超声清创联合重组人表皮生长因子治疗肛周脓肿合并感染的效果

目的探讨超声清创联合重组人表皮生长因子对肛周脓肿合并感染患者表皮细胞生长因子(Epidermal growth factor,EGF)、激活素A(Activin A,ACTA)水平及创面血流量的影响。方法选取2018年2月-2020年1月承德医学院附属医院肛周脓肿合并感染患者117例,依据随机数字表法分为对照A组(n=39)、对照B组(n=39)、联合组(n=39)。常规干预基础上对照A组采取超声清创,对照B组采取重组人表皮生长因子,联合组采取超声清创及重组人表皮生长因子。统计三组治疗情况、治疗前后疼痛程度评分、创面血流量及经皮氧分压、EGF、转化生长因子-β(Transforming growth factor-β,TGF-β)、ACTA、C-反应蛋白(C-reactive protein,CRP)水平及临床疗效。结果联合组创面愈合时间、感染控制时间、住院时间分别为(12.39±2.01)d、(5.22±1.56)d、(13.91±2.51)d短于对照A组、对照B组,创面细菌清除率为(89.13±4.64)%高于对照A组、对照B组(P<0.001);治疗后1 d、3 d、7 d、14 d三组VAS评分较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);治疗后1 d联合组创面血流量及经皮氧分压分别为(0.92±0.25)PU、(35.69±3.20)mmHg大于对照A组、对照B组(P<0.05);治疗后1 d联合组血清EGF、TGF-β分别为(0.70±0.11)μg/L、(0.68±0.12)μg/L高于对照A组、对照B组(P<0.05);治疗后1 d联合组血清ACTA、CRP分别为(9.45±3.58)μg/L、(5.71±2.68)mg/L低于对照A组、对照B组(P<0.05);联合组疗效优于A组和B组(P<0.05)。结论联合采取超声清创及重组人表皮生长因子治疗肛周脓肿合并感染,可改善创面愈合及感染控制情况,缓解疼痛程度,增加创面血流量及经皮氧分压,调节EGF、ACTA等水平,提高整体治疗效果。

Effects of ultrasound debridement combined with recombinant human epidermal growth factor on treatment of patients with perianal abscess complicated with infection

OBJECTIVE To investigate the effect of ultrasound debridement combined with recombinant human epidermal growth factor on the levels of epidermal growth factor(EGF), activin A(ACTA) and wound blood flow in patients with perianal abscess complicated with infection. METHODS A total of 117 patients with perianal abscess co-infection in the Affiliated Hospital of Chengde Medical College from Feb. 2018 to Jan. 2020 were selected and divided into control group A(n=39), control group B(n=39) and combination group(n=39) according to the random number table method. On the basis of routine intervention, the control group A was treated with ultrasound debridement, the control group B was treated with recombinant human epidermal growth factor, and the combined group was treated with ultrasound debridement and recombinant human epidermal growth factor. The treatment status, pain score before and after treatment, wound blood flow and transcutaneous oxygen pressure, EGF, transforming growth factor-β(TGF-β), ACTA, C-reactive protein(CRP) levels and clinical efficacy of the three groups were calculated. RESULTS The wound healing time, infection control time, and hospitalization time of the combination group were(12.39±2.01),(5.22±1.56), and(13.91±2.51) days, respectively, significantly shorter than those of control group A and control group B. The clearance rate of wound bacteria was(89.13±4.64)%, significantly higher than that of control group A and control group B(P<0.001). The VAS scores of the three groups at day 1, 3, 7, and 14 after treatment were significantly lower than that before treatment, and the combination group was significantly lower than the control group A and the control group B(P<0.05). After treatment for 1 day, the wound blood flow and transcutaneous oxygen partial pressure of the combination group were(35.69±3.20) mmHg and(0.92±0.25) PU, respectively, which were significantly greater than those of the control group A and control group B(P<0.05). After treatment for 1 day, the serum EGF and TGF-β of the combination group were(0.70±0.11) μg/L and(0.68±0.12) μg/L, respectively, significantly higher than those in the control group A and control group B(P<0.05). After treatment for 1 day, serum ACTA and CRP of the combination group were(9.45±3.58) μg/L and(5.71±2.68)mg/L, respectively, which were significantly lower than those of control group A and control group B(P<0.05). The curative effect of the combined group was significantly better than that of group A and group B(P<0.05). CONCLUSION The combined use of ultrasonic debridement and recombinant human epidermal growth factor in the treatment of perianal abscess complicated with infection can improve wound healing and infection control, relieve pain, increase wound blood flow and transcutaneous oxygen partial pressure, regulate EGF, ACTA and other levels to improve the overall treatment effect.