口服甲硝唑减轻痔疮术后疼痛的疗效评估
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摘要
目的评价口服甲硝唑对缓解混合痔外剥内扎术后疼痛的有效性。方法选取2016年11月至2017年10月南方医科大学附属小榄医院均行混合痔外剥内扎术的Ⅲ度和Ⅳ度痔疮病人178例,分为甲硝唑组93例和安慰剂组(对照组) 85例,采用倾向得分匹配法(PSM)均衡病人组间一般资料混杂因素的影响,对匹配后的两组病人进行术后疼痛评分即视觉模拟评分(VAS)、术后回归正常工作或生活的时间进行分析。结果在PSM匹配前,两组一般资料中的病程和痔疮分度分布不均衡(P <0. 05),经PSM后,全部资料分布均衡(P> 0. 05),共72对病人匹配成功;甲硝唑组与对照组术后6、12、24 h、3、7、10、14 d的术后VAS评分分别为(3. 4±0. 8)比(7. 1±0. 8)分,(5. 0±0. 7)比(8. 3±0. 6)分,(7. 1±0. 6)比(8. 7±0. 5)分,(4. 7±0. 8)比(7. 5±0. 4)分,(3. 9±0. 4)比(6. 3±0. 6)分,(2. 7±0. 5)比(5. 3±0. 5)分,(1. 1±0. 5)比(3. 8±1. 0)分,均差异有统计学意义(P <0. 05);甲硝唑组和对照组分别回归正常生活或工作的时间为(10. 2±3. 1) d比(14. 6±4. 7) d,差异有统计学意义(P <0. 05)。结论口服甲硝唑可以减轻混合痔外剥内扎术后病人肛周疼痛程度,并且病人能更快的从术后恢复到正常的生活或工作当中。
Objective To evaluate the effectiveness of oral metronidazole to relieve postoperation rain of Milligan-Morgan hemorrhoidectomy. Methods From November 2016 to October 2017 a total of 178 cases of third and fourth degree hemorrhoids patients in our hospital for mixed hemorrhoids,were divided into metronidazole group and placebo group( control group) 85 casesusing propensity score matching( PSMpatients were analyzed. Results PSM,the general data of the two groups in the course of disease and hemorrhoids dividing uneven distribution( P < 0. 05) fter PSM,of 72 patients matched; fter 6 h,12 h,24 h,3 d,7 d,10 d,14 d after operation the VAS scores were( 3. 4 ± 0. 8) vs.( 7. 1 ± 0. 8),( 5. 0 ± 0. 7) vs.( 8. 3 ± 0. 6),( 7. 1 ± 0. 6) vs.( 8. 7 ± 0. 5),( 4. 7 ± 0. 8) vs.( 7. 5 ± 0. 4),( 3. 9 ±0. 4) vs.( 6. 3 ± 0. 6),( 2. 7 ± 0. 5) vs.( 5. 3 ± 0. 5),( 1. 1 ± 0. 5) vs.( 3. 8 ± 1. 0),there was statistically significant( P <0. 05) were back to normal life or work s( 10. 2 ± 3. 1) d vs.( 14. 6 ± 4. 7) d,statistically significant( P < 0. 05). Conclusion Oral metronidazole can relieve postoperative pain of Milligan-Morgan hemorrhoidectomy and patients recover faster from postoperative to normal life or work.
Objective To evaluate the effectiveness of oral metronidazole to relieve postoperation rain of Milligan-Morgan hemorrhoidectomy. Methods From November 2016 to October 2017 a total of 178 cases of third and fourth degree hemorrhoids patients in our hospital for mixed hemorrhoids,were divided into metronidazole group and placebo group( control group) 85 casesusing propensity score matching( PSMpatients were analyzed. Results PSM,the general data of the two groups in the course of disease and hemorrhoids dividing uneven distribution( P < 0. 05) fter PSM,of 72 patients matched; fter 6 h,12 h,24 h,3 d,7 d,10 d,14 d after operation the VAS scores were( 3. 4 ± 0. 8) vs.( 7. 1 ± 0. 8),( 5. 0 ± 0. 7) vs.( 8. 3 ± 0. 6),( 7. 1 ± 0. 6) vs.( 8. 7 ± 0. 5),( 4. 7 ± 0. 8) vs.( 7. 5 ± 0. 4),( 3. 9 ±0. 4) vs.( 6. 3 ± 0. 6),( 2. 7 ± 0. 5) vs.( 5. 3 ± 0. 5),( 1. 1 ± 0. 5) vs.( 3. 8 ± 1. 0),there was statistically significant( P <0. 05) were back to normal life or work s( 10. 2 ± 3. 1) d vs.( 14. 6 ± 4. 7) d,statistically significant( P < 0. 05). Conclusion Oral metronidazole can relieve postoperative pain of Milligan-Morgan hemorrhoidectomy and patients recover faster from postoperative to normal life or work.
引文
[1]沈奎,朱竞,张承岳,等.封闭式分段结扎术治疗环状混合痔的疗效观察[J].安徽医药,2015(6):1130-1132.
