[收稿日期]2021-12-30 [修回日期]2022-11-17[基金项目]河北省中医药管理局科研计划项目(2019445)[作者单位]河北省石家庄市中医院妇科,050000[作者简介]杨 洁(1983-),女,主治医师.[文章编号]1000⁃2200(2023)07⁃0932⁃05㊃临床医学㊃穴位贴敷联合补肾活血法对复发性流产病人外周血中抗β2糖蛋白Ⅰ抗体㊁血小板功能的有效性分析杨 洁,毕亚菊,梁志超[摘要]目的:探究穴位贴敷联合补肾活血法对复发性流产病人的有效性分析㊂方法:选取复发性流产病人90例,将其随机分为西药组(A 组)㊁西药+中药组(B 组)㊁西药+中医综合治疗组(C 组),每组30例㊂A 组:口服阿司匹林;B 组:口服阿司匹林同时给予补肾活血中药;C 组在B 组的基础上应用穴位贴敷;均至孕12周㊂观察3组病人治疗前后临床疗效㊁血清人绒毛促性腺激素(hCG)㊁孕酮(P)㊁抗心磷脂抗体(ACA)㊁抗β2糖蛋白Ⅰ抗体(Anti⁃β2⁃GPⅠ)及B 超情况等㊂结果:治疗后,3组疗效差异有统计学意义(P <0.05);C 组疗效高于A㊁B 组(P <0.05~P <0.01)㊂治疗后,3组病人hCG 与P 较同组治疗前明显升高(P <0.01),C 组明显高于A㊁B 组(P <0.01)㊂治疗后,B㊁C 组病人ACA 及Anti⁃β2⁃GPI 阳性率均较同组治疗前降低(P <0.05),A 组与治疗前比较降低程度差异无统计学意义(P >0.05)㊂治疗后,3组ACA 和Anti⁃β2⁃GPI 阳性率比较,差异均有统计学意义(P >0.05),其中C 组低于A 组和B 组(P <0.05)㊂治疗后,3组血小板功能均有所改善,D⁃二聚体(D⁃D)水平明显低于治疗前(P <0.01),C 组D⁃D 水平明显低于A㊁B 组(P <0.01),B 组明显低于A 组(P <0.01)㊂结论:穴位贴敷联合补肾活血法对复发性流产病人治疗具有显著疗效,可有效改善病人激素水平及血小板功能,提高病人治愈率,值得在临床应用㊂[关键词]复发性流产;穴位贴敷;补肾活血法;血小板功能;抗β2糖蛋白Ⅰ抗体[中图法分类号]R 714 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2023.07.018Effectiveness analysis of acupoint application combined with kidney tonificationand blood activation method on anti⁃β2glycoprotein Ⅰantibodyand platelet function in patients with recurrent abortionYANG Jie,BI Ya⁃ju,LIANG Zhi⁃chao(Department of Gynecology ,Shijiazhuang Hospital of Traditional Chinese Medicine ,Shijiazhuang Hebei 050000,China )[Abstract ]Objective :To investigate the effectiveness analysis of acupoint application combined with kidney tonification and blood activation method on patients with recurrent abortion.Methods :A total of 90patients with recurrent abortion were selected and randomly divided into western medicine group (group A),western medicine +triditional Chinese medicine group (group B)and western medicine +Chinese medicine comprehensive treatment group (group C),with 30patients in each group.Group A:oral aspirin;group B:oral aspirin and triditional Chinese medicine for kidney tonification and blood activation;group C:acupoint application on the basis of group B;all until 12weeks of pregnancy.The clinical efficacy,serum human chorionic gonadotropin (hCG),progesterone (P),anti⁃cardiolipin antibody (ACA),anti⁃β2⁃glycoprotein Ⅰantibody (anti⁃β2⁃GPⅠ)and ultrasound were observed before and after treatment in the three groups.Results :After treatment,the