針灸治療在全膝關節(jié)置換術圍手術期血液管理中的影響
發(fā)布時間：2018-11-08 21:05
【摘要】：目的：探討針灸治療在老年人初次行全膝關節(jié)置換術(TKA)圍手術期血液管理中的影響。通過客觀規(guī)范地評價針灸對初次全膝關節(jié)置換術圍手術期出血管理中臨床療效和安全性,為臨床提供實用、有效、體現(xiàn)中醫(yī)特色的規(guī)范化方案和新方法,探討其臨床價值及推廣意義。方法：收集于2015年1月到2015年10月在廣東省中醫(yī)院骨科進行初次單側全膝關節(jié)置換手術的老年膝骨關節(jié)炎患者。采用隨機、對照臨床試驗研究。將符合研究要求的病例分為針灸組和對照組,每組35例,共70例。兩組在采用相同的治療基礎上,分別采用針灸治療和非針灸治療方案。通過臨床比較,進而觀察針灸在全膝關節(jié)置換術圍手術期中血液管理的影響。本研究以術前、術后當天、1、3、7天血常規(guī)包括：血色素、紅細胞壓積；術后引流量、輸血量,計算各階段失血量包括：實際失血總量,顯性與隱性失血總量；凝血功能包括：術前、術后當天、1、3、7天凝血3項、D2聚體；局部癥狀包括：術前、術后第3、7天患肢疼痛評分、腫脹；關節(jié)功能包括：術前、術后第3、7天進行膝關節(jié)功能情況調查(HSS評分表)；安全性包括：患肢皮膚情況、肢端感覺、血運等；以及不良事件記錄；經濟效益包括：住院時間為觀察項目。并用SPSS19.0統(tǒng)計軟件對結果進行統(tǒng)計分析。成果：70例病例中,經統(tǒng)計學檢驗,兩組紅細胞比容(HCT),術后10小時內,P0.05,具有統(tǒng)計學意義,表示兩組的術后10小時內HCT有明顯差異。而術后第1、3、7天中,P0.01,具有統(tǒng)計學意義,表示兩組的術后第1、3、7天的HCT有顯著差異。血紅蛋白(Hb),術前、術后10小時內和術后第1天的Hb無統(tǒng)計學意義(P0.05),兩組Hb無明顯差異。術后第三天的Hb比較,P0.05,具有統(tǒng)計學意義,表示兩組的術后第三天Hb有明顯差異。而術后第七天中,Hb比較,P0.01,具有統(tǒng)計學意義,表示兩組的術后第七天的Hb有顯著差異。失血量差異比較兩組的術后10小時、術后10小時至第1天間和術后第1天至第3天間的失血量統(tǒng)計學意義(P0.01),兩組失血量有顯著差異,而在術后第3天至第7天間的失血量無統(tǒng)計學意義(P0.05),兩組失血量無明顯差異。不同時段的總失血量差異比較,兩組的1天總失血量、3天的總失血量和1周的總失血量均具有統(tǒng)計學意義(P0.01),兩組在不同時段的總失血量均有顯著差異�？傦@性失血量和總引流量情況的差異比較,P0.05,均無統(tǒng)計學意義,表示針灸組與對照組之間的總顯性失血量和總引流量情況無明顯差異。隱性失血量差異比較,兩組的3天隱性失血量和1周隱性失血量有統(tǒng)計學意義(P0.01),兩組失血量有顯著差異。凝血酶原時間(PT)、凝血酶原活動度(AT)、纖維蛋白原(FIB)、活化部分凝血活酶時間(APPT)和D-二聚體(D-dimer)情況的差異比較,P0.05,均無統(tǒng)計學意義,表示針灸組與對照組之間無明顯差異。術后1周和術后2周的HSS評分差異比較兩組的疼痛、功能、活動度、肌力有統(tǒng)計學意義(P0.01),兩組HSS評分有顯著差異。疼痛VAS評分差異比較,兩組的VAS評分,除術前的VAS評分無統(tǒng)計學意義(P0.05),無明顯差異,術后3天和術后7天的VAS評分,有統(tǒng)計學意義(P0.01),該時段的兩組的疼痛VAS評分有顯著差異。髕上10cm腿圍情況的差異比較,入院第1天、術后第3天,P0.05,均無統(tǒng)計學意義,表示該時段的針灸組與對照組之間的髕上10cm腿圍情況無明顯差異,而在術后第7天,針灸組與對照組之間的髕上10cm腿圍情況,P0.05,有統(tǒng)計學意義,表示在該時段的髕上10cm腿圍情況有明顯差異。小腿中部的腿圍情況的差異比較,入院第1天的小腿中部的腿圍,P0.05,均無統(tǒng)計學意義,表示該時段的針灸組與對照組之間的小腿中部的腿圍情況無明顯差異,而在術后第3天和第7天,針灸組與對照組之間的小腿中部的腿圍情況,P0.01,有統(tǒng)計學意義,表示在該時段的小腿中部的腿圍情況有顯著差異。兩組患者實驗過程中未出現(xiàn)嚴重出血以及其他不適。結論：通過臨床驗證,針灸治療能明顯降低全膝關節(jié)置換術患者的總失血量和隱性失血量。而術后1周和2周的膝關節(jié)功能,針灸能使疼痛明顯減輕,而功能、活動度、肌力也能明顯改善。針灸治療在術后的并發(fā)癥上也有明顯改善,除了疼痛明顯減輕,下肢的腫脹也有顯著改善,其中小腿的消腫速度較大腿的速度快。在經濟效益上,針灸能縮短住院時間,加快醫(yī)院輪轉,讓更多的病人受惠。
[Abstract]:Objective: To study the effect of acupuncture and moxibustion on the perioperative blood management of primary total knee arthroplasty (TKA) in the elderly. Objective To evaluate the clinical efficacy and safety of acupuncture on the management of the primary total knee arthroplasty in the perioperative period, and to provide a practical, effective and effective method for the clinical value and the popularization of the traditional Chinese medicine. Methods: The first one-sided total knee replacement surgery in the middle hospital of Guangdong Province from January 2015 to October 2015 was collected. Randomized, controlled clinical trial study. The cases in which the study requirements were met were divided into acupuncture group and control group, 35 cases in each group and 70 cases. In the two groups, acupuncture and non-acupuncture treatment were used on the basis of the same treatment. The effect of acupuncture on the management of blood during the perioperative period of total knee replacement was also observed by clinical comparison. The blood routine of the day, day, day, day, and day after operation was as follows: blood pigment, red blood cell pressure product, post-operative drainage and blood transfusion, and the amount of blood loss in each stage was calculated. The total amount of blood loss, the total amount of the dominant and the recessive blood loss were calculated, and the coagulation function included: before the operation, 3, 3 and 7 days after operation, D2 poly (s); local symptoms include: pre-operative, postoperative day 3, 7-day limb pain score, swelling; joint function including: pre-operative, postoperative day 3, 7-day knee function investigation (HSS scale); safety including limb skin condition, limb-side feel, blood transport, and the like; and the record of adverse event; the economic benefit includes: the hospital stay time is the observation project. The results were analyzed by SPSS 19.0. Results: In 70 cases, the hematocrit (HCT) of the two groups was statistically tested, and the difference of HCT in the two groups was statistically significant within 10 hours after the operation. The postoperative day 1, 3 and 7 days, P 0.01, had statistical significance, indicating that there was a significant difference in HCT between the two groups after the first, third and seventh day. Hb was no significant difference between the two groups (P0.05). The Hb in the third day of the operation was significantly different from that of the third day after the operation, and there was a significant difference in the Hb in the third day after the operation. In the seventh day of the operation, Hb was compared with that of p0.01, and there was a significant difference in Hb in the seventh day after the operation. The difference in blood loss was 10 hours after operation, 10 hours after operation and 1 to 3 days after operation (P0.01). There was a significant difference between the two groups of blood loss, and the amount of blood loss between the third and