2021年2月3日星期三

preparation h hemorrhoids,A clinical study on the prevention of anal margin edema after hemorrhoid surgery with guanaconitine hydrobromide

    Summary

    OBJECTIVE: To compare the postoperative anal marginal edema of the patients with circular mixed hemorrhoids by intravenous infusion of gaaconitine hydrobromide and intravenous drip to observe the effects of gaaconitine on the prevention of anal edema The role and its mechanism. Methods: Thirty patients with circular mixed hemorrhoids requiring surgery were selected and randomly divided into test group and blank control group. The test group was injected at Yaoshu acupoint (1% lidocaine 20ml+3~4 drops of epinephrine hydrochloride + aconitine 2ml), after the operation, guanaconitine hydrobromide 8mg was added to 5% GNS500ml intravenously qd, three times in a row Day; the blank control group does not use aconitine, the rest are the same as the test group. The postoperative anal edema, complications and adverse drug reactions of the two groups of patients were observed and compared. Results: The incidence of anal marginal edema after the operation of circular mixed hemorrhoids was lower in those who used aconitine without treatment contraindications; the postoperative wound pain of patients who used aconidin was less than that of those who did not; It was observed that the use of aconitine A increased the occurrence of postoperative complications; no related manifestations of adverse reactions to the use of aconitine were observed. Conclusion: ①Gao Aconitum A has a definite effect on the prevention and treatment of anal marginal edema after circular mixed hemorrhoids; ②It is safe to use Gao Aconidin in hemorrhoid surgery; The wound pain can be relieved.

    Subject headings: Gaaconitine, prevention, hemorrhoid surgery, anal edema

    ABSTRACT

    Purpose:Observing the effect and mechanism of lappaconitine which can prevent from postoperative edema of the edge of the anus after hemorrhoidectomy, through the clinical study to compare 2 groups: a group patients who have crico-mixed hemorrhoids accept injection into Yaoshu point and intervenous drop infusion with lappaconitine, another group is a blank group. Method:Choose 30 patients with crico-mixed hemorrhoids who need operation and divide them into 2 groups in random: experimental group, comparison group. The experimental group accept injection into Yaoshu point (8mg lappaconitine ) before the operation and intervenous drop infusion (8mg lappaconitine add in 5% GNS500ml, iv gtt, qd, use 3 days )after the operation with lappaconitine. The comparison group neither accept injection into Yaoshu point (8mg lappaconitine) nor accept intervenous drop infusion (8mg lappaconitine add in 5% GNS500ml, iv gtt, qd, use 3 days ). The edema of the edge of anus,complication,and side effects w ere assessed. Result:The patients who were accepted injection into Yaoshu point and intervenous with lappaconitine had lower incidence of edema than the blank group. Furthermore,the subjective pain response was significantly less in the lappaconitine group. The method of lappaconitine did not increase the incidence of postoperative complications and side effects. Conclusion:①Lappaconitine can prevent from haemorrhoid postoperative edema of the edge of the anus after hemorrhoidectomy;②Lappaconitine can prevent the anorectal postoperative pain;③It is safe to inject lappaconitine before the operation of hemorrhoidectomy.

    Key words: lappaconitine precaution hemorrhoidectomy edema of the edge of the anus

    One. clinical information

    two. treatment method

    In group A, during hemorrhoid surgery, 20ml of 1% lidocaine + 3 to 4 drops of epinephrine hydrochloride + 2ml of epinephrine hydrobromide were injected at the Yaoshu point during anesthesia for hemorrhoid surgery. After the operation, 8mg of coronatine was added to 5% GNS500ml for intravenous Drop qd for three days. (2 ml of gacconate hydrobromide injection, containing 8mg of gacconate hydrobromide, plus 8 ml of normal saline); group B did not use gacconate hydrobromide during or after surgery. (The gauconine hydrobromide used in this clinical observation is all produced by Gansu Lanyao Pharmaceutical Group Co., Ltd., trade name: Lamborghini, product batch number: 20041101)

    three. Observation method

    Anal marginal edema evaluation method: According to the Zhengzhou National Anorectal Postoperative Efficacy Standard in 1978, follow-up for 14 days after the operation, record the presence or absence of edema and evaluate the edema, observe for 14 days without edema, the clinical score is 0; Edema is evaluated as I degree, and if it resolves within 7 days or appears as edema as II degree, within 10 days, the clinical score is 2; if the edema is evaluated as I or II degree, it resolves within 14 days, and the clinical score is 4. The appearance of edema is assessed as I or II degree, and the skin tag has not subsided after 14 days, and the clinical score is 6. And observe whether the two groups of patients have nausea, vomiting, dizziness, chest tightness, palpitation, itching, urticaria and other adverse reactions after medication.