differences were statistically significant in the efficacy of the three groups (P <0.05),and the efficacy of group C was higher than that of group A and group B (P <0.05to P <0.01).The hCG and P were significantly higher in patients of the three groups compared with the same group before treatment (P <0.01),and group C was significantly higher than group A and group B (P <0.01).The positive rates of ACA and anti⁃β2⁃GPⅠin group B and group C were lower than those before treatment in the same group (P <0.05),and the difference between the degree of reduction in group A and before treatment was not statistically significant (P >0.05).The positive rates of ACA and anti⁃β2⁃GPⅠbetween the three groups were statistically significant (P >0.05),among which,group C was lower than group A and group B (P <0.05).The platelet functionimproved in all groups,the (D⁃D)levels were significantly lower than before treatment (P <0.01),the D⁃D levels in group C were significantly lower than those in group A and group B (P <0.01),and group B was significantly lower than group A (P <0.01).Conclusions :Acupoint application combined with kidney tonification and blood activation method has significant efficacy in the treatment of patients with recurrent abortion,which can effectively improve the hormone level and platelet function of patients and increase the cure rate of patients,and is worthy of clinicalapplication.[Key words ]recurrent abortion;acupoint application;kidney tonification and blood activation method;platelet function;anti⁃β2glycoproteinⅠantibody 妇女在孕龄期同一性伴侣的情况下,连续2次及其以上的自然流产被称为复发性流产,其发病率在1%~5%,反复流产给病人身心带来严重的打击[1]㊂近年来,复发性流产发病率有升高的趋势,且病因复杂,治疗方案有限,临床处理困难,急需寻求安全有效的综合治疗手段㊂妊娠是一个较复杂的生理过程,其过程涉及到子宫环境㊁生殖系统㊁胚胎发育㊁激素水平与免疫调节等多个因素,一种因素的紊乱都将会影响妊娠结局[2-4]㊂复发性流产早期多表现为阴道少量出血㊁下腹隐痛等,尽早干预治疗,可有效增大妊娠成功的概率[5-6]㊂西医目前常常给予内分泌治疗㊁免疫治疗㊁抗凝治疗等手段[7],但治疗临床疗效不佳,而越来越多的学者报道显示,采用中西医结合法治疗复发性流产取得了明显的进步,中医强调补肾以固先天,大多通过补肾活血的治疗原则来预防流产㊂本研究通过观察穴位贴敷联合补肾活血中药对复发性流产的临床疗效,来探讨此法保胎作用的机制,并为该病的治疗探索出一条安全有效的新方案㊂现作报道㊂1 资料与方法1.1 纳入及排除标准 纳入标准:符合西医诊断标准,根据‘妇产科学“复发性流产诊断标准[8];符合中医诊断标准,根据‘中医妇科学“标准制定[9],屡孕屡堕,阴道出血,腰膝酸软,头晕耳鸣,夜尿频多,经色暗红,舌紫黯,苔薄白,脉细滑或细涩;2次及以上自然流产史;B超检查生殖器官无畸形;男方精液无异常;签署知情同意书㊂排除标准:生殖器官异常等其他感染㊁免疫等因素引起的流产;严重精神疾病病人;心肺肝肾功能不全者㊂1.2 一般资料 选取2019年1月至2020年3月我院符合纳入标准的复发性流产病人90例,将其随机分为西药组(A组)㊁西药+中药组(B组)㊁西药+中医综合治疗组(C组),每组30例㊂A组:年龄21~38岁;流产次数3~6次,流产时间孕28~ 