[2] BHATTI MI,SAJID MS,BAIG MK. Milligan-Morgan(Open)Versus Ferguson Haemorrhoidectomy(Closed):A Systematic Review and Meta-Analysis of Published Randomized,Controlled Trials[J]. World J Surg,2016,40(6):1509-1519.
[3] WATSON AJ,HUDSON J,WOOD J,et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease(e THo S):a pragmatic,multicentre,randomised controlled trial[J]. Lancet,2016,388(10058):2375-2385.
[4] KHAN KI,AKMAL M,WAQAS A,et al. Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy-a randomized control trial[J]. Int J Surg,2014,12(8):868-871.
[5] CARAPETI EA,KAMM MA,MCDONALD P J,et al. Double-blind randomised controlled trial of effect of metronidazole on pain after daycase haemorrhoidectomy[J]. Lancet,1998,351(9097):169-172.
[6] SUGIMOTO T,TSUNODA A,KANO N,et al. A randomized,prospective,double-blind,placebo-controlled trial of the effect of diltiazem gel on pain after hemorrhoidectomy[J]. World J Surg,2013,37(10):2454-2457.
[7]何芳,谢永俊,彭兵.消痔灵注射术治疗老年性混合痔临床应用及与其它方法的比较[J].安徽医药,2016,20(5):987-989.
[8]闻永,李俊,龙庆,等.电针联合穴位埋线用于混合痔术后疼痛研究[J].中国针灸,2017,37(3):243-246.
[9] SHEN J,LUO X,ZHOU X,et al. Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption:a prospective study[J]. J Pain Res,2017,10:197-201.
[10] WANIS KN,EMMERTON-COUGHLIN HM,COUGHLIN S,et al.Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain:A Meta-Analysis of Randomized Controlled Trials[J]. Dis Colon Rectum,2017,60(4):446-455.
[11] ALA S,SAEEDI M,ESHGHI F,et al. Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy[J]. Dis Colon Rectum,2008,51(2):235-238.
[12] LYONS N,CORNILLE JB,PATHAK S,et al. Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief[J]. Colorectal Dis,2017,19(9):803-811.
[13] SOLORIO-LOPEZ S,PALOMARES-CHACON UR,GUERREROTARIN JE,et al. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial[J]. Rev Esp Enferm Dig,2015,107(11):681-685.
[14] URAIQAT A. Post hemorrhoidectomy pain. A randomized controlled trial[J]. Saudi Med J,2007,28(5):814.
[2] BHATTI MI,SAJID MS,BAIG MK. Milligan-Morgan(Open)Versus Ferguson Haemorrhoidectomy(Closed):A Systematic Review and Meta-Analysis of Published Randomized,Controlled Trials[J]. World J Surg,2016,40(6):1509-1519.
[3] WATSON AJ,HUDSON J,WOOD J,et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease(e THo S):a pragmatic,multicentre,randomised controlled trial[J]. Lancet,2016,388(10058):2375-2385.
[4] KHAN KI,AKMAL M,WAQAS A,et al. Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy-a randomized control trial[J]. Int J Surg,2014,12(8):868-871.
[5] CARAPETI EA,KAMM MA,MCDONALD P J,et al. Double-blind randomised controlled trial of effect of metronidazole on pain after daycase haemorrhoidectomy[J]. Lancet,1998,351(9097):169-172.
[6] SUGIMOTO T,TSUNODA A,KANO N,et al. A randomized,prospective,double-blind,placebo-controlled trial of the effect of diltiazem gel on pain after hemorrhoidectomy[J]. World J Surg,2013,37(10):2454-2457.
[7]何芳,谢永俊,彭兵.消痔灵注射术治疗老年性混合痔临床应用及与其它方法的比较[J].安徽医药,2016,20(5):987-989.
[8]闻永,李俊,龙庆,等.电针联合穴位埋线用于混合痔术后疼痛研究[J].中国针灸,2017,37(3):243-246.
[9] SHEN J,LUO X,ZHOU X,et al. Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption:a prospective study[J]. J Pain Res,2017,10:197-201.
[10] WANIS KN,EMMERTON-COUGHLIN HM,COUGHLIN S,et al.Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain:A Meta-Analysis of Randomized Controlled Trials[J]. Dis Colon Rectum,2017,60(4):446-455.
[11] ALA S,SAEEDI M,ESHGHI F,et al. Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy[J]. Dis Colon Rectum,2008,51(2):235-238.
[12] LYONS N,CORNILLE JB,PATHAK S,et al. Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief[J]. Colorectal Dis,2017,19(9):803-811.
[13] SOLORIO-LOPEZ S,PALOMARES-CHACON UR,GUERREROTARIN JE,et al. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial[J]. Rev Esp Enferm Dig,2015,107(11):681-685.
[14] URAIQAT A. Post hemorrhoidectomy pain. A randomized controlled trial[J]. Saudi Med J,2007,28(5):814.