中药涂擦、硬膏热贴敷与定向透药技术对肛周脓肿术后中重度疼痛影响的回顾性研究

A Retrospective Study on the Effects of Traditional Chinese Medicine Application, Hot Plaster Compress and Directional Drug Penetration Technology on Moderate to Severe Pain after Perianal Abscess Surgery

摘要: 目的：比较中药涂擦、硬膏热贴敷与定向透药技术对肛周脓肿术后中重度疼痛患者镇痛效果及对创面恢复的影响，为临床优化术后疼痛管理方案提供循证依据。方法：回顾性收集2020年1月至2025年12月本院肛肠科60例肛周脓肿术后中重度疼痛患者病历资料，按实际接受外治法分为中药涂擦组、硬膏热贴敷组与定向透药组，分别为58例、46例、35例(因存在联合治疗，三组病例存在重叠)。采用多元线性回归对年龄、性别、BMI及脓肿类型等已知混杂因素进行校正。主要指标为术后即刻、治疗后第1、2、3天及出院当天的NRS评分和住院期间补救性镇痛药使用情况；次要指标包括红肿消退天数、出院时创面渗液及红肿情况、住院时间。结果：年龄、性别、BMI基线均衡；脓肿类型和手术方式分布存在差异(P = 0.039)。定向透药组术后第3天NRS评分与另两组差异无统计学意义(P = 0.605)；术后第2天及出院当天三组NRS评分差异亦无统计学意义(P = 0.568、P = 0.824)。三组补救性镇痛药使用率差异无统计学意义(P = 0.848)。三组红肿消退天数比较差异无统计学意义(P = 0.529)。出院时三组患者创面均仍有渗液；出院时仍有红肿者三组各仅1例，差异无统计学意义(P = 1.000)。定向透药组住院时间短于硬膏热贴敷组，但差异无统计学意义(P = 0.408)。结论：在本研究回顾性数据条件下，定向透药技术与较低的术后第3天NRS评分之间存在数值差异趋势，但差异无统计学意义，校正已知混杂因素后二者亦未见独立关联。此发现有待前瞻性随机对照试验进一步验证，临床决策应结合患者个体特征审慎判断。

Abstract: Objective: To compare the analgesic effects of traditional Chinese medicine application, hot plaster compress, and targeted drug penetration technology on patients with moderate to severe postoperative pain after perianal abscess surgery, and to investigate the impact on wound recovery. This study aims to provide evidence-based data for optimizing postoperative pain management strategies in clinical practice. Methods: The medical records of 60 patients with moderate to severe postoperative pain after perianal abscess surgery in the Department of Colorectal Surgery of our hospital from January 2020 to December 2025 were retrospectively collected. The patients were divided into the traditional Chinese medicine application group, the hot plaster compress group, and the targeted drug penetration group based on the actual external treatment received, with 58, 46, and 35 patients in the three groups, respectively (due to combined treatments, the three groups overlapped). Multivariable linear regression was used to adjust for known confounders including age, sex, BMI and abscess type. The primary outcomes were NRS scores immediately after surgery, on postoperative days 1, 2 and 3, and on the day of discharge, as well as the use of rescue analgesics during hospitalization; secondary outcomes included the time for redness/swelling resolution, wound exudate and redness status at discharge, and length of hospital stay. Results: Age, sex, and BMI were comparable, whereas abscess type and surgical approach differed (P = 0.039). On postoperative day 3, NRS scores did not differ significantly among the three groups (P = 0.605); no significant differences were found on postoperative day 2 or on the day of discharge either (P = 0.568 and P = 0.824). There was no statistically significant difference in the usage rate of rescue analgesics among the three groups (P = 0.848). There was no statistically significant difference in the time for redness/swelling resolution among the three groups (P = 0.529). At discharge, wound exudate persisted in all patients of the three groups; only one patient in each group still had redness/swelling, with no statistically significant difference (P = 1.000). The hospital stay of the targeted drug penetration group was numerically shorter than that of the hot plaster compress group, but the difference was not statistically significant (P = 0.408). Conclusion: The targeted drug penetration technique was associated with a numerical trend toward lower day-3 NRS scores, but the difference was not statistically significant, and no independent association was found after adjustment for known confounders. These findings need to be further verified by prospective randomized controlled trials, and clinical decisions should be made prudently according to individual patient characteristics.