116d㊂B组:年龄20~39岁;流产次数3~7次,流产时间孕26~120d㊂C组:年龄21~39岁;流产次数3~6次,流产时间孕25~122d㊂本研究已通过医学伦理委员会批准及本人同意,3组病人一般资料均具有可比性㊂1.3 方法 3组均给予黄体酮基础治疗,A组:口服阿司匹林(25mg,100片,国药准字H13023716,神威药业集团有限公司)75mg,1次/天;B组:在A 组的基础上给予补肾活血中药(基本方为菟丝子15g,川断15g,桑寄生15g,阿胶6g,熟地15g,太子参15g,茯苓15g,白术12g,山萸肉10g,当归9g,鸡血藤9g,丹参9g,随症加减),每日一剂,水煎至200mL,早晚分服;C组:在B组的基础上同时给予穴位贴敷(将上述方剂中药材按比例研磨为粉,并加蜂蜜混合,加热后融化为糊状,制成大小约1cm×1cm的穴位贴敷贴),取穴双足三里㊁双涌泉穴㊁双公孙穴,每次4~6h,1次/天㊂3组病人均给药直至孕12周㊂1.4 观察指标 1.4.1 临床疗效 显效:病人阴道出血消失及其他临床症状消失,B超检查胎儿各项指标与妊娠时间相符合,妊娠成功;有效:病人阴道出血减少,其他临床症状好转,B超检查胎儿各项指标基本正常;无效:病人症状无明显改善,或发生流产[10]㊂总有效率=(显效例数+有效例数)/总例数×100%㊂1.4.2 指标检测 抽血病人空腹外周血,静置后, 3000r/min离心15min取上清液,电化学发光免疫法测量孕酮(P)㊁人绒毛膜促性腺激素(hCG)水平;全自动生化分析仪检测血小板计数(PLT)㊁D⁃二聚体(D⁃D)水平;酶联免疫吸附法检测抗心磷脂抗体(ACA)和抗β2糖蛋白Ⅰ抗体(Anti⁃β2⁃GPⅠ)阳性率的变化㊂1.5 统计学方法 采用方差分析㊁q检验和χ2检验㊂2 结果2.1 3组病人临床疗效比较 3组疗效差异有统计学意义(P<0.05)㊂3组总有效率比较,差异亦有统计学意义(P<0.05),其中C组均高于A组和B组(P<0.05~P<0.01)(见表1)㊂表1 3组病人临床疗效比较[n;百分率(%)]分组n显效有效无效总有效A组307(23.33)11(36.67)12(40.00)18(60.00) B组3010(33.33)12(40.00)8(26.67)22(73.33) C组3013(43.33)15(50.00)2(6.67)28(93.33)**#χ2 7.149.14P <0.05<0.05 与A组比较**P<0.01;与B组比较#P<0.052.2 3组病人hCG、P水平比较 治疗后,3组病人hCG和P均较同组治疗前明显升高(P<0.01),C 组明显高于A㊁B组(P<0.01),B组明显高于A组(P<0.01)(见表2)㊂表2 3组病人hCG㊁P水平比较(x±s)分组n hCG/(mIU/L)P/(nmol/L)治疗前 A组3036.18±4.6271.09±5.87 B组3036.80±4.0571.30±5.92 C组3036.67±4.5671.15±5.33 F 0.160.02 P >0.05>0.05 MS组内 19.51432.637治疗后 A组3064.69±6.37▲89.33±6.20▲ B组3098.27±7.83*▲112.92±6.40*▲ C组30124.80±8.39*#▲133.84±7.43*#▲ F 474.06331.56 P <0.01<0.01 MS组内 57.42644.868 q检验:与A组比较*P<0.01,与B组比较#P<0.01;与同组治疗前比较▲P<0.012.3 3组病人ACA和Anti⁃β2⁃GPI阳性率变化比较 治疗后,B㊁C组病人ACA及Anti⁃β2⁃GPI阳性率均较同组治疗前降低(P<0.05),A组与治疗前比较降低程度差异无统计学意义(P>0.05),治疗后,3组ACA和Anti⁃β2⁃GPI阳性率比较,差异均有统计学意义(P>0.05),其中C组低于A组和B组(P<0.05)(见表3)㊂ 表3 3组病人ACA及Anti⁃β2⁃GPI阳性率变化比较[n;百分率(%)]分组n ACA Anti⁃β2⁃GPI治疗前 A组3013(43.33)15(50.00) B组3014(46.67)14(46.67) C组3014(46.67)16(53.33) χ2 0.090.27 P >0.05>0.05治疗后 A组3011(36.67)12(40.00) B组305(16.67)#6(20.00)# C组302(6.67)*#3(10.00)*# χ2 8.757.82 P <0.05<0.05 与A组比较*P<0.01,与同组治疗比较#P<0.052.4 3组病人血小板功能比较 治疗后,3组血小板功能均有所改善,但治疗前后3组PLT差异无统计学意义(P>0.05),D⁃D水平明显低于治疗前(P<0.01),C组D⁃D水平明显低于A㊁B组(P<0.01),B组明显低于A组(P<0.01)(见表4)㊂表4 3组病人血小板功能比较(x±s)分组n PLT/(×109/L)D⁃D/(μg/L)治疗前 A组30173.64±28.70372.54±46.88 B组30174.14±29.08373.65±45.90 C组30173.57±29.21373.69±45.25 