2020 年第 9 期 第 15 卷

止痛如神汤联合肛门皮下亚甲蓝神经阻滞术治疗痔疮术后疼痛的临床效果及安全性

Clinical effect and safety of Zhitong Rushen decoction combined with anal subcutaneous methylene blue injection nerve block in treatment of postoperative pain of hemorrhoids

作者：杨三选张成靖李思

英文作者：Yang Sanxuan Zhang Chengjing Li Sipeng 

单位：云南省曲靖市第一人民医院中医肛肠科655000 

英文单位：Department of Chinese Medicine Proctology Qujing First People′s Hospital Yunnan Province Qujing 655000 China

关键词：痔疮；止痛如神汤；术后疼痛；肛门皮下亚甲蓝神经阻滞术

英文关键词：Hemorrhoids;ZhitongRushendecoction;Postoperativepain;Analsubcutaneousmethyleneblueinjectionnerveblock

• 摘要：

• 目的 探讨止痛如神汤联合肛门皮下组织亚甲蓝神经阻滞术治疗痔疮术后疼痛的临床效果及安全性。方法 选取2017年1月至2019年1月云南省曲靖市第一人民医院收治的160例混合痔患者，按照随机数字表法分为对照组和观察组，各80例。2组均行混合痔外剥内扎术，对照组于术毕行肛门皮下亚甲蓝神经阻滞术，观察组在对照组基础上联合服用止痛如神汤治疗7 d。评价2组临床疗效。比较2组术前、术后48及72 h的疼痛视觉模拟量表（VAS）评分，术后疼痛消失时间和镇痛药物使用率。观察2组术后并发症发生情况。结果 观察组临床总有效率明显高于对照组［91.2%（73/80）比71.2%（57/80）］，差异有统计学意义（P＝0.001）。2组术后48 h的VAS评分均较术前明显升高，术后72 h均较48 h明显降低（均P<0.05），组间术前和术后48 h的VAS评分比较差异均无统计学意义（均P＞0.05），但观察组术后72 h时VAS评分明显低于对照组［（2.2±0.8）分比（3.1±0.8）分］（P＜0.001）。观察组疼痛消失时间明显短于对照组［（4.3±0.8）d比（9.2±1.3）d］，镇痛药物使用率明显低于对照组［1.2%（1/80）比8.8%（7/80）］，差异均有统计学意义（均P＜0.05）。2组术后并发症发生率差异无统计学意义（P＝0.798）。结论 止痛如神汤联合肛门皮下亚甲蓝神经阻滞术治疗痔疮术后疼痛的镇痛效果明显，且并发症较少。

• Objective To observe the clinical efficacy and safety of Zhitong Rushen decoction combined with anal subcutaneous methylene blue injection nerve block in treatment of postoperative pain of hemorrhoids. Methods A total of 160 patients with mixed hemorrhoids admitted to Qujing First People′s Hospital, Yunnan Province, from January 2017 to January 2019 were randomly divided into control group and observation group, with 80 cases in each group. Both groups were treated with external dissection and internal ligation of hemorrhoids and anal subcutaneous methylene blue injection nerve block after operation. The observation group took Zhitong Rushen decoction for 7 days. Clinical efficacy was observed. Visual Analogue Scale(VAS) score before and 48, 72 h after operation, pain disappearance time,analgesics use and postoperative complications were analyzed. Results Total effective rate in the observation group was significantly higher than that in the control group［91.2%（73/80） vs 71.2%（57/80）］（P＝0.001）. VAS score increased at 48 h and reduced at 72 h after operation; the scores before and at 48 h after operation showed no statistical difference between groups（all P＞0.05）, and it was significantly lower in the observation group than that in the control group at 72 h after operation［（2.2±0.8） vs （3.1±0.8）］（P＜0.001）. Pain disappearance time in the observation group was significantly shorter and the use rate of analgesics were lower than those in the control group［（4.3±0.8）d vs （9.2±1.3）d, 1.2%（1/80） vs 8.8%（7/80）］(both P＜0.05). There was no significant difference of complications between groups（P＝0.798）. Conclusion Zhitong Rushen decoction combined with anal subcutaneous methylene blue injection nerve block is safe and effective in the treatment of postoperative pain of mix hemorrhoids.