仙方消毒汤联合温和灸对肛瘘术后创面恢复的影响

目的:观察仙方消毒汤联合温和灸对肛瘘术后创面恢复的有效性以及对血清表皮生长因子(EGF)和直肠分泌物分泌型免疫球蛋白A(SIg A)水平的影响。方法:将134例肛瘘术后患者随机按数字表法分为对照组和治疗组各67例。两组均采用基础治疗,包括术后左氧氟沙星氯化钠注射液,静脉滴注,0.4 g/次,1次/d,共用3 d;口服痔宁片,4片/次,3次/d。对照组术后第2天采用高锰酸钾液熏洗,20 min/次,1次/d,常规换药;治疗组采用仙方消毒汤内服,1剂/d,常规水煎煮2次,同时局部创面及长强穴温和灸疗法,20 min/次,1次/d,常规换药。两组疗程均为2周。记录两组患者术后创面疼痛、创面渗出和创面肿胀评分,记录创面愈合天数、创面面积、创面纵径,检测两组患者血清EGF和SIg A水平。结果:治疗组临床总有效率为97.01%,对照组为83.58%,治疗组优于对照组(P0.05);治疗组治疗后第7天和第14天患者的创面疼痛、创面渗出和创面肿胀评分分别低于对照组术后第7天和第14天(P0.01);治疗组治疗后患者的创面面积和创面纵径均明显小于对照组,愈合时间也少于对照组,比较差异均有统计学意义(P0.01);治疗组术后14 d患者血清EGF和SIg A水平均显著高于对照组术后14 d,比较差异均有统计学意义(P0.01)。结论:仙方消毒汤联合温和灸治疗肛瘘术后创面恢复可减轻创面疼痛,减少创面渗出和水肿,促进创面愈合,其作用可能与升高血清EGF和SIg A水平有关。

Effect of Xianfang Xiaodu Decoction Combined with Warming Moxibustion on Wounds Healing After Anal Fistula

Objective: To observe the clinical efficacy of Xianfang Xiaodu decoction combined with warming moxibustion on wounds healing after anal fistula and its influence on epidermal growth factors (EGF) and rectal secretory immunoglobulin A (SIgA). Method: One hundred and thirty-four patients with anal fistula were randomly divided into control group and treatment group according to the method of random digits table, 67 patients for each group. All patients received basic treatment, including postoperative intravenous drip of levofloxacin for three days (0.4 g/time, qd) and orally taking Zhining pill (4 piece/time, tid). Control group received sitz bath of potassium permanganate liquid on the second day after operation (20 mins/time and 1 time/d), and then with conventional dressing. Patients in treatment group orally took Xianfang Xiaodu decoction (1 dose/d and 2 times for conventional boiling water), combined with warming moxibustion on wound and Changqiang point (20 mins/time, qd), and then with conventional dressing. All cases received treatment for 2 weeks. Scores of postoperative pain, wound exudation, and wound swelling were recorded for two groups. Wound healing time, wound area, and wound longitudinal diameter were recorded. Serum EGF and SIgA were detected for both groups. Result: The total efficacy for treatment group (97.01%) was higher than that of control group (83.58%), with statistical difference after 2 weeks (P<0.05). Scores for wound pain, exudation, and swelling at 7 d and 14 d after operation in treatment group were lower than those of control group (P<0.01). After treatment, wound area, wound longitudinal diameter, and wound healing time were less than those in control group (P<0.01). At 14 d after treatment, serum EGF and SIgA levels of treatment group were significantly higher than those of control group (P<0.01). Conclusion: Xianfang Xiaodu decoction combined with warming moxibustion may significantly decrease wound pain, wound exudation and swelling, promote wound healing after anal fistula, and its mechanism may associated with increasing serum EGF and SIgA levels.