F 0.000.01 P >0.05>0.05 MS组内 840.8542117.369治疗后 A组30174.17±29.52185.27±32.91▲ B组30174.58±32.84149.71±30.49*▲ C组30175.19±35.42116.40±27.73*#▲ F 0.0138.38 P >0.05<0.01 MS组内 1068.158927.220 q检验:与A组比较*P<0.01;与B组比较#P<0.01;与同组治疗前比较▲P<0.013 讨论 复发性流产是不育症的常见类型之一,病因复杂多样,且常常为多环节异常共同导致,现代人群普遍生活压力较大,生活习惯不规律,加之环境污染因素,复发性流产的发病率呈增长趋势[11-13]㊂西医在治疗一些不明原因的复发性流产时,应用主动免疫及被动免疫疗法[14-15],但此方法复杂且风险较高,在临床应用上未进行大规模推广,中医药综合疗法在治疗妇产科疾病方面,有独特的优势,坚持中西医并重联合治疗,可弥补中西医两方在治疗疾病方面的不足,互相发挥所长[16]㊂本研究采用穴位贴敷联合补肾活血中药形成中医综合疗法,加上阿司匹林对复发性流产病人进行治疗,研究结果表明,病人治疗总有效率明显提高,hCG㊁P水平显著升高,病人ACA及Anti⁃β2⁃GPI阳性率均显著降低,血小板功能明显改善,B超检查胎儿各项指标㊁胎心㊁胎囊等发育与妊娠时间符合度提高,说明该方法有效可靠,具有一定的临床价值㊂hCG与胚胎滋养细胞的数量和对数生长有关,能直观㊁特异地反映受精后早期胚胎的生长发育情况,在受精后的第九天就可以在母体的血清中检测到,足量的hCG可使妊娠黄体不退化,维持胚囊发育,反之持续低水平的hCG将影响胚胎的发育或着床[17-19]㊂在先兆流产病例中,流产结局者的P水平也显著低于保胎成功继续妊娠者,这提示检测血清P水平对早期妊娠不良结局有预示作用,P过低,与血HCG水平不相符,可提示胚胎无活力等,可见在孕早期对hCG㊁P水平检测尤为重要[20]㊂Anti⁃β2⁃GPI能够对血小板细胞表面凝血酶原的活性进行抑制,ACA抗体阳性病人具有较强的血小板凝集功能,易形成血栓,当ACA存在较多时,可利用Anti⁃β2⁃GPI增加其表达作用,因此,目前研究认为ACA 与Anti⁃β2⁃GPI在机体中与血栓形成密切相关,降低病人ACA阳性率是维持妊娠结局的重要因素[21]㊂血小板功能指标可直观的显示体内高凝状态,检测血小板功能,及时给予干预治疗,能增加胎盘血供,阻止流产发生㊂中医将该病称为 滑胎” 胎漏”等, 肾藏精,主生殖”,肾精不足,内生虚热,血热迫血妄行,至于脉外而致血瘀,或肾气亏虚,推动无力,血瘀阻胞脉,胎元无所养,可致滑胎,可见本病是以肾虚为本,血瘀为标为病机,在治疗过程中应以补肾㊁活血作为主要原则[22-23]㊂方中菟丝子㊁川断㊁桑寄生固冲任㊁益精血;白术健脾益气且可起安胎之效,茯苓健脾宁心,太子参益气健脾,此三味药共起健脾益气之效,补益后天之本以助生血,同时以气行血,改善血瘀之象;阿胶滋阴补血,当归㊁鸡血藤补血活血,丹参活血祛瘀㊁清心除烦,此四味药同为血药,补血活血,以防活血太过;山萸肉㊁熟地温阳补肾安胎;诸药合用补中益气㊁活血养血㊁固肾安胎之效㊂现代药理表明药物通过透皮吸收入体循环可发挥较好的疗效,穴位贴敷是一种中医外治法,药物通过贴于肌表特定穴位,通经络沟通表里上下,连接五脏六腑,调理诸病[24]㊂足三里为足阳明经穴位,健脾益气,生发胃气;涌泉穴为足少阴肾经穴位,生发肾气,固肾益精;公孙为足太阴之络穴,八脉交会之穴,直通冲脉,冲脉为血海,调节十二经之气血㊂本研究结果表明刺激足三里穴㊁涌泉穴㊁公孙穴,可达到疏通经络,益气固冲,补肾安胎的目的㊂综上,穴位贴敷联合补肾活血中药在治疗复发性流产时,疗效显著,为中医药综合疗法的推广提供临床依据㊂该研究需进一步研究中医手段安胎的作用机制与安全性,使之成为防治复发性流产的安全有效必备措施㊂[参考文献][1] 李佶,陈应超.复发性流产的中西医结合诊治思考[J].中国中西医结合杂志,2019,39(5):525.[2] 兖娜娜,杨菁.复发性流产的治疗进展[J].中华生殖与避孕杂志,2018,38(11):951.[3] 李欣艺,赵金霞,刘湘源.抗磷脂抗体相关性复发性流产的诊治:附75例抗磷脂综合征患者妊娠期用药和结局分析[J].北京大学学报(医学版),2018,50(6):956.[4] 贺立颖,王统菲,刘志兰,等.复发性流产患者抑郁㊁焦虑情况调查及其相关因素分析[J].上海交通大学学报(医学版),2017,37(3):381.[5] ARJMAND F,GHASEMI N,MIRGHANIZADEH SA,et al.Thebalance of the immune system between HLA⁃G and NK cells inunexplained recurrent spontaneous abortion and polymorphismsanalysis[J].Immunol Res,2016,64(3):785.[6] AFKHAMI F,KHANIANI MS,FARZADI L,et al.The HLA⁃G14bp insertion/deletion polymorphism in recurrent spontaneousabortion among iranian women[J].Tissue Antigens,2015,86(2):94.