Effect of rejuvenation package and acupuncture therapy on anal function, wound recovery, pain media and anti-inflammatory effect in patients with urinary retention after mixed hemorrhoids operation
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摘要: 目的 探讨热奄包联合针刺疗法对混合痔术后尿潴留患者肛门功能、创面恢复程度和疼痛介质及抗炎作用的影响。方法 选择2020年1月—2021年6月治疗的92例混合痔且行混合痔外剥内扎术的患者进行前瞻性研究，将纳入研究的所有患者分为2组，分别为对照组和研究组，分组方法采用随机数字表法，2组患者行不同的术后治疗方案。对照组患者于术后次日行针刺疗法，研究组患者在对照组基础上额外行热奄包外敷治疗。2组患者均连续治疗7 d。对比2组患者临床疗效、术后7 d时临床疗效指标评分，包含术后首次排尿时间、术后首次排尿情况、术后腹部症状、术后膀胱叩诊情况；对比2组患者术后7 d创面愈合率；对比2组患者术后1 d和术后7 d肛门功能，包含Wexner肛门失禁评分、肛门狭窄评分、CSS排便评分；对比2组患者术后1 d和术后7 d疼痛介质和炎性因子含量，包括前列腺素E2(PGE2)、5-羟色胺(5-HT)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)。结果 研究组西医治疗总有效率95.65%，明显高于对照组的82.61%(P< 0.05)，研究组中医治疗总有效率93.48%，明显高于对照组的78.26%(P< 0.05)；研究组术后首次排尿时间、首次排尿情况、腹部症状、膀胱叩诊情况评分均明显优于对照组(P< 0.05)；术后7 d研究组患者Wexner肛门失禁评分、肛门狭窄评分、CSS排便评分均明显低于对照组(P< 0.05)；研究组创面愈合率明显高于对照组(P< 0.05)；术后7 d研究组患者血清PGE2、5-HT、IL-6、IL-8、TNF-α含量均明显低于对照组(P< 0.05)，差异有统计学意义。结论 热奄包联合针刺疗法对混合痔术后尿潴留患者排尿功能改善疗效较好，能有效促进创面恢复，改善患者肛门功能，减轻疼痛水平并降低炎性因子含量。Abstract: Objective To explore the effects of hot pack combined with acupuncture on anal function, wound recovery, pain mediators and anti-inflammatory effects in patients with postoperative urinary retention of mixed hemorrhoids.Methods The 92 patients with mixed hemorrhoids who underwent external dissection and internal ligation of mixed hemorrhoids who were treated in our hospital from January 2020 to June 2021 were selected for prospective study. All patients included in the study were divided into two groups, namely the study group and the control group.And the random number table method was used for grouping, and the patients in the two groups received different postoperative treatment plans. The patients in the control group received acupuncture on the next day after the operation, and the patients in the study group received external hot packs on the basis of the control group. Both groups were continuous treatment for 7 days. To compare the clinical efficacy of the two groups of patients. The clinical efficacy index scores at 7 days after operation were compared between the two groups of patients, including the first urination time after the operation, the situation of first urination after the operation, postoperative abdominal symptoms, and postoperative bladder percussion; wound healing rate of the two groups was compared at the 7th day after the operation; The anal function of the patients in the 1 day and 7 days after the operation, including Wexner anal incontinence score, anal stenosis score, and CSS defecation score; compared the content of pain mediators and inflammatory factors, including prostaglandin E2(PGE2), serotonin(5-HT), interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α).Results The total effective rate of western medicine treatment in the study group was 95.65%, which was significantly higher than that in the control group, which was 82.61%(P< 0.05). The total effective rate of Chinese medicine treatment in the study group was 93.48%, which was significantly higher than that in the control group, 78.26%(P< 0.05); The scores of first urination time, first urination, abdominal symptoms, and bladder percussion scores were significantly better than those of the control group(P< 0.05); the Wexner anal incontinence score, anal stenosis score, and CSS defecation score of the study group were all significantly lower than those of the control group(P< 0.05); the wound healing rate of study group was significantly higher(P< 0.05); serum PGE2, 5-HT, IL-6, IL-8, TNF-α The content was significantly lower(P< 0.05), and the difference was statistically significant.Conclusion Rejuvenation package combined with acupuncture has a good effect on improving urinary function in patients with postoperative urinary retention after mixed hemorrhoids, effectively promoting wound recovery, improving patient's anal function, reducing pain levels and reducing inflammatory factors.
