两种浓度亚甲蓝注射液治疗老年人肛瘘切除术后疼痛的临床结局比较

秦蕾; 刘莉; 张晶; 韩宝; 徐慧岩; 叶宇飞; 曹科

doi:10.3969/j.issn.2095-5227.2021.10.009

两种浓度亚甲蓝注射液治疗老年人肛瘘切除术后疼痛的临床结局比较

Intradermal methylene blue injection with two different concentrations on postoperative pain reduction after anal fistulectomy in elderly patients

摘要

摘要:
背景亚甲蓝作为长效镇痛剂被广泛应用于肛肠疾病中，然而关于亚甲蓝对老年肛瘘患者术后镇痛效果及肛门功能影响的研究报道甚少。
目的观察两种浓度亚甲蓝注射液对老年人肛瘘切除术后的镇痛效果。
方法选取2012年3月- 2020年12月就诊于解放军总医院第一医学中心中医肛肠科的60岁以上肛瘘切除术后老年患者80例，按随机数字表法分为0.1%亚甲蓝注射液组和0.05%亚甲蓝注射液组，每组40例，患者术毕创面分别予以0.1%和0.05%亚甲蓝注射液封闭注射，观察不同时间点两组疼痛、创缘水肿、肛门坠胀、尿潴留、创面愈合时间、肛门失禁及其他不良反应。
结果 0.05%亚甲蓝注射液组术后1个月肛门失禁Wexner评分低于0.1%亚甲蓝注射液组Md(IQR)：2.00(2.00，3.00) vs 3.00(2.00，4.00)，P=0.009；术后3个月两组Wexner评分均降为0，差异无统计学意义(P ＞ 0.05)；两组术后1 d、3 d、7 d疼痛、创缘水肿、肛门坠胀及术后尿潴留、创面愈合时间均无统计学差异(P均＞ 0.05)。
结论 0.1%浓度亚甲蓝注射液与0.05%浓度亚甲蓝注射液对老年人肛瘘切除术后镇痛效果相当，但0.05%浓度亚甲蓝注射液对肛门功能的影响小，术后药物性肛门失禁风险低。

Abstract:
Background Methylene blue injection as a long-acting analgesic is widely used in anorectal diseases. However, there are few clinical studies on the effect of methylene blue injection on postoperative pain and anal function of anal fistulectomy in elderly patients.
Objective To observe the effect of methylene blue injection with two different concentrations on postoperative pain of anal fistulectomy in elderly patients.
Methods From March 2012 to December 2020, 80 elderly patients over sixty years old with anal fistulectomy were divided into two groups by random number method. Patients in the two groups were respectively injected with 0.1% and 0.05% methylene blue injection. Postoperative pain (NRS), anal bulge, wound-edge edema at different time points, uroschesis, wound healing time, copracrasia (Wexner score) and other adverse reactions were observed and compared between the two groups.
Results The Wexner score of 0.05% methylene blue injection group was lower than that of 0.1% methylene blue injection group at 1 month after surgery, and the difference between the two groups was statistically significant (MdIQR: 2.002.00, 3.00 vs 3.002.00, 4.00, P=0.009). There was no significant difference in Wexner score between the two groups at 3 months after surgery (P ＞ 0.05). No significant difference was found in the score of NRS, anal bulge, wound-edge edema, at the 1^st day, the 3^rd day, the 7^th day after surgery as well as in the score of uroschesis, wound healing time or other adverse reactions between the two groups (all P＞0.05).
Conclusion 0.1% methylene blue injection and 0.05% methylene blue injection are equivalent to postoperative pain of anal fistulectomy in elderly patients. However, 0.05% methylene blue injection has less effect on anal function and lower risk of copracrasia.

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