[7] XIANG H,LIU S,CHEN Z,et al.A single nucleotidepolymorphism in the MTOR gene is associated with recurrentspontaneous abortion in the Chinese female population[J].SystBiol Reprod Med,2015,61(4):205.[8] 刘洪娟,易蕾,陈梅娟,等.逍遥散与归芍五子汤联合参芎葡萄糖注射液治疗子宫动脉血流阻力增高型复发性流产的临床效果[J].中华全科医学,2019,17(3):423.[9] 谈勇.中医妇科学[M].北京:中国中医药出版社,2016:45.[10] 姜朵生,张迎春,李芳园,等.中西医结合治疗对原因不明复发性流产患者性激素及外周血免疫细胞的影响[J].现代中西医结合杂志,2017,26(5):461.[11] 张清华,潘静,姚丽.复发性流产患者病因构成分析[J].中国全科医学,2020,23(14):5.[12] 常卓,李娜,张杨,等.补肾活血方对抗心磷脂抗体阳性复发性流产患者血清和蜕膜中环氧化酶2及前列腺素E2的影响研究[J].中国全科医学,2020,23(9):1158. [13] 李伟莉,郝乐乐,金雅,等.补肾安胎冲剂调节TGF⁃β1及其下游PI3K/AKT信号通路改善复发性流产小鼠母胎界面血管生成[J].北京中医药大学学报,2020,43(2):125. [14] 韩春艳,孙自学,胡晓华,等.加味寿胎丸治疗血栓前状态致复发性流产的疗效及对凝血因子的影响[J].中国实验方剂学杂志,2020,26(10):51.[15] 谢多,杜丹丽,梁军.不明原因复发性流产的临床免疫治疗进展[J].蚌埠医学院学报,2019,44(6):836.[17] 于鹏跃,赵凤莲,张晓华,等.血栓弹力图㊁平均血小板体积/血小板计数比值和纤维蛋白原水平对复发性流产的预测价值[J].吉林大学学报(医学版),2020,46(1):127. [17] 韩春艳,孙自学,宋艳丽.补肾安胎饮对肾虚型不明原因复发性流产患者的临床疗效[J].中成药,2019,41(12):3067. [18] 陈莎,谢京红,周文清,等.补肾助孕法孕前调理治疗复发性流产的临床观察[J].中国中医基础医学杂志,2019,25(10):1397.[19] 武颖,张莹,辛明蔚,等.养血安胎方对肾虚血瘀型复发性流产小鼠胚胎植入及蛋白表达的作用机制[J].中华中医药杂志,2019,34(10):4552.[20] 冯晓玲,赵小萱,王磊,等.治未病思想指导下针刺结合补肾活血法治疗复发性流产的临床观察[J].时珍国医国药,2019,30(9):2183.[21] 李华,傅晓冬,柳怡,等.补肾调冲方联合常规西药治疗复发性流产肾虚血瘀型疗效及对患者血清Th1/Th2细胞因子平衡偏移的影响[J].中国实验方剂学杂志,2018,24(5):171.[收稿日期]2020-11-10 [修回日期]2022-08-25[基金项目]上海市卫生健康委员会中医优势病种培育项目(ZYBZ⁃2017055)[作者单位]上海市嘉定区中医医院1.麻醉科,2.肛肠科,201800[作者简介]金玉燕(1981-),女,主治医师.[文章编号]1000⁃2200(2023)07⁃0936⁃05㊃临床医学㊃地塞米松复合罗哌卡因切口浸润对复杂性肛瘘术后疼痛及切口愈合的影响金玉燕1,邵 逸1,童贻捷1,应光耀2[摘要]目的:探讨地塞米松复合罗哌卡因切口浸润对复杂性肛瘘术后疼痛及切口愈合的影响㊂方法:收集复杂性肛瘘病人120例,随机分为对照组㊁罗哌卡因组和复合组,各40例㊂均采用定向挂线法治疗,术前3组病人均应用罗哌卡因行硬腰联合麻醉,术中及术后罗哌卡因组病人切口使用罗哌卡因浸润,复合组病人切口使用地塞米松复合罗哌卡因浸润,对照组病人切口不做处理,比较3组病人术后切口疼痛㊁渗液情况及愈合时间㊂此外,大鼠肛瘘手术模型同样随机分为对照组㊁罗哌卡因组和复合组,术中及术后用药及处理同病人分组㊂术后7d 观察大鼠切口愈合情况,然后取创面组织,采用Western blotting 法检测组织中血管内皮生长因子(VEGF)㊁碱性成纤维细胞生长因子(bFGF)蛋白表达水平;分析各组创面组织病理变化及炎症细胞浸润情况;采用qPCR 法检测组织中白细胞介素(IL)⁃1β㊁IL⁃6㊁肿瘤坏死因子α(TNF⁃α)mRNA 表达水平㊂结果:术后3㊁7㊁14d,复合组和罗哌卡因组病人疼痛及渗液积分均明显优于对照组,复合组病人亦均明显优于罗哌卡因组(P <0.01)㊂动物实验结果显示,相较于对照组,复合组和罗哌卡因组大鼠创面组织愈合率及VEGF㊁bFGF 蛋白表达均明显增加,IL⁃1β㊁IL⁃6㊁TNF⁃αmRNA 表达均明显降低(P <0.01);且复合组大鼠创面组织愈合率㊁VEGF㊁bFGF 蛋白表达均高于罗哌卡因组,IL⁃1β㊁IL⁃6㊁TNF⁃αmRNA 表达均明显低于罗哌卡因组(P <0.01)㊂结论:地塞米松复合罗哌卡因切口浸润切口明显降低复杂性肛瘘病人术后疼痛并加速切口愈合,动物实验得到同样结论,可为临床应用提供依据㊂[关键词]复杂性肛瘘;地塞米松;罗哌卡因;疼痛;切口愈合[中图法分类号]R 