蜂针联合阴部神经阻滞对混合痔术后镇痛及其机制的临床研究

Bee Acupuncture Combined with Pudendal Nerve Block for Postoperative Analgesia in Mixed Hemorrhoids and Its Mechanism: A Clinical Study

摘要: 目的：观察蜂针联合阴部神经阻滞对混合痔术后患者的协同镇痛、消肿效果，并探讨其作用机制。方法：将100例混合痔术后患者随机分为治疗组(蜂针 + 阴部神经阻滞)与对照组(单用阴部神经阻滞)，每组50例。两组均于混合痔外剥内扎术后行阴部神经阻滞术，治疗组于术后6小时、48小时加用蜂针。比较两组患者术后不同时间点疼痛程度(VAS评分)、肛缘水肿评分、排便功能(Wexner评分)，检测血清β-内啡肽及前列腺素E2 (PGE2)水平，并评估安全性。结果：两组术后6小时、12小时、24小时的VAS评分差异无统计学意义(P > 0.05)；治疗组术后3天、5天、7天的VAS评分显著低于对照组(P < 0.05)。治疗组术后3天、5天的肛缘水肿评分及Wexner便秘评分均优于对照组(P < 0.05)。与对照组相比，治疗组术后血清β-内啡肽升高更显著、PGE2降低更明显(P < 0.05)。安全性方面，治疗组仅少数患者出现局部轻微瘙痒、风疹，未见严重过敏反应，与对照组相比，差异均无统计学意义。结论：在阴部神经阻滞基础上加用蜂针，可显著增强混合痔术后中后期镇痛效果，减轻肛缘水肿，改善排便功能，其机制可能与上调β-内啡肽、下调前列腺素E2水平有关。基于当前单中心研究，该联合方案显示出有前景的疗效，并具有一定的临床应用价值。

Abstract: Objective: To observe the synergistic analgesic and anti-edema effects of bee acupuncture combined with pudendal nerve block in patients after mixed hemorrhoid surgery and to explore its mechanism of action. Methods: A total of 100 patients after mixed hemorrhoid surgery were randomly divided into a treatment group (bee acupuncture + pudendal nerve block) and a control group (pudendal nerve block alone), with 50 cases in each group. Both groups received pudendal nerve block after mixed hemorrhoid external dissection and internal ligation, and the treatment group received additional bee acupuncture at 6 hours and 48 hours after surgery. Postoperative pain (VAS score) at different time points, perianal edema score, and defecation function (Wexner score) were compared between the two groups. Serum levels of β-endorphin and prostaglandin E2 (PGE2) were measured, and safety was evaluated. Results: There were no statistically significant differences in VAS scores between the two groups at 6 h, 12 h, and 24 h after surgery (P > 0.05). At 3 d, 5 d, and 7 d after surgery, VAS scores in the treatment group were significantly lower than those in the control group (P < 0.05). The perianal edema scores and Wexner constipation scores in the treatment group at 3 d and 5 d after surgery were better than those in the control group (P < 0.05). Compared with the control group, the treatment group showed a more significant increase in serum β-endorphin and a more significant decrease in PGE2 (P < 0.05). Regarding safety, only a few patients in the treatment group developed mild local itching and urticaria, and no severe allergic reactions occurred; there were no statistically significant differences compared with the control group. Conclusion: Adding bee acupuncture to pudendal nerve block can significantly enhance the analgesic effect in the middle and late stages after mixed hemorrhoid surgery, reduce perianal edema, and improve defecation function. The mechanism may be related to upregulating β-endorphin and downregulating PGE2 levels. Based on the current single-center study, this combination regimen demonstrates promising efficacy and holds certain clinical application value.