發(fā)布時(shí)間：2018-03-13 10:04

  本文選題：髖關(guān)節(jié)人工關(guān)節(jié)置換術(shù)　切入點(diǎn)：膝關(guān)節(jié)人工關(guān)節(jié)置換術(shù)　出處：《湖北中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過臨床對(duì)比研究,探究髖膝關(guān)節(jié)關(guān)節(jié)置換術(shù)后應(yīng)用桃紅四物湯防治下肢深靜脈血栓的臨床療效及其運(yùn)用的安全性。方法:將120例入住十堰市太和醫(yī)院行人工髖膝關(guān)節(jié)置換術(shù)患者作為研究對(duì)象,按照隨機(jī)平均分組的原則,分為對(duì)照組(共60例患者,年齡在50-80歲之間,平均年齡(65.1±10.1)歲,男34例,女26例;髖關(guān)節(jié)置換29例,膝關(guān)節(jié)置換31例)和觀察組(共60例患者,年齡在50-80歲之間,平均年齡(63.2±11.3)歲,男29例,女31例;髖、膝關(guān)節(jié)置換例數(shù)分別為33例、27例)。對(duì)照組僅給予低分子肝素鈣4000iu qd皮下注射,觀察組則在對(duì)照組基礎(chǔ)上予以桃紅四物湯口服,對(duì)比研究分析對(duì)照組和觀察組患者,術(shù)后第7天的C-反應(yīng)蛋白(CRP)、血小板計(jì)數(shù)、紅細(xì)胞計(jì)數(shù)、白細(xì)胞計(jì)數(shù);術(shù)后48小時(shí)拔除負(fù)壓引流管時(shí),對(duì)患者傷口引流量作記錄;術(shù)前分別測定患者的大腿周徑并記錄,術(shù)后患者給藥后第3天、第7天再分別測量大腿周徑并記錄;對(duì)患者在術(shù)后第5天的疼痛進(jìn)行VAS評(píng)分;比較兩組患者髖膝關(guān)節(jié)置換術(shù)后下肢深靜脈血栓的發(fā)病及治療情況。結(jié)果:觀察組與對(duì)照組術(shù)前白細(xì)胞計(jì)數(shù)、紅細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、C-反應(yīng)蛋白(CRP)計(jì)數(shù)、術(shù)前大腿周徑的數(shù)值經(jīng)方差分析,術(shù)前各項(xiàng)指標(biāo)對(duì)比不具統(tǒng)計(jì)學(xué)意義。觀察組較對(duì)照組患者的傷口引流量小,觀察組患者在術(shù)后第3天、第7天的大腿周徑均相對(duì)小于對(duì)照組。各自術(shù)后第7天較第3天所測量的大腿所減少的大腿周徑,即各自消腫情況采用獨(dú)立樣本t檢驗(yàn),其差異具有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組患者在術(shù)后第5天的疼痛VAS評(píng)分均低于對(duì)照組。觀察組與對(duì)照組患者在術(shù)后第7天各自的白細(xì)胞計(jì)數(shù)進(jìn)行統(tǒng)計(jì)學(xué)分析。兩組術(shù)后紅細(xì)胞計(jì)數(shù)采用獨(dú)立樣本t檢驗(yàn),不具統(tǒng)計(jì)學(xué)意義;各自術(shù)后血小板計(jì)數(shù)具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)后C反應(yīng)蛋白數(shù)值結(jié)果具有統(tǒng)計(jì)學(xué)的意義(P0.05)。觀察組患者未出現(xiàn)下肢深靜脈血栓,對(duì)照組患者中6例出現(xiàn)下肢深靜脈血栓,因不滿足卡方檢驗(yàn)條件,采用fisher精確檢驗(yàn),其fisher精確p值(0.027),差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:桃紅四物湯可以顯著的減輕患者術(shù)后炎癥,并消退患者DVT患肢的腫脹狀況、減輕病人術(shù)后疼痛,降低病人術(shù)后引流量等等來降低患者的風(fēng)險(xiǎn),并且最后Doppler檢查進(jìn)一步驗(yàn)證服用桃紅四物湯患者血流全部暢通,無血栓形成。綜述所有臨床試驗(yàn)結(jié)果,可以說明桃紅四物湯與低分子肝素鈣這兩種藥物聯(lián)合應(yīng)用防治髖膝置換術(shù)后DVT患者的效果,與單純使用低分子肝素鈣相比,采用桃紅四物湯結(jié)合低分子肝素鈣預(yù)防與治療下肢深靜脈血栓顯然更具優(yōu)勢。不僅表現(xiàn)在術(shù)后炎癥控制方面具有療效優(yōu)勢,也能使患肢腫脹的消除加快,減少術(shù)后的出血量,緩解術(shù)后疼痛,從而改善術(shù)后患者的生活質(zhì)量,提高其治療的依從性,具有較好的臨床療效和一定的安全性,值得在臨床推廣運(yùn)用。
[Abstract]:Objective: to compare the clinical characteristics of the two groups. Objective: to investigate the clinical efficacy and safety of Taohong Siwu decoction in the treatment of deep venous thrombosis of lower extremity after hip and knee arthroplasty. Methods: 120 patients underwent hip and knee arthroplasty in Taihe Hospital of Shiyan City were studied. According to the principle of randomized and average grouping, the patients were divided into control group (60 patients aged 50-80 years, mean age 65.1 鹵10.1 years), male 34 cases, female 26 cases, hip replacement 29 cases, knee arthroplasty 31 cases) and observation group (60 cases). The average age was 63.2 鹵11.3 years old, male 29 cases, female 31 cases, hip and knee arthroplasty were 33 cases and 27 cases