) symptom scores were evaluated; urination situation was recorded and compared after the treatment. Result: Urodynamic parameters such as maximum urination quantity (Q-max) and detrusor pressure at maximum urine rate Pdet-Q-max were increased in both groups after treatment (P<0.01); maximum cysto-metric capacity (VMCC) and postvoiding residual volume (PRV) were decreased (P<0.01); bladder detrusor dysfunction, low bladder compliance and incidence of bladder sensory were decreased (P<0.05); acraturesis, abdominal bulge and languid symptom scores were decreased in both groups after treatment (P<0.01).As compared with control group after treatment, levels of Q-max and Pdet-Q-max were higher (P<0.01); VMCC, PVR levels were lower (P<0.01); the incidences of bladder detrusor dysfunction, bladder compliance and bladder sensory loss were lower (P<0.05); self urination, completely unobstructed urination, defecation and eating time was shorter (P<0.01); acraturesis, abdominal bulge and fatigue symptom scores were lower (P<0.01); and the total efficiency was higher in treatment group (P<0.05). Conclusion: Modified Bazhengsan can promote the bladder urination, reduce the residual urine volume, shorten the self urination time, and improve the ability restoration of automatic micturition, so it can be used to effectively treat damp-heat pouring downward syndrome postoperative urinary retention.