Observation on the curative effect of Bingxiaosan in the treatment of postoperative edema of hemorrhoids and its effect on serum PDGF, bFGF, VEGF and anorectal dynamics
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摘要: 目的 探讨冰硝散外敷治疗痔术后水肿患者疗效及对血清血小板源性生长因子(PDGF)、碱性成纤维细胞生长因子(bFGF)、血管内皮生长因子(VEGF)和肛肠动力学的影响。方法 选择2019年12月—2021年3月混合痔术后水肿患者80例，依据随机数字表法分为观察组40例与对照组40例。对照组口服地奥司明片，观察组在对照组基础上给予冰硝散外敷治疗。比较2组治疗疗效，肛门下坠和便血缓解时间，术后第1天和术后第7天的水肿评分、视觉模拟评分法(VAS)评分、PDGF、bFGF、VEGF水平及肛肠动力学变化。结果 观察组治疗总有效率(95.00%)高于对照组(80.00%)(P< 0.05)。2组术后第7天水肿、VAS评分低于手术后第1天(P< 0.05)；观察组术后第7天水肿、VAS评分值低于对照组(P< 0.05)。观察组肛门下坠和便血缓解时间短于对照组(P< 0.05)。2组术后第7天血清PDGF、bFGF、VEGF水平高于第1天(P< 0.05)；观察组术后第7天血清PDGF、bFGF、VEGF水平高于对照组(P< 0.05)。2组术后第7天RRP、ARP和AMCP高于术后第1天(P< 0.05)；观察组术后第7天直肠静息压(RRP)、肛管静息压(ARP)和肛管最大收缩压(AMCP)高于对照组(P< 0.05)。结论 冰硝散外敷治疗混合痔术后水肿患者疗效良好，其机制可能与上调血清PDGF、bFGF、VEGF表达有关，且可改善患者肛肠动力学。Abstract: Objective To investigate the curative effect of external application of Bingxiaosan in the treatment of postoperative hemorrhoid edema and its effect on serum platelet-derived growth factor(PDGF), basic fibroblast growth factor(bFGF), vascular endothelial growth factor(VEGF) and anorectal dynamics.Methods Eighty patients with mixed hemorrhoid postoperative edema from December 2019 to March 2021 in our hospital were selected. According to the random number table method, they were randomly divided into an observation group of 40 cases and a control group of 40 cases. The control group received oral diosmin tablets, and the observation group received external application of Bingxiaosan on the basis of the control group. The therapeutic effects of the two groups were compared, the time of anus drop and blood in the stool remission; the edema score, visual analog scale(VAS) score, PDGF, bFGF, VEGF levels and changes in anorectal dynamics on the 1st and 7th day after the operation.Results The total effective rate of the observation group(95.00%) was higher than that of the control group(80.00%)(P< 0.05). The edema score and VAS score on the 7th day after operation were lower than those on the 1st day after operation(P< 0.05); The edema score and VAS score on the 7th day after operation in the observation group were lower than those in the control group(P< 0.05). The relief time of anal falling and bloody stool in the observation group was shorter than that in the control group(P< 0.05). The levels of serum PDGF, bFGF and VEGF on the 7th day after operation were higher than those on the 1st day(P< 0.05); The levels of serum PDGF, bFGF and VEGF in the observation group were higher than those in the control group on the 7th day after operation(P< 0.05). RRP, ARP and AMCP on the 7th day after operation were higher than those on the 1st day after operation(P< 0.05); On the 7th day after operation, the rectal resting pressure(RRP), anal resting pressure(ARP) and anal maximal systolic pressure(AMCP) in the observation group were higher than those in the control group(P< 0.05).Conclusion External application of Bingxiaosan has a good effect in the treatment of postoperative edema of mixed hemorrhoids. Its mechanism may be related to the up-regulation of serum PDGF, bFGF and VEGF expression, and it can improve the anorectal dynamics of patients.
