本文關(guān)鍵詞：穴位貼敷療法聯(lián)合低分子肝素預(yù)防THA術(shù)后DVT形成的療效觀察　出處：《福建中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 穴位貼敷療法 桃紅四物湯 全髖關(guān)節(jié)置換術(shù) 深靜脈血栓

【摘要】：目的:觀察穴位貼敷療法聯(lián)合低分子肝素在全髖關(guān)節(jié)置換術(shù)后預(yù)防下肢深靜脈血栓形成的臨床療效和安全性,為臨床中進(jìn)一步應(yīng)用提供依據(jù)。方法:按照病例選擇的診斷、納入、排除標(biāo)準(zhǔn),收集2015-12-1至2016-12-1期間在南京軍區(qū)福州總醫(yī)院骨二科因股骨頸骨折或股骨頭缺血性壞死初次行單側(cè)全髖關(guān)節(jié)置換術(shù)的患者70例,隨機(jī)分成對(duì)照組和試驗(yàn)組,各35例。試驗(yàn)方案如下:對(duì)照組:在術(shù)后12h皮下注射低分子肝素(速碧林),每天1次,連續(xù)使用10d,同時(shí)術(shù)后12h開(kāi)始應(yīng)用穴位貼劑(安慰劑)貼敷于膈俞、委中、足三里、血海和三陰交,左右共10個(gè)刺激點(diǎn),每次時(shí)間持續(xù)6h,每天2次,6點(diǎn)和18點(diǎn)使用,連續(xù)使用10d。試驗(yàn)組:術(shù)后常規(guī)應(yīng)用低分子肝素(具體操作同對(duì)照組)。同時(shí)術(shù)后12h也開(kāi)始使用穴位貼劑(桃紅四物湯加減)貼敷于患者的膈俞、委中、足三里、血海和三陰交(具體操作同對(duì)照組)。記錄兩組患者術(shù)前資料(性別、年齡、身高、體重、體重指數(shù)、患髖部位、兩類(lèi)疾病及術(shù)前合并癥)和術(shù)中資料(手術(shù)時(shí)間、麻醉時(shí)間、出血量)的分布情況,檢查并記錄術(shù)前1d及術(shù)后第2、6、10d的主要觀察指標(biāo)(血栓彈力圖、D-二聚體和下肢深靜脈彩超)、輔助觀察指標(biāo)(紅細(xì)胞壓積、血紅蛋白濃度、紅細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、大腿周徑、術(shù)后引流量及術(shù)后輸血情況)。觀察術(shù)后不良反應(yīng)的發(fā)生情況,分析其與本項(xiàng)研究的關(guān)聯(lián)。收集數(shù)據(jù)并建立數(shù)據(jù)庫(kù),運(yùn)用SPSS20.0對(duì)兩組的各項(xiàng)對(duì)比資料的差異性進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:①本次臨床試驗(yàn)過(guò)程中,對(duì)照組終止2例,最終完成33例,試驗(yàn)組終止1例,最終完成34例。兩組患者術(shù)前資料(性別、年齡、身高、體重指數(shù)、患髖部位、術(shù)前合發(fā)癥和兩類(lèi)疾病的病人分布情況)的比較均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性;兩組患者術(shù)中資料(手術(shù)時(shí)間、麻醉時(shí)間及出血量)的比較均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),也具備可比性。②兩組病例的R值、K值、CI值、α角和MA值術(shù)后第2、6、10d與術(shù)前比較具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組病例的K值、α角在術(shù)后第6d的組間比較具有統(tǒng)計(jì)學(xué)意義(P0.05),MA值和CI值在術(shù)后第6、10d的組間比較均有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后第6d和第10d試驗(yàn)組中血液高凝狀態(tài)比例明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。③ 在術(shù)后第6、1Od試驗(yàn)組D-二聚體明顯低于對(duì)照組,且比較具有統(tǒng)計(jì)學(xué)意義(P0.05)。④對(duì)照組術(shù)后并發(fā)2例DVT,試驗(yàn)組無(wú)并發(fā)DVT,對(duì)照組的深靜脈血栓發(fā)生(5.71%)高于試驗(yàn)組(0.00%)。⑤兩組病例RBC、HB、HCT、PLT術(shù)后第2、6、10d與術(shù)前的比較有統(tǒng)計(jì)學(xué)意義(P0.05),RBC、HB、HCT在手術(shù)前后各時(shí)間點(diǎn)的組間比較均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而PLT在術(shù)后第2、6d的組間比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。⑥術(shù)后第6、10d試驗(yàn)組大腿腫脹消退較試驗(yàn)組明顯,且兩組病例大腿周徑比較具有統(tǒng)計(jì)學(xué)差異(P0.05)。⑦兩組患者術(shù)后引流量、術(shù)后輸血人數(shù)及輸血量比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。⑧對(duì)照組并發(fā)2例切口脂肪液化、2例泌尿系感染和1例壓瘡,而試驗(yàn)組并發(fā)1例切口脂肪液化、1例泌尿系感染、1例壓瘡和1例皮膚過(guò)敏,比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:穴位貼敷療法聯(lián)合低分子肝素可顯著的改善THA患者術(shù)后血液高凝狀態(tài),進(jìn)一步降低DVT形成的風(fēng)險(xiǎn),同時(shí)還可改善患髖下肢的腫脹程度,具備良好的安全性,操作簡(jiǎn)便,患者依從性高。
[Abstract]:Objective: To observe the effect of acupoint therapy combined with low molecular heparin in the prevention of clinical efficacy and safety of deep venous thrombosis of the lower limbs in total hip arthroplasty, provide the basis for further application in clinic. Methods: according to the diagnosis, selection of cases included, exclusion criteria, collection of 2015-12-1 to 2016-12-1 during the 70 Nanjing General Hospital of Fuzhou military command two with femoral neck fracture or bone avascular necrosis of the femoral head underwent primary unilateral total hip replacement surgery were randomly divided into control group and experimental group, 35 cases each. The test plan is as follows: the control group: the subcutaneous injection of low molecular heparin 12h after surgery (Fraxiparine), 1 times a day, continuous use of 10d, at the same time operation 12h after application of acupoint patch (placebo) sticking to the Commission, Geshu and Zusanli, Xuehai and Sanyinjiao, about a total of 10 stimuli, each time lasted 6h, 2 times a day, 6 points and 18 points, using 10d. test The experimental group: low molecular weight heparin after routine applications (specific operation with the control group). At the same time after 12h began using Acupoint Plaster (Taohongsiwutang) sticking to the patients with Geshu, Weizhong, Zusanli, Xuehai and Sanyinjiao (specific operation with the control group). The two groups of patients were recorded before operation data (gender, age, height, weight, body mass index, hip part, two kinds of disease and preoperative complications) and intraoperative data (operation time, anesthesia time, blood loss) distribution, check and record the preoperative 1D and postoperative observation of the main 2,6,10d index (Thrombelastogram two, D- dimer and lower extremity deep venous ultrasound), auxiliary indexes (blood transfusion hematocrit, hemoglobin concentration, red blood cell count, platelet count, thigh circumference, postoperative drainage and postoperative adverse reactions). Postoperative observation, analysis of its relationship with the study. Collect data and build 绔嬫暟鎹簱,榪愮敤SPSS20.0瀵逛袱緇勭殑鍚勯」瀵規(guī)瘮璧勬枡鐨勫樊寮傛，

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