万焱华 王日玮 万莎莎

*基金项目：江西省中医药管理局科技计划项目（2023B0474）

【摘要】 目的：探究布比卡因+亚甲蓝混合液肛周封闭术联合中药熏蒸对混合痔嵌顿术后的效果。方法：2022年8月—2023年8月选取于九江市第一人民医院行手术治疗的混合痔嵌顿患者80例，用随机抽签法分为对照组（行中药熏蒸治疗）与观察组（行布比卡因+亚甲蓝混合液肛周封闭联合中药熏蒸治疗），各40例。比较两组临床疗效、疼痛程度、肛门功能、术后并发症。结果：与对照组（75.00%）比较，观察组总有效率（92.50%）显著更高（P<0.05）。术后24 h及治疗14 d后，两组视觉模拟评分法评分均较术前显著降低，且观察组[（3.39±0.87）、（1.82±0.56）分]较对照组[（4.27±1.03）、（2.37±0.70）分]均显著更低（P<0.05）。术后1个月，两组肛管最大收缩压、肛管静息压均升高，肛管高压带均缩短，且与对照组[（112.36±10.87）mmHg、（51.11±4.25）mmHg、（2.94±0.36）cm]比较，观察组肛管最大收缩压[（119.48±11.31）mmHg]、肛管静息压[（54.56±4.39）mmHg]均显著更高，肛管高压带[（2.71±0.28）cm]显著更短（P<0.05）。与对照组（27.50%）比较，观察组术后并发症发生率（10.00%）显著更低（P<0.05）。结论：布比卡因+亚甲蓝混合液肛周封闭联合中药熏蒸可减轻混合痔嵌顿患者术后疼痛，改善肛门功能，降低术后并发症发生率，促进患者术后恢复。

【关键词】 混合痔嵌顿 布比卡因 亚甲蓝 肛周封闭术 中药熏蒸

Observation on the Effect of Perianal Block with Bupivacaine + Methylthioninium Chloride Admixture Combined with Traditional Chinese Medicine Fumigation and Steaming after Incarcerated Mixed Hemorrhoid Surgery/WAN Yanhua， WANG Riwei， WAN Shasha. //Medical Innovation of China， 2024， 21（15）： 0-014

[Abstract] Objective： To investigate the effect of perianal block with Bupivacaine + Methylthioninium Chloride admixture combined with traditional Chinese medicine fumigation and steaming after incarcerated mixed hemorrhoid surgery. Method： A total of 80 patients who underwent surgery for incarcerated mixed hemorrhoid at Jiujiang NO.1 People's Hospital from August 2022 to August 2023 were selected and divided into control group （treated with traditional Chinese medicine fumigation and steaming） and observation group （treated with perianal block with Bupivacaine + Methylthioninium Chloride admixture combined with traditional Chinese medicine fumigation and steaming） by random drawing method， with 40 cases in each group. The clinical efficacy， pain degree， anal function and postoperative complications were compared between the two groups. Result： Compared with the control group （75.00%）， the total effective rate of the observation group （92.50%） was significantly higher （P<0.05）. 24 h after surgery and 14 d after treatment， the scores of visual analogue scale in both groups were significantly lower than those before surgery， and the scores of observation group [（3.39±0.87）， （1.82±0.56） scores] were significantly lower than those of control group [（4.27±1.03）， （2.37±0.70） scores] （P<0.05）. 1 month after surgery， the maximum systolic pressure and resting pressure of anal canal in both groups were increased， and the high pressure band of anal canal were shortened， and compared with the control group [（112.36±10.87） mmHg， （51.11±4.25） mmHg， （2.94±0.36） cm]， the maximum systolic pressure of anal canal [（119.48±11.31） mmHg] and resting pressure of anal canal [（54.56±4.39） mmHg] in the observation group were significantly higher， and the high pressure band of anal canal [（2.71±0.28） cm] in the observation was significantly shorter （P<0.05）. Compared with the control group （27.50%）， the incidence of postoperative complications in the observation group （10.00%） was significantly lower （P<0.05）. Conclusion： Perianal block with Bupivacaine + Methylthioninium Chloride admixture combined with traditional Chinese medicine fumigation and steaming can alleviate postoperative pain， improve anal function， reduce the incidence of postoperative complications and promote postoperative recovery in patients with incarcerated mixed hemorrhoid surgery.

[Key words] Incarcerated mixed hemorrhoid Bupivacaine Methylthioninium Chloride Perianal block Traditional Chinese medicine fumigation and steaming

First-author's address： Department of General Surgery Ⅲ， Jiujiang NO.1 People's Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2024.15.003

混合痔是一种常见的肛肠类慢性疾病，其形成与长时间久坐、便秘、腹泻、肛门炎症、妊娠、肥胖和高纤维饮食不足等因素有关。混合痔嵌顿是指内痔突出肛门外，卡在外痔的环形肌内，无法自行复位的状态。混合痔嵌顿的症状包括疼痛、肿胀感、排便困难及肛门出血等，部分患者可能会出现局部感染、溃疡和坏死等[1]。临床广泛使用手术治疗混合痔嵌顿，然而术后患者易出现肛门疼痛、大量出血、水肿、括约肌痉挛、感染等并发症[2]。中药熏蒸是药物中挥发成分通过热蒸气或水浸泡深入肛周皮肤、黏膜或组织，起到止痛、消肿、活血化瘀的作用，具有方便、易操作、无刺激、无副作用等优点。中药熏蒸对痔疮患者术后创面有一定促进愈合的效果，还可减轻不适感，降低术后并发症发生，提高综合治疗效果[3]。亚甲蓝肛周封闭术常应用于混合痔患者术后治疗，可抑制术后感染，减轻术后疼痛及手术引发的其他不良影响[4]。……