657.16 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2023.07.019Effects of dexamethasone combined with ropivacaine incision infiltrationon pain and wound healing after complex anal fistula surgeryJIN Yu⁃yan 1,SHAO Yi 1,TONG Yi⁃jie 1,YING Guang⁃yao 2(1.Department of Anesthesiology ,2.Department of Proctology ,Shanghai Jiading Hospitalof Traditional Chinese Medicine ,Shanghai 201800,China )[Abstract ]Objective :To explore the effects of dexamethasone combined with ropivacaine incision infiltration on pain and wound healing after complex anal fistula surgery.Methods :A total of 120patients with complex anal fistula surgery were collected and randomly divided into control group,ropivacaine group,and combination group,with 40patients in each group.All patients were treated by directional thread⁃drawing procedure.Before surgery,the patients were anesthetized by ropivacaine via spinal anesthesia.During or post⁃surgery,the incisions were infiltration with dexamethasone combined with ropivacaine in the combination group,the incisions were infiltration with ropivacaine in the ropivacaine group,and the incision of the control group was not treated.The pain,exudation andwound healing time after operation were compared among the three groups.Besides,the rats with anal fistula were randomly divided into control group,ropivacaine group,and combination group.The medication and treatment during and postoperation were the same as those of the patients.The wound tissues were collected 7days after surgery.Western blotting was used to measure the protein expressions of VEGF and bFGF.Histopathology was used to analyze the inflammatory cell infiltration.qPCR was used to detect the mRNA expressions of IL⁃1β,IL⁃6and TNF⁃α.Results :At 3,7and 14day aftersurgery,the pain and seepage grades in patients of the ropivacaine group and combination group were significantly better than those of the control group,and the patients in the combination group were also significantly better than those inthe ropivacaine group (P <0.01).Animal experiment results[22] 黄淑晖,刘淮.抗磷脂综合征的围产期抗凝治疗[J].中国实用妇科与产科杂志,2017,33(7):675.[23] 贺晓霞,王若光.补肾化瘀方治疗孕早期复发性流产前血栓状态的临床研究[J].中药药理与临床,2016,32(6):209.[24] 郭佳丽,茆康卫,杨自金,等.培土生金穴位敷贴对CVA 患儿免疫球蛋白及T 淋巴细胞亚群的影响[J].蚌埠医学院学报,2019,44(8):1084.(本文编辑 刘畅)。