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表 1 观察组和对照组疗效比较
例 组名 数量 治愈 显效 有效 无效 总有效率/% 观察组 40 8 18 12 2 95.00 对照组 40 3 15 14 8 80.00 χ2 4.114 P < 0.05 
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表 2 2组术后第1天和术后第7天水肿评分及VAS评分比较
分，X±S 组别 例数 水肿评分 VAS评分 术后第1天 术后第7天 术后第1天 术后第7天 观察组 40 2.46±0.32 0.74±0.131) 5.13±1.28 1.28±0.431) 对照组 40 2.48±0.37 1.46±0.241) 5.16±1.47 2.16±0.541) t 0.259 3.078 0.097 8.063 P >0.05 < 0.05 >0.05 < 0.05 与术后第1天比较，1)P < 0.05。
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表 3 2组肛门下坠和便血缓解时间比较
d，X±S 组别 例数 肛门下坠 便血 观察组 40 2.68±0.79 3.76±1.23 对照组 40 3.84±0.65 5.12±1.14 t 7.171 5.129 P < 0.05 < 0.05
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表 4 2组术后第1天和术后第7天血清PDGF、bFGF、VEGF水平比较
ng/L，X±S 组别 例数 PDGF bFGF VEGF 术后第1天 术后第7天 术后第1天 术后第7天 术后第1天 术后第7天 观察组 40 32.42±4.56 58.37±7.961) 54.53±7.63 68.23±4.541) 89.54±14.23 187.93±13.421) 对照组 40 32.71±4.89 45.23±7.121) 56.12±8.38 62.12±4.211) 90.32±16.56 137.42±15.561) t 0.274 7.782 0.887 6.241 0.226 15.547 P >0.05 < 0.05 >0.05 < 0.05 >0.05 < 0.05 与同组术后第1天比较，1)P < 0.05。
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表 5 2组术后第1天和术后第7天肛肠动力学比较
kPa，X±S 组别 例数 RRP ARP AMCP 术后第1天 术后第7天 术后第1天 术后第7天 术后第1天 术后第7天 观察组 40 2.54±0.38 3.27±0.231) 13.54±1.23 16.56±1.081) 12.12±0.64 13.43±0.431) 对照组 40 2.58±0.21 2.84±0.251) 13.37±1.31 14.78±1.431) 12.17±0.83 12.68±0.391) t 0.583 8.006 0.598 6.282 0.302 8.171 P >0.05 < 0.05 >0.05 < 0.05 >0.05 < 0.05 与术后第1天比较，1)P < 0.05。
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[1] Frizziero M, Wang X, Chakrabarty B, et al. Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres[J]. World J Gastroenterol, 2019, 25(39): 5991-6005. doi: 10.3748/wjg.v25.i39.5991
[2] 许旭峰, 刘良东, 黄丽娟, 等. 外剥内扎术联合痔结扎术治疗环状混合痔的疗效研究[J]. 局解手术学杂志, 2021, 30(1): 32-35. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202101007.htm
[3] He YH, Tang ZJ, Xu XT, et al. A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids[J]. Surg Innov, 2017, 24(6): 574-581. doi: 10.1177/1553350617731205
[4] 彭军良, 王琛, 姚向阳, 等. 悬吊绑缚动脉结扎切除闭合术联合敛痔散外敷治疗重度混合痔疗效观察[J]. 现代中西医结合杂志, 2021, 30(1): 12-18. doi: 10.3969/j.issn.1008-8849.2021.01.003
[5] 郭丹, 王淑娟. 中药坐浴熏洗对混合痔外剥内扎术后肛门疼痛及肛缘水肿程度的影响[J]. 国际中医中药杂志, 2020, 42(7): 656-659. doi: 10.3760/cma.j.cn115398-20191022-00232
[6] 于永铎, 尹玲慧, 于厚仁, 等. 硝矾散坐浴治疗混合痔术后水肿疗效评价[J]. 辽宁中医药大学学报, 2019, 21(4): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201904001.htm
[7] 易超英. 冰硝散外敷治疗心源性水肿临床研究[J]. 光明中医, 2019, 34(23): 3575-3576. doi: 10.3969/j.issn.1003-8914.2019.23.016
[8] 国家中医药管理局. 中医病症诊断疗效标准[M]. 南京: 南京大学出版社, 2017: 137.