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表 1 混合痔分期标准
症状 Ⅰ期 Ⅱ期 Ⅲ期 Ⅳ期 便血 染纸或滴血 滴血、射血、量多 少或不出血 少或大便带血 脱出 不脱出 脱出可自行还纳 易脱出，需手还纳 不能还纳 表面黏膜改变 充血，轻度糜烂 充血，糜烂，出血点 增生纤维化 增生纤维化 痔核大小 囊性隆起，较小 多大于1 cm2 痔核大，界限不清 常呈环状 
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表 2 2组患者西医疗效比较
例 组别 例数 治愈 好转 无效 总有效率/% 对照组 46 17 21 8 82.61 研究组 46 22 22 2 95.65 χ2 4.039 P 0.044
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表 3 2组患者中医疗效比较
例 组别 例数 治愈 好转 无效 总有效率/% 对照组 46 11 25 10 78.26 研究组 46 19 24 3 93.48 χ2 4.390 P 0.036
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表 4 2组患者疗效性指标评分比较
分，X±S 组别 例数 术后首次排尿时间 术后首次排尿情况 术后腹部症状 术后膀胱叩诊情况 对照组 46 2.52±0.56 2.87±0.51 2.58±0.49 2.35±0.53 研究组 46 1.59±0.34 1.62±0.44 1.32±0.36 1.40±0.38 t 9.628 12.586 14.054 9.880 P ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 5 2组患者肛门功能评分情况
分，X±S 组别 例数 Wexner肛门失禁评分 肛门狭窄评分 CSS排便评分 术后1 d 术后7 d 术后1 d 术后7 d 术后1 d 术后7 d 对照组 46 8.45±1.96 6.72±1.44 3.15±0.76 1.72±0.50 19.13±3.55 11.90±2.63 研究组 46 8.53±1.89 4.39±1.35 3.22±0.79 1.31±0.46 18.85±3.74 8.17±2.37 t 0.199 8.006 0.433 4.093 0.368 7.146 P 0.842 ＜0.001 0.666 ＜0.001 0.714 ＜0.001
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表 6 2组患者疼痛评分、疼痛因子和炎性因子水平比较
X±S 组别 例数 VAS评分/分 PGE2/(ng·mL-1) 5-HT/(ng·mL-1) 术后1 d 术后7 d 术后1 d 术后7 d 术后1 d 术后7 d 对照组 46 7.45±1.29 4.40±1.15 408.41±42.36 329.24±38.96 683.56±97.55 616.52±87.28 研究组 46 7.56±1.42 3.64±1.08 399.64±45.38 288.08±34.27 690.18±103.65 533.47±69.16 t 0.389 3.267 0.958 5.380 0.315 5.058 P 0.698 0.002 0.341 0.000 0.753 0.000 组别 例数 IL-6/(mg·L-1) IL-8/(mg·L-1) TNF-α/(pg·mL-1) 术后1 d 术后7 d 术后1 d 术后7 d 术后1 d 术后7 d 对照组 46 220.84±58.28 163.34±35.29 297.15±27.33 239.45±25.87 179.66±36.03 142.23±30.23 研究组 46 216.39±54.42 140.37±31.40 292.35±29.91 197.68±23.49 174.34±35.82 105.25±28.86 t 0.379 3.298 0.804 8.107 0.710 11.473 P 0.706 0.001 0.424 0.000 0.479 0.000
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