目的：探讨加味五味消毒饮改善肛瘘术后创口微环境PH的疗效观察。方法：选取台州市黄岩区中医院肛瘘术后患者60例，随机分为两组各30例。对照组患者给高锰酸钾液(1:5000)对肛门进行坐浴熏洗，观察组给加味五味消毒饮进行坐浴熏洗，两组患者均持续治21 d。结果：经过治疗后，创面愈合总有效率均为100%，观察组与对照组比较差异无统计学意义(p > 0.05) 。术后第７天、第14天、第21天两组患者创面PH值均降低，观察组PH值较对照组显著降低(p < 0.05)。术后第７天、第14天、第21天两组患者创面愈合率均上升，观察组创面愈合率显著高于对照组(p < 0.05)。结论：加味五味消毒饮坐浴熏洗可降低肛瘘病术后创口微环境PH值，促进创口愈合，且安全性较高，值得在临床上推广应用。
Objective: To investigate the curative effect of Jiawei Wuwei Xiaoduyin on improving the PH of wound microenvironment after anal fistula surgery. Methods: A total of 60 patients with anal fistula in Huangyan District Hospital of Taizhou City were selected and randomly divided into two groups with 30 cases in each group. The patients in the control group were given potassium permanganate solution (1:5000) for sitz bath fumigation and washing of the anus, and the observation group was given sitz bath fumigation and fumigation with the flavored Wuwei disinfectant drink. The patients in both groups were treated continuously for 21 days. Results: After treatment, the total effective rate of wound healing was 100%, and there was no significant difference between the observation group and the control group (p > 0.05). On the 7th, 14th, and 21st days after operation, the PH value of the wounds of the two groups of patients decreased, and the PH value of the observation group was significantly lower than that of the control group (p < 0.05). On the 7th, 14th, and 21st days after operation, the wound healing rate of the two groups increased, and the wound healing rate of the observation group was significantly higher than that of the control group (p < 0.05). Conclusion: Modified Wuwei Disinfecting Drink can reduce anal fistula. The PH value of the wound microenvironment after the disease can promote wound healing. And the safety is high, it is worthy of clinical application.
目的：探讨加味五味消毒饮改善肛瘘术后创口微环境PH的疗效观察。方法：选取台州市黄岩区中医院肛瘘术后患者60例，随机分为两组各30例。对照组患者给高锰酸钾液(1:5000)对肛门进行坐浴熏洗，观察组给加味五味消毒饮进行坐浴熏洗，两组患者均持续治21 d。结果：经过治疗后，创面愈合总有效率均为100%，观察组与对照组比较差异无统计学意义(p > 0.05) 。术后第７天、第14天、第21天两组患者创面PH值均降低，观察组PH值较对照组显著降低(p < 0.05)。术后第７天、第14天、第21天两组患者创面愈合率均上升，观察组创面愈合率显著高于对照组(p < 0.05)。结论：加味五味消毒饮坐浴熏洗可降低肛瘘病术后创口微环境PH值，促进创口愈合，且安全性较高，值得在临床上推广应用。
肛瘘，加味五味消毒饮，创口PH值
Boyang Wei*, Zhenkun Kuang*
Taizhou Huangyan District Hospital of Traditional Chinese Medicine, Taizhou Zhejiang
Received: Oct. 18th, 2021; accepted: Dec. 7th, 2021; published: Dec. 14th, 2021
Objective: To investigate the curative effect of Jiawei Wuwei Xiaoduyin on improving the PH of wound microenvironment after anal fistula surgery. Methods: A total of 60 patients with anal fistula in Huangyan District Hospital of Taizhou City were selected and randomly divided into two groups with 30 cases in each group. The patients in the control group were given potassium permanganate solution (1:5000) for sitz bath fumigation and washing of the anus, and the observation group was given sitz bath fumigation and fumigation with the flavored Wuwei disinfectant drink. The patients in both groups were treated continuously for 21 days. Results: After treatment, the total effective rate of wound healing was 100%, and there was no significant difference between the observation group and the control group (p > 0.05). On the 7th, 14th, and 21st days after operation, the PH value of the wounds of the two groups of patients decreased, and the PH value of the observation group was significantly lower than that of the control group (p < 0.05). On the 7th, 14th, and 21st days after operation, the wound healing rate of the two groups increased, and the wound healing rate of the observation group was significantly higher than that of the control group (p < 0.05). Conclusion: Modified Wuwei Disinfecting Drink can reduce anal fistula. The PH value of the wound microenvironment after the disease can promote wound healing. And the safety is high, it is worthy of clinical application.
