Clinical And Experimental Study Of Injection And Embedding In ChangQiang Points On Postoperative Pain Of Anal Disease

Therapy of western medicine on anal postoperative pain has many side-effects.Indication and high economic expense of modified operation and technique holdback its spread and application.Traditional Chinese medicine(TCM)has its advantages of convenience,validity and less side-effects,but it has some problems in its clinical studies,retard its extension.Study on injection and embedding in changqiang points for intervention on hemorrhoid post-operative pain has its advantages of easy to operate,safe and effective.This study include literature study, prophase research,experimental and clinical studies.Study mechanism of its effects from both clinical and experimental.Provide bases for extension.Study include four parts.First part:Documental summary1.Summary the name,the mechanism,dialectical and therapy of postoperative pain.2.Summary influencing factors include sex,age,psycho-mental factors on pain.3.Summary progress of western medicine on postoperative pain include its epidemiology,mechanism,animal model and therapy.Provide basis for experimental studies.4.Review progress of western medicine on hemorrhoid postoperative pain,provide basis for clinical studies.Second part:prophase research(1)Retrospective study of analgesics on hemorrhoid postoperative pain.Objective:Find out the limitation of analgesia on hemorrhoid postoperative pain.Method:Analysis of 344 case history of hemorrhoid postoperative patients.Find out the service condition of analgesics,include its first intervention,total dose,type of analgesics and influencing factors.Result:Different age and number of incision has statistical differences on use of analgesics (P＜0.05).Demand for analgesics within 24h postoperative is much more than 24h afterwards(P＜0.001).In 344 patients 97 patients(28.20%)had used analgesics.First intervention time is(21.72±42.79)h,median demand time is 6.3h.(2)Clinical study of point injection and embedding on hemorrhoid postoperative pain.Objective:clinical study on efficacy and safety of point injection and embedding on hemorrhoid postoperative pain.Method:60 patients are divided into treatment group.30 patients with point injected Lappaconitine hydrobromide(LH)injection,point embedding and control group 30 patients with Indometacin Suppositories(IS).Evaluate pain intensity with VAS,compare safe and effective of groups.Result:VAS on period of 6h,12h,24h and 7d followed operation in treatment group is significant less than control group(P＜0.05).In treatment group 5 patients had marked effect,21 patients had effect,4 patients had no effect,total effective rate is 86.7%;in control group,2 patients had marked effect,17 patients had effect,11 patients had no effect,total effective rate is 63.3%(P＜0.05).In treatment group 1 patients had adverse effect,in control group,8 patients had adverse effect.Second part:Clinical research.Objective:RCT study on evaluate safe and effective of point injection and embedding(PIE) on hemorrhoid postoperative pain.Provide basis for less pain hemorrhoid post-operation with intervention of TCM.Method:120 patients are randomly divided into two groups.i.e.treatment group(n=60)and control group(n=60).The treatment group is treated by PIE.The control group is treated by IS,1 pill per day,treatment course is 7days.Compare effects of intervention methods on psycho-mental factors.Compare efficacy and safety of two groups.Result:Basic pain threshold has significant sex differences.Threshold in male is higher than female.patients with moderate-severe pain intensity in PIE group is less than IS group on period of 48h,4d post surgery(P均＜0.05)。On all interview periods,comprehensive therapeutictotal effect score(CTES)in PIE group is less than IS group.(P＜0.05)。In PIE group, patients with dysuria,anus edema,analgesics combinations are significant less than IS group (P＜0.05)。Patient satisfaction in PIE group is better than IS group(P＜0.05)。With no difference in baseline,YSDS and YSAS in PIE group is significant less than IS group post-operation(P＜0.05)。Total effective rate of PIE group on all periods is 53.7%,75.9%, 79.6%,96.3%,respectively.Total effective rate of IS group on all periods is 27.5%,58.8%, 68.6%,84.3%,respectively.Total effective rate of PIE is significance higher than IS group on 1 d,7d post operation(P＜0.05)o 4 patients(7.4%)have side-effects in PIE group,but 13 patients(16.2%)in IS group(P＜0.05).Third part:Experimental researchExperiment 1:Study on establishing anus incisional pain model of experimental rats. Objective:Research on the method of making anus incisional pain model of experimental rats.Method:Choose 60 healthy rats,under intraperitoneal anesthesia,make a radial incision with length of 1cm on the left of anus,six rats are determined primary hyperalgesia and secondary hyperalgesia with electronic vonfrey detector on all periods.6 rats are sacrificed 2h post-operation,6 rats are sacrificed 24h post-operation,6 rats are sacrificed 7d post-operation,6 rats made no incision.Local tissue were cut out-for to make histological observation,if it accord with clinical surgical