    four. Treatment result

    (1) Observation and comparison of postoperative anal marginal edema, see Table 1 for details

    Table 1: Comparison of postoperative anal edema

    Number of cases

    No edema

    I degree edema

    Grade II edema

    P value

    Group A

    15

    12 (80%)

    3 (20%)

    0 (0%)

    <0.05

    Group B

    15

    5 (33.33%)

    9 (60.00%)

    1 (6.67%)

    After experimental observation and comparison, the data of the two groups were compared and analyzed by Chi-square test, and the P value was less than 0.05, indicating that the postoperative anal edema between the two groups was statistically significant, indicating that the use of aconitine can prevent postoperative anal edema after hemorrhoids occur.

    (2) Comparison of postoperative anal margin I degree edema with wound pain in the two groups, see Table 2 for details

    Table 2: Comparison of I-degree edema with wound pain in the two groups

    Group

    Number of cases

    4.5

    5.5

    6.5

    7

    7.5

    8

    8.5

    VAS mean value (x±s)

    A

    15

    1

    1

    1

    5.67±1.26

    B

    15

    1

    3

    1

    1

    3

    7.61±0.78

    After experimental observation and comparison, the data of the two groups were compared and analyzed by t-test, and the P value was less than 0.01, indicating that the two groups had postoperative anal marginal edema with wound pain. VAS score [2] [3] was statistically significant, indicating that the use of high Aconitine can not only prevent the occurrence of anal marginal edema after hemorrhoid surgery, but also significantly improve the painful symptoms of postoperative anal marginal edema accompanied by wounds.

    (3) Comparison of postoperative second-degree edema of anal margin with wound pain between the two groups

    There was no postoperative second-degree edema of the anal margin in the test group, and only 1 case in the control group, accompanied by a VAS pain score of 10.

    (4) Clinical analysis of postoperative edema

    A 14-day follow-up was carried out after the operation to record the comparison of the clinical efficacy scores of anal marginal edema, see Table 3

    Table 3: Comparison of clinical efficacy scores of anal marginal edema

    Group

    Number of cases

    0 marks

    2 minutes

    4 points

    6 points

    Average score (x±s)

    P value

    Group A

    15

    12

    2

    1

    0

    0.53±1.19

    <0.01

    Group B

    15

    5

    4

    5

    1

    2.27±1.98

    After experimental observation and comparison, the data of the two groups were compared and analyzed by t-test, and the P value was less than 0.01, indicating that the clinical curative effect score of anal marginal edema between the two groups was statistically significant. The occurrence of edema, and promotes the reduction of edema.

    (5) Observation and comparison of postoperative urine retention, see Table 4 for details

    Table 4: Comparison of postoperative urine retention

    Group

    Number of cases

    Grade I

    Grade II

    Grade III

    Grade IV

    P value

    Group A

    15

    12

    3

    0

    0

    >0.05

    Group B

    15

    6

    5

    3

    1

    After observation and records, the two groups were compared and analyzed by chi-square test. P>0.05, the difference in the occurrence of urinary retention between the groups was not statistically significant. It is believed that the use of aconitine had no effect on the occurrence of urinary retention after hemorrhoids. (Level I has no urinary dysfunction. Level II has poor urination, but does not require treatment and can discharge spontaneously. Level III requires conservative treatment. Level IV requires urinary catheterization.)

    (6) Observation of postoperative anal function:

    No patients with abnormal anal function were found after operation, so it can be considered that the use of aconitine will not cause abnormal anal function in patients after anorectal disease.

    (7) Observation of other postoperative complications and drug side effects, see Table 5 for details

    Table 5: Observation table of postoperative complications and drug side effects

    Group

    Number of cases

    Dizzy

    Chest tightness

    Flustered

    nausea

    Urticaria

    Number of cases

    P value

    Number of cases

    P value

    Number of cases

    P value

    Number of cases

    P value

    Number of cases

    P value

    Group A

    15

    1

    6.67

    >0.05

    0

    0.00

    >0.05

    0

    0.00

    >0.05

    1

    6.67

    >0.05

    0

    0

    >0.05

    Group B

    15

    1

    6.67

    1

    6.67

    1

    6.67

    1

    6.67

    0

    0

    Note: No vomiting, headache, skin pruritus occurred in each group, not listed in the table

    Statistical analysis of the observation results showed that the exact probability method among the groups showed that P>0.05, which was not statistically significant. Therefore, it can be considered that the use of aconitine seldom causes nausea, vomiting, dizziness, chest tightness, palpitation, skin itching, and urticaria.