Keywords:Anal Fistula, Flavored Wuwei Disinfection Drink, Wound PH Value
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肛瘘病是肛肠外科疾病中的常见病与多发病，随着经济、社会的发展，肛瘘病的发生率呈持续上升趋势。肛瘘病是指直肠或肛管因病理原因形成的与肛门周围皮肤相通的异常通道，也被称为肛管直肠瘘。临床以肛周脓肿引起的继发性肛瘘最为常见 [
1) 参照2012年8月1日中华中医药学会实施的《中医肛肠科病证诊断疗效标准》拟定诊断标准及中医证型诊断如下；
诊断标准：排便时和排便后肛口剧烈锐痛，可持续数小时，少量便血，色鲜红，可伴有大便秘结，肛口分泌物、痊痒等。
中医证型属湿热下注型：大便干结不甚，便时腹痛不适，排便不爽，肛口坠胀，时有黏液鲜血，有时伴有肛口部湿疹，肛裂口伴少许化液，舌红，苔黄腻，脉濡数。
2) 参照《肛瘘的现代外科治疗》中的肛瘘诊断及分类如下：
诊断：视诊可见肛门外口形态异常，肛门周围可触及条索状硬结，直肠指诊可触及结节、凹陷或内口。
分类：低位单纯性肛瘘：内口在肛隐窝，经外括约肌浅部或下部与皮肤相通，且仅有一个瘘管。
1) 符合湿热下注型低位单纯性肛瘘的诊断标准，并自愿接受手术治疗及临床观察者，术后的伤口为开放性，创面面积范围为1 cm × 2 cm~2 cm × 3 cm；2) 年龄18~60岁；3) 肛门形态及肛门功能活动无异常者；4) 依从性好，接受手术方式治疗，配合术后用药；5) 没有严重肝肾功能异常、血液系统及心脑血管等相兼疾病患者。
1) 退出标准：① 精神病病人；② 依从性差，不能坚持换药者；③ 凝血功能差、具有基础疾病患者。
2) 剔除标准：① 出院、死亡或病情恶化不能继续追踪者；② 要求退出研究者。
笔者选取台州市黄岩区中医院，从2018年8月至2020年8月入院60例湿热下注型肛瘘术后患者临床资料。性别不限，年龄于18岁~60岁之间。随机分成观察组及对照组，每组30名患者。经t检验，p > 0.05，认为两组患者的年龄分布比较差异无统计学意义，具有可比性。经x2检验p > 0.05认为两组患者的性别差异无统计学意义，具有可比性。见表1。
| 组别 | 例数 | 年龄(岁) | 性别 | |
|---|---|---|---|---|
| 男 | 女 | |||
| 观察组 | 30 | 18~58 | 20 | 10 |
| 观察组 | 30 | 19~60 | 22 | 8 |
| p | 0.356 | 0.671 | ||
表1. 性别、年龄分布情况
采取的手术方式均为局麻下低位肛瘘切除术，术后第2 d开始换药。
观察组以清洁换药 + 加减五味消毒饮进行坐浴熏洗(药物组成：紫花地丁10 g，野菊花10 g，蒲公英10 g，金银花15 g，紫背天葵15 g，苦参10 g，栀子10 g，艾叶10 g，黄柏10 g，五倍子10 g，红花10 g，苍术10 g，牡丹皮15 g，防风10 g)，清水煎煮，1000 mL药汁。先熏洗10~15 min，坐浴水温38℃~40℃，坐浴时间10~15 min。
对照组以清洁换药 + 高锰酸钾液(1:5000)对肛门进行坐浴熏洗，先熏洗10~15 min，坐浴水温38℃~40℃，坐浴时间10~15 min。
1) 术后第7 d、14 d、21 d观察两组术后创面PH值情况，用精密PH值试纸(6.4~8.0，上海试纸三厂生产)进行比色，并记录结果。
2) 创面愈合：术毕和术后第n天，分别测量创面面积，创面面积之差与原始创面面积之比即为创面愈合率。