seventh day after operation was not statistically significant (P0.05). There was no significant difference between the two groups of blood loss. The total blood loss in the two groups was statistically significant (P0.01), and the total blood loss in the two groups was significantly different from the total blood loss in different periods (P0.01). There was no significant difference between the total dominant blood loss and the total flow rate, and there was no significant difference between the total dominant blood loss and the total flow rate between the acupuncture group and the control group. There was a significant difference between the two groups (P0.01), and the two groups had significant difference in the amount of blood loss. The difference of prothrombin time (PT), prothrombin activity (AT), fibrinogen (FIB), activated partial thromboplastin time (APPT) and D-dimer was not statistically significant, indicating no significant difference between the acupuncture group and the control group. There was a significant difference between the two groups of HSS scores after 1 week and 2 weeks after the operation (P 0.01). The VAS scores of the two groups were not significant (P0.05). There was no significant difference in the VAS scores before and after the operation (P0.05). There was no significant difference between the two groups. The VAS scores of the two groups were statistically significant (P0.01). There was no significant difference between the acupuncture group and the control group on the first day, the third day after the operation, and the difference of the 10 cm leg circumference between the acupuncture group and the control group, and the case of the 10cm leg circumference between the acupuncture group and the control group on the 7th day after the operation. P0.05, there was a statistical significance, indicating that there was a significant difference in the circumference of the 10cm leg during the period. The leg circumference in the middle of the lower leg in the middle of the lower leg of the lower leg of the lower leg of the lower leg of the lower leg was not statistically significant, and there was no significant difference between the acupuncture group and the control group in the middle of the lower leg of the lower leg, and the leg circumference in the middle of the lower leg between the acupuncture group and the control group was not significantly different between the acupuncture group and the control group, and at the third and seventh days after the operation, The leg circumference in the middle of the lower leg between the acupuncture group and the control group was significantly different from that in the middle of the lower leg of the control group. No serious bleeding and other discomfort occurred during the course of the two groups of patients. Conclusion: The total blood loss and the recessive blood loss in patients with total knee replacement can be significantly reduced by clinical verification. and the function, activity and muscle strength of the knee joint can be obviously improved after 1 and 2 weeks after the operation. Acupuncture and moxibustion also have a significant improvement in the postoperative complications. In addition to the obvious reduction of the pain, the swelling of the lower limbs also has a marked improvement, in which the swelling speed of the lower leg is higher than that of the legs. In the economic benefit, the acupuncture can shorten the hospital stay time, accelerate the hospital rotation, and let more patients benefit.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9
[Abstract]:Objective: To study the effect of acupuncture and moxibustion on the perioperative blood management of primary total knee arthroplasty (TKA) in the elderly. Objective To evaluate the clinical efficacy and safety of acupuncture on the management of the primary total knee arthroplasty in the perioperative period, and to provide a practical, effective and effective method for the clinical value and the popularization of the traditional Chinese medicine. Methods: The first one-sided total knee replacement surgery in the middle hospital of Guangdong Province from January 2015 to October 2015 was collected. Randomized, controlled clinical trial study. The cases in which the study requirements were met were divided into acupuncture group and control group, 35 cases in each group and 70 cases. In the two groups, acupuncture and non-acupuncture treatment were used on the basis of the same treatment. The effect of acupuncture on the management of blood during the perioperative period of total knee replacement was also observed by clinical comparison. The blood routine of the day, day, day, day, and day after operation was as follows: blood pigment, red blood cell pressure product, post-operative drainage and blood transfusion, and the amount of blood loss in each stage was calculated. The total amount of blood loss, the total amount of the dominant and the recessive blood loss were calculated, and the coagulation function included: before the operation, 3, 3 and 7 days after operation, D2 poly (s); local symptoms include: