目的 观察凉血地黄汤加减对混合痔术后患者创面愈合及并发症的影响，并探讨其促进创面愈合的作用机制。方法 将80例混合痔术后患者，采用随机数字表法分为观察组和对照组，每组40例。对照组予抗感染、中药熏洗及换药等常规治疗，观察组在对照组基础上予以凉血地黄汤加减口服治疗，疗程7 d。术后1、7 d，对两组患者创面疼痛和水肿程度进行评分；对两组术后并发症进行评估；患者出院后随访两组患者创面愈合时间；术后1、3、7 d分别检测两组患者血清中转化生长因子-β（transforming growth factor-β，TGF-β）、表皮生长因子（epidermal growth factor，EGF）、Ⅰ型胶原蛋白（collagenⅠ，COL-Ⅰ）水平。结果 术后7 d，两组患者的疼痛评分、水肿评分均较术后1 d降低，其中两组患者术后1 d与术后7 d疼痛评分差值比较，差异有统计学意义（P＜0.05）。两组术后并发症发生率比较，差异有统计学意义（P<0.05）。两组患者创面愈合时间比较，差异有统计学意义（P＜0.05）。术后3 d，两组患者TGF-β、EGF及COL-Ⅰ水平均较术后1 d显著升高（P＜0.05）；术后7 d，两组患者TGF-β、EGF及COL-Ⅰ水平较术后3 d显著升高（P＜0.05）；术后3、7 d，两组患者TGF-β、EGF及COL-Ⅰ水平比较，差异均有统计学意义（P＜0.05）。结论 凉血地黄汤加减联合常规治疗可减轻混合痔患者术后疼痛，减少术后并发症，缩短创面愈合时间。其促进创面愈合的机制可能与提高血清TGF-β、EGF、COL-Ⅰ水平有关。
Objective To investigate the effect of modified Liangxue Dihuang Decoction on postoperative wound healing and complications in patients with mixed hemorrhoids, as well as its mechanism of action in promoting wound healing. Methods A total of 80 patients with mixed hemorrhoids after surgery were divided into observation group and control group using a random number table, with 40 patients in each group. The patients in the control group were given routine treatment such as anti-infective therapy, traditional Chinese medicine fumigation and washing, and dressing change, and those in the observation group were given oral administration of modified Liangxue Dihuang Decoction in addition to the treatment in the control group; the course of treatment was 7 days for both groups. On days 1 and 7 after surgery, the scores of wound pain and edema were determined, and postoperative complications were evaluated. The patients were followed up after discharge to observe wound healing time. On days 1, 3, and 7 after surgery, serum levels of transforming growth factor-β (TGF-β), epidermal growth factor (EGF), and collagen Ⅰ (COL-Ⅰ) were measured. Results Both groups had significant reductions in the scores of pain and edema from day 1 to day 7 after surgery, and there was a significant difference in the change in pain score between the two groups (P<0.05). There were significant differences between the two groups in the incidence rates of postoperative complications and wound healing time (both P<0.05). Both groups had significant increases in the levels of TGF-β and COL-Ⅰ from day 1 to day 3 after surgery (P<0.05) and significant increases in the levels of TGF-β, EFG, and COL-Ⅰ from day 3 to day 7 after surgery (P<0.05), and there were significant differences in the levels of TGF-β, EFG, and COL-Ⅰ between the two groups on days 3 and 7 after surgery (P<0.05). Conclusion In patients with mixed hemorrhoids, modified Liangxue Dihuang Decoction combined with routine treatment can improve postoperative pain, reduce postoperative complications, and shorten wound healing time, possibly by increasing the serum levels of TGF-β, EFG, and COL-Ⅰ.
查德华,张玉玲,汪 伟,王乐炜,沈 瑜.凉血地黄汤加减对混合痔术后创面愈合时间的影响及其机制研究[J].安徽中医药大学学报,2020,39(4):17-20复制