应用统计学软件SPSS 19.0进行数据分析，进行t检验及x2分析，以p < 0.05为有显著性差异。
经过治疗后，创面愈合总有效率均为100%，观察组与对照组比较差异无统计学意义(p > 0.05)。见表2。
| 组别 | 例数 | 治愈 | 有效 | 无效 | 有效率 |
|---|---|---|---|---|---|
| 观察组 | 30 | 27 | 3 | 0 | 100% |
| 对照组 | 30 | 24 | 6 | 0 | 100% |
表2. 两组创面愈合比较
经治疗后，术后第7天、第14天、第21天两组患者创面PH值均降低，观察组PH值较对照组显著降低(p < 0.05)，见表3。
| 组别 | 例数 | 术后7天 | 术后14天 | 术后21天 |
|---|---|---|---|---|
| 观察组 | 30 | 7.71 ± 0.09 | 7.46 ± 0.07 | 6.53 ± 0.08 |
| 对照组 | 30 | 7.89 ± 0.15 | 7.57 ± 0.17 | 7.26 ± 0.09 |
表3. 两组创面术后7天、14天、21天PH值情况
经治疗后，术后第7天、第14天、第21天两组患者创面愈合率均上升，观察组创面愈合率显著高于对照组(p < 0.05)，见表4。
| 组别 | 例数 | 术后7天 | 术后14天 | 术后21天 |
|---|---|---|---|---|
| 观察组 | 30 | 4.62 ± 2.16 | 14.51 ± 3.36 | 84.73 ± 8.76 |
| 对照组 | 30 | 4.54 ± 2.73 | 14.03 ± 2.89 | 79.73 ± 7.12 |
表4. 两组术后各时间点创面愈合率比较
肛瘘术后创面属外来伤害，金刃所伤。术后原病灶虽去，但肌肤受损，致脉络断裂，局部气血受阻流行不畅，经络阻滞。肛门居于下位，大便经常摩擦，湿易趋之。术后气血虚弱，创面失于濡养，再受外来伤害，至术后局部创面气血郁滞，经络阻塞，临床主要表现则为创面及周围疼痛剧烈，此为“不通则痛”也。若余邪存在，新肉不生，则创面难以愈合 [
创面PH值可作为评估术后创面愈合情况的指标。20世纪70年代，PH值作为影响创面愈合的一个重要因素被提出，并逐渐引起人们的重视 [
本研究显示，经过治疗后，创面愈合总有效率均为100%，观察组与对照组比较差异无统计学意义(p > 0.05)。术后第7天、第14天、第21天两组患者创面PH值均降低，观察组PH值较对照组显著降低(p < 0.05)。术后第7天、第14天、第21天两组患者创面愈合率均上升，观察组创面愈合率显著高于对照组(p < 0.05)，说明加味五味消毒饮熏洗坐浴用于肛瘘术后，可改善创面PH值呈现微酸环境，且增加创口愈合速度。研究过程中未见明显不良反应，用药安全性较高，值得临床推广应用。
魏博洋,匡振坤. 加味五味消毒饮改变肛瘘病术后创口微环境PH值临床疗效观察Clinical Observation of Modified Wuwei Disinfecting Drink on Changing the PH Value of Wound Microenvironment after Anal Fistula Operation[J]. 医学诊断, 2021, 11(04): 164-168. https://doi.org/10.12677/MD.2021.114027
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