    Fives. in conclusion

    Through the observation of this clinical trial, we came to the following conclusions: ①Gaoaconitine has a definite preventive effect on anal marginal edema after circular mixed hemorrhoids; ②Gaoaconitine is safe to use in hemorrhoid surgery; Aconitine can relieve the pain of wound after circular mixed hemorrhoid surgery.

    six. discuss

    Hemorrhoid surgery is prone to complicated anal marginal edema. Clinically, it is usually through comprehensive prevention before, during and after operation. Anorectal workers have also actively explored the surgical procedures, but it is still inevitable that anal marginal edema will occur after hemorrhoid surgery. . Can a drug prevention and treatment measure be found that has anti-inflammatory effects, prevents inflammatory factors from stimulating vasodilation and increased vascular permeability, and reduces the flow of fluid and cell components in blood vessels into the interstitium through the vascular wall, thereby reducing the local anal margin Tissue osmotic pressure and intravascular hydrostatic pressure prevent anal marginal edema; it also relieves local circulatory disturbances caused by anal sphincter spasm, so that two birds with one stone, inflammatory edema and congestive edema can be prevented.

    Aconitum hydrobromide is an alkaloid hydrobromide extracted from aconitum. In the early 1980s, it was approved by the drug administration department to become the first non-addictive analgesic drug in China. For more than 20 years, the drug has been widely used clinically to treat pain caused by various factors, and there are many reports of postoperative analgesia. Experimental studies have shown that its analgesic strength is seven times that of aminopyrine, and its analgesic effect is equivalent to that of melanidine, and it has anti-inflammatory and anti-swelling, cooling and antipyretic and local anesthetic effects [4].

    In this study, the experimental group used Yaoshu acupoint injection and postoperative intravenous infusion of Gaowujiasu to prevent and treat anal edema after hemorrhoids. The mechanism was analyzed and the following two points were made:

    There are three effects of injecting homoaconitine hydrobromide into Yaoshu points: one is local anesthesia, which is mainly aimed at rapid pain. It exerts analgesic effect in advance, prevents harmful stimuli from harmful effects on the body, and uses its analgesic effect to improve Pain threshold to relieve pain, relieve anal sphincter spasm, reduce capillary pressure, smooth blood circulation, body fluids rarely stay in the anal marginal loose subcutaneous space and form anal marginal edema. Similarly, the relief of anal sphincter spasm is also conducive to lymphatic fluid Reflux; the second is acupoint stimulation [5] [6]. Acupoint stimulation can release morphine-like substances from the central nervous system and act on opioid receptors to produce analgesic effects. Acupoint injection of analgesic drugs is used to play the dual role of acupoints and drugs. The combination of Chinese and Western medicine enhances the analgesic effect, thereby reducing the harm of noxious stimuli, and alleviating the spasm of the anal sphincter; the third is anti-inflammatory and anti-swelling effects, using the anti-inflammatory effect of aconitine hydrobromide to inhibit inflammatory mediators such as : Release of bradykinin, substance P, histamine, purine, etc., so as to avoid the damage of inflammatory mediators to vascular endothelial cells, improve vascular permeability, and prevent postoperative anal edema.

    Postoperative intravenous infusion of Gacconate Hydrobromide [7] can prevent central sensitization and inhibit the production of pain-causing substances. Modern pharmacological studies have shown that Gacconate can inhibit the effects of substance P and somatostatin on the spinal cord. It can also act on endogenous norepinephrine and 5-HT to produce an anti-noxious stimulus. Many pain-causing substances such as substance P, bradykinin and 5-HT are also inflammatory mediators that damage vascular endothelial cells. Aconitine intravenous infusion mainly has a systemic analgesic effect, relieves the spasm of anal sphincter to a certain extent, and can also inhibit the production of pain-causing substances (inflammatory mediators) that can damage vascular endothelial cells, improve microcirculation, and prevent anal margins after hemorrhoid surgery Edema.

    Therefore, in our clinical study on the prevention and treatment of postoperative pain of anorectal disease with acconitone hydrobromide, we found that it also has a preventive effect on postoperative anal edema, which coincides with the pharmacological effect of acconitone in anti-inflammatory and swelling And he.

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