[9] Qiu S, Pellino G, Warren OJ, et al. Mixed adenoneuroendocrine carcinoma of the colon and rectum[J]. Acta Chir Belg, 2018, 118(5): 273-277. doi: 10.1080/00015458.2018.1482697
[10] 余求祥, 王艳芝, 智从从, 等. 外剥内套保留齿线术治疗Ⅲ~Ⅳ度混合痔疗效观察[J]. 中国临床医生杂志, 2021, 49(2): 195-198. doi: 10.3969/j.issn.2095-8552.2021.02.020
[11] Kanthan R, Tharmaradinam S, Asif T, et al. Mixed epithelial endocrine neoplasms of the colon and rectum-An evolution over time: A systematic review[J]. World J Gastroenterol, 2020, 26(34): 5181-5206.
[12] 蒙政初. 吻合器痔上黏膜环切术联合缚扎术治疗重度环状混合痔疗效研究[J]. 陕西医学杂志, 2020, 49(5): 561-563, 567. doi: 10.3969/j.issn.1000-7377.2020.05.013
[13] 高翔, 侯勇, 洪利凯, 等. 三石生新膏外敷治疗混合痔术后肛缘水肿疗效观察[J]. 安徽中医药大学学报, 2015, 34(3): 32-34. doi: 10.3969/j.issn.2095-7246.2015.03.012
[14] 李昌权, 钱腊燕, 李岗, 等. PPH联合部分肛门内括约肌切断术对重度混合痔术后创缘水肿及肛门功能的影响[J]. 中国普外基础与临床杂志, 2020, 27(5): 574-578. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202005009.htm
[15] 盖娟娟, 曾科学. 董氏奇穴针刺结合中药坐浴对混合痔PPH术后创面愈合及相关指标的影响[J]. 现代中西医结合杂志, 2020, 29(34): 3771-3775, 3815. doi: 10.3969/j.issn.1008-8849.2020.34.003
[16] 彭应中. 痔洗散熏蒸坐浴对混合痔术后水肿疼痛疗效观察[J]. 四川中医, 2019, 37(12): 135-138. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY201912047.htm
[17] 周滔, 危北海, 陈誩, 等. 消化病中西医结合研究的热点与进展[J]. 中国中西医结合消化杂志, 2017, 25(8): 635-637. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW201708021.htm
[18] 张玉, 高倩, 邵建国, 等. 雷火灸治疗不同中医证型便秘的临床疗效分析[J]. 中国中西医结合消化杂志, 2021, 29(11): 773-777. doi: 10.3969/j.issn.1671-038X.2021.11.004
[19] 仰筱旺, 王霞, 蔡颖畅. 中药熏洗治疗对混合痔患者术后水肿疼痛影响的研究[J]. 新中医, 2020, 52(18): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-REND202018032.htm
[20] 许功宇, 蔡倩倩, 程凯, 等. 解毒生肌汤雾化熏洗与麻仁软胶囊联用治疗混合痔术后疼痛水肿临床研究[J]. 国际中医中药杂志, 2020, 42(8): 754-757. doi: 10.3760/cma.j.cn115398-20190812-00071
[21] 谭首海, 于秀芝, 刘海龙, 等. 加味四黄汤内服外敷联合针刺对老年混合痔PPH术后疼痛的疗效及血清VEGF、IL-1β、IFN-γ的影响[J]. 新中医, 2020, 52(10): 81-85. https://www.cnki.com.cn/Article/CJFDTOTAL-REND202010025.htm
[22] 高冬梅, 赵艺欣, 肖枫林. AKI患者行CRRT治疗抑制AngⅡ途径对PDGF表达的影响及意义[J]. 西南国防医药, 2021, 31(5): 369-373. doi: 10.3969/j.issn.1004-0188.2021.05.001
[23] 蒋维连, 龚璇, 唐慧娟等. 混合痔患者术后急性期的疼痛体验[J]. 中国护理管理, 2022, 22(1): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202201008.htm
[24] 蓝菲. 中西医结合疗法对混合痔患者疼痛及创面愈合的影响[J]. 中国药物经济学, 2020, 15(4): 85-88. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWA202004023.htm
[25] 仲丙广, 韩力平, 宋攀, 等. 苦参汤熏洗治疗混合痔术后血清中表皮生长因子、血管内皮生长因子水平与疗效关系[J]. 四川中医, 2020, 38(9): 174-177. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202009056.htm
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