李莹 黄丽 黎帅 王凤飞 曾娟妮

【摘要】 目的：觀察美洲大蠊提取液定向透药对克罗恩病（Crohns disease，CD）肛瘘术后创面的促愈疗效及安全性。方法：选取2019年1月-2020年8月于本院行CD肛瘘手术的患者64例为研究对象，按照“乱数表法”分为治疗组32例和对照组32例。两组均给予相同的基础治疗，治疗组加以美洲大蠊提取液定向透药，对照组不加予其他处理。观察两组患者术后第2、7、14天的疼痛症状并行VAS评分，患者出院后追踪其创面痊愈的时间，术后第28天评价治疗的总体效果，同时观察实验研究中可能会出现的各种不良反应，评价其安全性。结果：术后第2天两组创面VAS评分比较，差异无统计学意义（P>0.05）;术后第7、14天，治疗组在有效缓解疼痛方面优于对照组，差异均有统计学意义（P<0.05）。治疗组和对照组的术后创面愈合所需时间分别为（34.62±2.97）、（38.47±3.62）d，两组比较差异有统计学意义（P<0.05）。术后28 d治疗组的临床总有效率为90.6%优于对照组62.5%，两组比较差异有统计学意义（P<0.05）。在研究期间两组患者均未出现严重不适。结论：美洲大蠊提取液定向透药对克罗恩病肛瘘术后创面的促愈疗效肯定，安全舒适，体现了中医定向透药治疗的优势，值得推广。

【关键词】 克罗恩病肛瘘 创面愈合 美洲大蠊提取液 中医定向透药

Clinical Study of Directional Penetration of American Periplaneta Extract to Promote Wound Healing after Crohns Disease Anal Fistula Surgery/LI Ying， HUANG Li， LI Shuai， WANG Fengfei， ZENG Juanni. //

Medical Innovation of China， 2021， 18（07）： 0-047

[Abstract] Objective： To observe the effect and safety of directional penetrating medicine of Periplaneta americana extract on wounds after Crohns disease anal fistula surgery. Method： Sixty-four patients with CD anal fistula from January 2019 to August 2020 in our hospital were selected as the research objects， and they were divided into treatment group of 32 cases and control group of 32 cases according to random number table method. The two groups were given the same basic treatment. The treatment group was treated with periplaneta americana extract for directed drug penetration， and the control group was not treated with other treatments.The pain symptoms and VAS scores of the two groups were observed on the 2nd， 7th and 14th day after operation. The wound healing time was tracked after discharge. The overall effect of the treatment was evaluated on the 28th day after operation. At the same time， the possible adverse reactions in the experimental study were observed and the safety was evaluated. Result： There was no significant difference in VAS score between the two groups on the second day after operation （P>0.05）; on the seventh and fourteenth day after operation， the treatment group was better than that of the control group in effective pain relief， the differences were statistically significant （P<0.05）. The wound healing time of treatment group and control group was （34.62±2.97） and （38.47±3.62） d respectively， the difference was statistically significant （P<0.05）. 28 days after operation， the total effective rate of the treatment group was 90.6%， which was better than 62.5% of the control group （P<0.05）. There was no serious discomfort in both groups during the study period. Conclusion： The directional drug penetration of Periplaneta americana extract has a positive effect on the healing of wounds after Crohns disease anal fistula operation， which is safe and comfortable. It reflects the advantages of directional drug penetration of TCM and is worthy of promotion.

[Key words] Crohns disease anal fistula Wound healing American Periplaneta extract Chinese medicine directed drug penetration

First-authors address： Hunan University of Traditional Chinese Medicine， Changsha 410208， China

doi：10.3969/j.issn.1674-4985.2021.07.011

克罗恩病（Crohns disease，CD）是一类起病较为隐蔽、原因尚未确定的炎症性肠病。近年来，中国的CD发病率大幅增加，合并有肛周病变的患者占25%～80%，其中17%～43%肛周CD表现为肛瘘[1-3]。CD肛瘘病情较为复杂，一般难以自愈，需通过手术方式干预。术后疼痛、创面修复和肛瘘复发等问题是肛肠科医患密切关注的方向，所以用于促进CD肛瘘术后恢复的、疗效显著且安全舒适的治疗方法亟待发掘。美洲大蠊提取液具有生肌养阴、通利血脉等作用[4]，应用于各类创面及黏膜溃疡者，取得显著疗效，临床上得到了广泛认可。中医定向透药是当前兴起和逐渐发展的一项具有鲜明中医特色的治疗方法，仪器通过独特的不对称的中频电流产生电磁场，对药物离子产生一种推动力，促使药物有效成分通过扩张的皮肤黏膜快速而有效地直达病灶局部或透过穴位靶向调节，以期能够促进患者康复[5]。本研……