pre-operative, postoperative day 3, 7-day limb pain score, swelling; joint function including: pre-operative, postoperative day 3, 7-day knee function investigation (HSS scale); safety including limb skin condition, limb-side feel, blood transport, and the like; and the record of adverse event; the economic benefit includes: the hospital stay time is the observation project. The results were analyzed by SPSS 19.0. Results: In 70 cases, the hematocrit (HCT) of the two groups was statistically tested, and the difference of HCT in the two groups was statistically significant within 10 hours after the operation. The postoperative day 1, 3 and 7 days, P 0.01, had statistical significance, indicating that there was a significant difference in HCT between the two groups after the first, third and seventh day. Hb was no significant difference between the two groups (P0.05). The Hb in the third day of the operation was significantly different from that of the third day after the operation, and there was a significant difference in the Hb in the third day after the operation. In the seventh day of the operation, Hb was compared with that of p0.01, and there was a significant difference in Hb in the seventh day after the operation. The difference in blood loss was 10 hours after operation, 10 hours after operation and 1 to 3 days after operation (P0.01). There was a significant difference between the two groups of blood loss, and the amount of blood loss between the third and seventh day after operation was not statistically significant (P0.05). There was no significant difference between the two groups of blood loss. The total blood loss in the two groups was statistically significant (P0.01), and the total blood loss in the two groups was significantly different from the total blood loss in different periods (P0.01). There was no significant difference between the total dominant blood loss and the total flow rate, and there was no significant difference between the total dominant blood loss and the total flow rate between the acupuncture group and the control group. There was a significant difference between the two groups (P0.01), and the two groups had significant difference in the amount of blood loss. The difference of prothrombin time (PT), prothrombin activity (AT), fibrinogen (FIB), activated partial thromboplastin time (APPT) and D-dimer was not statistically significant, indicating no significant difference between the acupuncture group and the control group. There was a significant difference between the two groups of HSS scores after 1 week and 2 weeks after the operation (P 0.01). The VAS scores of the two groups were not significant (P0.05). There was no significant difference in the VAS scores before and after the operation (P0.05). There was no significant difference between the two groups. The VAS scores of the two groups were statistically significant (P0.01). There was no significant difference between the acupuncture group and the control group on the first day, the third day after the operation, and the difference of the 10 cm leg circumference between the acupuncture group and the control group, and the case of the 10cm leg circumference between the acupuncture group and the control group on the 7th day after the operation. P0.05, there was a statistical significance, indicating that there was a significant difference in the circumference of the 10cm leg during the period. The leg circumference in the middle of the lower leg in the middle of the lower leg of the lower leg of the lower leg of the lower leg of the lower leg was not statistically significant, and there was no significant difference between the acupuncture group and the control group in the middle of the lower leg of the lower leg, and the leg circumference in the middle of the lower leg between the acupuncture group and the control group was not significantly different between the acupuncture group and the control group, and at the third and seventh days after the operation, The leg circumference in the middle of the lower leg between the acupuncture group and the control group was significantly different from that in the middle of the lower leg of the control group. No serious bleeding and other discomfort occurred during the course of the two groups of patients. Conclusion: The total blood loss and the recessive blood loss in patients with total knee replacement can be significantly reduced by clinical verification. and the function, activity and muscle strength of the knee joint can be obviously improved after 1 and 2 weeks after the operation. Acupuncture and moxibustion also have a significant improvement in the postoperative complications. In addition to the obvious reduction of the pain, the swelling of the lower limbs also has a marked improvement, in which the swelling speed of the lower leg is higher than that of the legs. In the economic benefit, the acupuncture can shorten the hospital stay time, accelerate the hospital rotation, and let more patients benefit.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9
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