五苓散加味治疗椎管内麻醉混合痔术后尿潴留的临床效果

Clinical Effect of Modified Wuling San on Postoperative Urinary Retention in Patients Undergoing Mixed Hemorrhoid Surgery under Spinal Anesthesia

摘要: 目的：探讨五苓散加味在椎管内麻醉下混合痔术后尿潴留的治疗效果，为术后尿潴留患者提供安全、有效的中医药干预方案。方法：选取肛肠外科行椎管内麻醉混合痔手术的60例患者，随机分为观察组和对照组，各30例。对照组给予常规围手术期护理 + 甲硫酸新斯的明肌注，观察组给予常规围手术期护理 + 口服五苓散加味。比较两组术后首次自主排尿时间、首次排尿量、膀胱残余尿量、腹部症状评分、排尿状况评分、疼痛评分及临床总有效率。结果：观察组首次排尿时间明显早于对照组(14.45 ± 5.31 h vs. 17.24 ± 5.23 h, P < 0.05)；首次排尿量增加(463.45 ± 100.36 mL vs. 380.07 ± 100.46 mL, P < 0.01)；膀胱残余尿量明显减少(81.70 ± 41.59 mL vs. 108.79 ± 28.56 mL, P < 0.01)。术后24 h及3 d疼痛评分低于对照组(P < 0.01)。腹部症状、排尿状况及排尿持续时间评分改善显著，临床总有效率达93.33%，明显高于对照组的73.33% (P < 0.05)。结论：五苓散加味能够有效缩短椎管内麻醉混合痔术后首次排尿时间、增加排尿量、减少膀胱残余尿量，同时改善腹部不适及排尿费力感，缓解术后疼痛，提高患者排尿舒适度和临床疗效。

Abstract: Objective: To investigate the therapeutic effect of modified Wuling San on postoperative urinary retention (PUR) in patients undergoing mixed hemorrhoid surgery under spinal anesthesia, and to provide a safe and effective traditional Chinese medicine (TCM) intervention for PUR. Methods: Sixty patients undergoing mixed hemorrhoid surgery under spinal anesthesia in the colorectal surgery department were randomly assigned to an observation group and a control group, 30 cases in each. The control group received conventional perioperative care with Intramuscular injection of neostigmine hydrochloride, while the observation group received oral administration of modified Wuling San in addition to routine care. Postoperative first spontaneous urination time, first voided volume, residual urine volume, abdominal symptoms score, urination status score, pain score, and overall clinical efficacy were compared between the two groups. Results: The observation group had significantly earlier first spontaneous urination time than the control group (14.45 ± 5.31 h vs. 17.24 ± 5.23 h, P < 0.05), greater first voided volume (463.45 ± 100.36 mL vs. 380.07 ± 100.46 mL, P < 0.01), and lower residual urine volume (81.70 ± 41.59 mL vs. 108.79 ± 28.56 mL, P < 0.01). Pain scores at 24 h and 3 d postoperatively were significantly lower in the observation group (P < 0.01). Abdominal symptom scores, urination status scores, and urination duration scores improved significantly, and the overall clinical efficacy rate was 93.33%, higher than that of the control group (73.33%, P < 0.05). Conclusion: Modified Wuling San effectively shortens the first urination time, increases voided volume, reduces residual urine, alleviates abdominal discomfort and difficulty in urination, and relieves postoperative pain in patients undergoing mixed hemorrhoid surgery under spinal anesthesia. This TCM intervention improves urination comfort and overall clinical efficacy.