目的:观察冰硝散外敷对混合痔术后水肿的干预作用。方法:选取2019年7月—2020年7月石家庄市中医院收治的80例混合痔术后患者。随机分为研究组与对照组，各40例。对照组给予地奥司明片治疗，研究组在对照组基础上给予冰硝散外敷治疗。于治疗前、后检测两组可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、碱性成纤维生长因子(bFGF)、血小板源性生长因子(PDFG)、血管内皮生长因子(VEGF)、前列腺素E(PGE)、P物质(SP)水平，于治疗后第1、3、5、7天进行肛缘水肿程度评分，评价患者肛门疼痛、排便困难、便血、肛门坠胀等并发症情况，比较两组患者临床疗效。结果:研究组sICAM-1、IL-1β、IL-6水平低于对照组[(201.21±38.06)μg/L、(23.66±6.94)ng/L、(15.45±4.14)ng/mL vs (123.12±35.03)μg/L、(31.31±10.13)ng/L、(19.32±5.73)ng/mL]，差异有统计学意义(P<0.05)，研究组IL-10水平高于对照组[(65.19±16.06)pg/m vs (56.61±15.52)pg/m]，差异有统计学意义(P<0.05)，研究组bFGF、PDFG、VEGF水平高于对照组[(94.07±27.03)ng/L、(56.61±14.18)ng/L、(139.02±36.32)ng/mL vs (77.31±23.89)ng/L、(47.93±12.26)ng/L、(121.84±33.25)ng/mL]，差异有统计学意义(P<0.05)，研究组患者PGE、SP物质水平低于对照组[(304.26±30.65)ng/L、(4.16±1.12)μg/mL vs (349.19±34.31)ng/L、(7.25±2.16)μg/mL]，差异有统计学意义(P<0.05)，研究组患者肛缘水肿程度评分低于对照组[(3.11±0.95)分、(2.73±0.81)分vs(3.65±1.07)分、(3.18±1.01)分]，差异有统计学意义(P<0.05)，研究组患者疼痛、便血、排便困难、肛门坠胀评分低于对照组[(3.12±0.61)分、(1.45±0.32)分、(1.52±0.46)分、(1.54±0.41)分 vs(4.17±1.09)分、(2.41±0.73)分、(2.64±0.75)分、(2.45±0.73)分]，差异有统计学意义(P<0.05)，研究组总有效率(97.5%)高于对照组(77.5%)，差异有统计学意义(P<0.05)。结论:冰硝散外敷应用于混合痔术后，可明显改善患者炎症水平，提升患者bFGF、PDFG、VEGF水平，降低患者PGE、SP水平，缓解患者肛缘水肿程度，改善患者肛门疼痛、便血、排便困难、肛门坠胀等并发症情况，提高患者临床治疗效果。
Intervention Effect of External Application of Bingxiao Powder on Postoperative Edema of Mixed Hemorrhoids
JIAO Hao,YUAN Chun-jing,WANG Hai-hong
Department of Anorectal, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang 050051, China
Abstract:
Objective To observe the intervention effect of Bingxiao powder on postoperative edema of mixed hemorrhoids. Methods 80 postoperative patients with mixed hemorrhoids who were admitted to Traditional Chinese Medicine Hospital of Shijiazhuang from July 2019 to July 2020 were selected randomly divided into a study group and a control group, 40 cases in each group.The control group was treated with Diosmin tablets, and the study group was treated with Bingxiao powder on the basis of the control group. Soluble intercellular adhesion molecules-1 (Soluble cell adhesion molecules-1, sICAM-1), interleukin-1β(IL1β) and interleukin-6 (Interleukin- 6, IL-6), interleukin-10 (Interleukin-10, IL-10), basic fibroblast growth factor (Recombinant Human Fibroblast Growth Factor-basic, bFGF), platelet-derived growth factor (plateletderived growth) factor, PDFG), vascular endothelial growth factor (vascular endothelial growth factor, VEGF), prostaglandin E (platium group element, PGE), and substance P (substance P, SP) levels of two groups were detected before and after treatment. The degree of anal marginal edema was scored on the 1st, 3rd, 5th and 7th days after treatment. The anal pain, difficulty in defecation, blood in the stool, anal swelling and other complications were evaluated. The clinical efficacy of the two groups of patients was compared. Results Soluble intercellular adhesion molecule-1, interleukin-1 in the study group β and the level of interleukin-6 were lower than those in the control group [(201.21±38.06) μg/L, (23.66±6.94) ng/L, (15.45±4.14) ng/mL] vs (123.12±35.03) μg/L, (31.31±10.13) ng/L, (19.32±5.73) ng/mL] (P< 0.05). The level of interleukin-10 in the study group was higher than that in the control group [(65.19 ±16.06) pg/m] vs [(56.61±15.52) pg/m] (P < 0.05). The levels of basic fibroblast growth factor, platelet-derived growth factor and vascular endothelial growth factor in the study group were higher than those in the control group [(94.07 ±27.03) ng/L, (56.61± 14.18) ng/L, (139.02±36.32) ng/mL] vs [(77.31±23.89) ng/L, (47.93±12.26) ng/L, (121.84±33.25) ng/ mL] (P < 0.05). The levels of prostaglandin E and substance P in the study group were lower than those in the control group [(304.26±30.65) ng/L, (4.16±1.12) μg/mL] vs [(349.19±34.31) ng/L, (7.25±2.16) μg/mL] (P < 0.05). The score of anal edema in the study group was lower than that in the control group [(3.11±0.95), (2.73± 0.81)] vs [(3.65±1.07), (3.18±1.01)] (P < 0.05). The scores of pain, bloody stool, difficult defecation and anal distension in the study group were lower than those in the control group [(3.12 ±0.61), (1.45±0.32), (1.52±0.46), (1.54±0.41) points] vs [(4.17±1.09), (2.41±0.73), (2.64±0.75), (2.45±0.73)] (P < 0.05). The total effective rate of the study group (97.5%) was higher than that of the control group (77.5%) (P < 0.05). Conclusion External application of Bingxiaosan after mixed hemorrhoid surgery can significantly improve inflammation level, increase bFGF, PDFG, VEGF level, reduce PGE and SP level, relieve anal edema. It also could improve anal pain, blood in the stool, difficult defecation, anal swelling and other complications as well as improve the clinical treatment effect of patients.
