【作者】 张莹；

【导师】 黄德铨；

【作者基本信息】 成都中医药大学 ， 中医外科学， 2015， 硕士

【摘要】 目的：通过观察皮粘散对肛瘘术后切口愈合迟缓的临床疗效,探讨一种可以用于促进术后切口愈合的切实有效的治疗方案。方法：选取符合纳入条件的研究病例52例,将其随机分为两组,治疗组26例,对照组26例。两组在年龄、性别、病例分型、病程、切口纵径、切口深度方面比较,差异无统计学意义(P>0.05),具有可比性。治疗组采用将适量皮粘散掺布于紫草油纱条上,再填塞入切口内引流的换药方法,对照组单纯采用紫草油纱条填塞入切口的换药方法,从术后第4周的第一天开始,每天换药1次。分别观察记录患者治疗前1天和治疗后第7、14、21天的创面分泌物、疼痛程度、肉芽组织生长、切口纵径、切口深度的情况,通过临床观察和数据分析结果客观评价两组的临床疗效。结果：统计学结果显示,治疗组的总有效率为96.15%,对照组的总有效率为88.46%,两组疗效在统计学上有显著差异(P<0.05)。治疗三周后,观察创面分泌物、肉芽组织生长、切口纵径、切口深度的情况,治疗组疗效明显优于对照组(P<0.05),两组差异具有统计学意义；创面疼痛程度情况,治疗组与对照组疗效无显著性差异(P>0.05)：(1)创面分泌物情况：治疗后第21天积分比较治疗组明显优于对照组,两组结果比较具有统计学意义(P<0.05)：治疗后第7、14天积分比较两组无统计学意义(P>0.05)。(2)创面疼痛程度情况：治疗后第7天积分比较治疗组优于对照组,两组差异具有统计学意义(P<0.05)；治疗后第14、21天积分比较两组差异无统计学意义(P>0.05)。(3)创面肉芽组织生长情况：治疗后第7、14、21天积分比较治疗组均明显优于对照组,两组差异具有统计学意义(P>0.05)。(4)创面切口纵径情况：治疗后第7、14、21天积分比较治疗组均明显优于对照组,两组差异具有统计学意义(P>0.05)。(5)创面切口深度情况：治疗后第21天积分比较治疗组优于对照组,两组具有差异具有统计学意义(P>0.05)；治疗后第7、14天积分比较两组差异无统计学意义(P>0.05)。(6)两组内治疗前、后各项目指标积分情况：积分下降较明显,经统计学分析,P<0.05,说明治疗组和对照组治疗前、后各观察指标差异具有统计学意义,即两组治疗前、后的创面分泌物情况,疼痛程度,肉芽生长情况,创面切口纵径,创面切口深度均有显著变化。结论:皮粘散对促进肛瘘术后切口的愈合具有显著疗效,其能够有效抗炎抑菌,吸收创面分泌物,减轻切口疼痛,促进肉芽组织生长,加快创面愈合并上皮化,缩短病程,大大缓解患者的焦虑和痛苦,是治疗切口愈合迟缓的外用良药。另皮粘散药性温和,安全性能好,无任何不良反应,价格低廉,易于储存,值得进一步研究和推广。更多还原

【Abstract】 Objective:To observe the therapeutic effect of Piniansan treatment of Anal Fis tula incision slowly healing,investgate a practical and effective treatment optio ns of postoperative incision slowly healing used in the clinic.Methods:52 cases coformed inclusion criteria of anal fistula after operation were randomly divided into two groups,26 cases in treatment group,26 cases in control group. There were no statistical differences in age, gender, case classification、Course and longitudinal diameter, depth of incision between the two groups (P<0.05),they were comparable. The treatment group use appropriate amount of Piniansan spreading in arnebia oil gauze, and then filling into incision and drainage。The control group is only treated with the dressing change method of arnebia oil gauze. Dressing start from the first day of fourth weeks after operation with one times a day. Observe and record data of wound secretion, the degree of pain, the growth of granulation extent, longitudinal diameter, depth of incision the day before treatment and 7th,14th ,21th days after treatment,through clinical observation and analysis of data to evaluate its clinical effect.Results:Statistical results show that, The total effective rate of treatment group was 96.15%, compared with the control group was 88.46%, there was a significant difference between the two groups in curative effect (P<0.05). To compare the situation of wound secretions, the growth of granulation tissue, longitudinal diameter , depth of incision, the efficacy of the treatment group was significantly better than the control group, the difference was statistically significant(P<0.05).To compare the situation of the degree of wound pain, The treatment group and the control group have no significant difference in efficacy:(1) The situation of wound secretions:the integrals of the treatment group were significantly better than the control group on the 21th day after treatment, their difference was statistically significant(P<0.05); the difference of the points of 7th,14th days after treatment between the two groups was not statistically significant between the two groups ( P>0.05).(2) The degree of wound pain:the integrals of the treatment group were significantly better than the control group on the 7th day after treatment. their difference was statistically significant(P<0.05); the difference of the points of 14th,21th after treatment between the two groups was not statistically significant between the two groups (P>0.05).(3) The growth of granulation tissue:the points of the treatment group were significantly better than the control group on the 7th,14th,21th day after treatment, their difference was statistically significant(P<0.05).(4) The longitudinal diameter of incision:the points of the treatment group were significantly better than the control group on the 7th,14th,21th day after treatment, their difference was statistically significant(P<0.05).(5) The depth of incision:the integrals of the treatment group were significantly better than the control group on the 21th day after treatment , their difference was statistically significant (P<0.05); the difference of the points of 7th,14th days after treatment between the two groups was not statistically significant between the two groups (P>0.05).(6) The integrals of each observation index of the two groups before and after treatment:They decreased obviously. After statistical analysis, P<0.05, it indicates that the observation index of the treatment group and the control group has significant difference.The situation of wound secretions, the growth of granulation tissue, longitudinal diameter, depth of incision have significant changes before and after treatment.Conclusion:Piniansan can can effectively promote the incision healing after anal fistula operation,which can effectively anti inflammation and bacteriostasis, absorb the wound secretion, alleviate the incision pain, promote the growth of granulation tissue, accelerate epithelization of the wound,shorten the course of disease and reduce patient anxiety and pain. It is a good effective medicine for external use to treatment the Anal Fistula incision slow healing. It is mild, good safety, Without any adverse reaction, low cost, easy to store and worth further research and promotion.更多还原