process,and produce hyperalgesia,the model is successful.Result:Compare with pre-operation,primary mechanical hyperalgesia persisted 5 days, and secondary mechanical hyperalgesia persisted 48h following incision in the anus.Two hours after incision,the tissue showed a mild inflammatory cell infiltrate containing mainly lymphocytes with a minor presence of plasma cells.Moderate inflammation was present within the underlying dermis 24 h after incision,seven days after incision,the tissues showed a mild-moderate inflammatory cell infiltrate in the dermis with overlying fibrinopurulent exudate.The control tissues showed a normal epidermis,dermis and subcutaneous tissue with no inflammatory cell infiltrate.The model is successful.Experiment 2:Method of PIE on hyperalgesia of incisional pain rats.Objective:Research on Method of PIE on hyperalgesia of incisional pain rats.Method:48 healthy rats with basic pain threshold in a range of 10~20s,divided into six groups randomly.i.e.normal group(A),model group(B),PI(point injection)group(C),PIE group(D),PE(E)(point embedding)and PS(point injection saline)group(F).Followed successful anesthesia,operate intervention.10 min later,make no operationg in A group,while make operation in B,C,D,E,F groups.Determined primary hyperalgesia and secondary hyperalgesia with electronic vonfrey detector on all different periods.Record amount of fecal pellet within 6h followed conscious.Result:(1)Vonfrey level(VF)of groupB are significant less than group A on all periods (P＞0.05).VF in group D on 6h,24h,48h,72h,4d followed operation in local tissue is higher than group C,the same as 1h,2h,6h,24h followed operation away from incision 15mm(P＜0.05).VF in group D on 1h,2h,6h,24h,48h,72h,4d,5d,6d followed operation in local tissue is higher than group B,the same as 1h,2h,6h,12h,24h,48h followed operation away from incision 15mm(P＜0.05).Number of fecal pellet(NFP)in group B is significant less than group A(P=0.02),NFP in group D and group C is significant more than group B. conclude:PIE can improve hyperalgesia,and more effective than PE and PI.Experiment 3:Effect of PIE on SP at peripheral and spinal levelObjective:Study effect of PIE on SP at peripheral and spinal level.Method:Followed successful intervention and operation,rats were sacrificed,cut out-for tissue of local and spinal,make immunohistochemical Detection.Result:SP in group C and D is less than group B at both levels of peripheral and spinal (P＜0.05).SP in group B is higher than group A at both levels of peripheral and spinal (P＜0.05).SP in group E is less than group B at levels of peripheral(P＜0.05).SP in group D is less than group E both at levels of peripheral and spinal(P＜0.05);No difference of SP in group C and E at levels of peripheral and spinal(P＞0.05).Conclude:SP may play important role in mechanism of incisional pain.PIand PIE may play its role at at levels of peripheral and spinal.Experiment 4:Effect of PIE on IL-1βat peripheral and spinal levelObjective:Study effect of PIE on IL-1βat peripheral and spinal level.Method:Followed successful intervention and operation,rats were sacrificed,cut outfor tissue of local and spinal,make immunohistochemical detection.Result:IL-1βin group C and D is less than group B both at levels of peripheral and spinal (P＜0.05).IL-1βin group B is higher than group A both at levels of peripheral and spinal (P＜0.05).IL-1βin group E is less than group B at levels of spinal(P＜0.05)。IL-1 pin group D is less than group E both at levels of peripheral and spinal(P＜0.05);IL-1βin group D is less than group C at levels of spinal(P＜0.05).No difference of IL-1βin group C and E at levels of peripheral and spinal(P＞0.05).Conclude:IL-1βmay play important role in mechanism of incisional pain.PI and PIE may play its role at at levels of peripheral and spinal.Experiment 5:Effect of PIE on p38MAPK at spinal levelObjective:Study effect of PIE on at spinal levelMethod:Followed successful intervention and operation,rats were sacrificed,cut outfor tissue of local and spinal,make immunohistochemical Detection.Result:p38MAPK in group C and D is less than group B(P＜0.05).p38MAPK in group B is higher than group A(P＜0.05).p38MAPK in group D is less than group C and E(P＜0.05)。No difference of p38MAPK in group C and E(P＞0.05).Conclude:p38MAPK may play important role in mechanism of incisional pain.Effect of PIE on p38MAPK may by synergistic effect of LH.Experiment 6:Effect of PIE on NMDAR at peripheral and spinal levelObjective:Study of effect of PIE on NMDAR at peripheral and spinal levelMethod:Followed successful intervention and operation,rats were sacrificed,cut outfor tissue of local and spinal,make immunohistochemical Detection.Result:NMDAR in group C and D is less than group B at both levels of peripheral and spinal(P＜0.05).NMDAR in group B is higher than group A both at levels of peripheral and spinal(P＜0.05).NMDAR in group D is less than group E at both levels of peripheral and spinal(P＜0.05)。NMDAR in group C is less than group E at levels of peripheral(P＜0.05)。Conclude:NMDAR may play important role in mechanism of incisional pain.Effect of PIE on p3 8MAPK may by synergistic effect of LH,embedding and point.