respectively. The control group was only given hypodermic injection of low molecular weight heparin calcium 4000iu QD. The observation group was given Taohong Siwu decoction orally on the basis of the control group. The patients in the control group and the observation group were compared and analyzed. The patients in the control group and the observation group were treated with C-reactive protein CRP, platelet count, erythrocyte count and white blood cell count on the 7th day after operation. When the negative pressure drainage tube was removed 48 hours after the operation, the wound drainage flow was recorded, the circumference of the thigh was measured and recorded before the operation, and the circumference of the thigh was measured and recorded on the 3rd day and the 7th day after the operation. VAS score was performed on the 5th day after operation, and the incidence and treatment of deep vein thrombosis of lower extremity after hip and knee arthroplasty were compared between the two groups. Results: the white blood cell count and red blood cell count before operation in the observation group and the control group were compared. Platelet count and C-reactive protein (CRP) count, preoperative thigh circumference value were not statistically significant by ANOVA, the wound drainage flow in the observation group was smaller than that in the control group, and the patients in the observation group were treated on the 3rd day after operation. The thigh circumference on the 7th day was relatively smaller than that of the control group. The thigh circumference, which was measured on the 7th day after operation, was measured by independent sample t test. The VAS scores of the patients in the observation group were lower than those in the control group on the 5th day after operation. The white blood cell counts of the patients in the observation group and the control group were statistically analyzed on the 7th day after operation. Red blood cell count was tested by independent sample t-test. There was no statistical significance; the platelet count after operation was statistically significant; the C-reactive protein values in both groups were statistically significant; the patients in the observation group had no deep venous thrombosis in the lower extremities. In the control group, 6 patients had deep venous thrombosis of lower extremity. Because they did not meet the chi-square test condition, the accurate value of fisher was 0.027% by fisher, and the difference was statistically significant (P 0.05). Conclusion: Taohong Siwu decoction can significantly reduce postoperative inflammation. In order to reduce the risk of patients with DVT, the swelling of the affected limbs of the patients was reduced, the pain of the patients was alleviated, the drainage volume of the patients was reduced, and the final Doppler examination further verified that the blood flow of the patients taking Taohong Siwu decoction was completely unblocked. There is no thrombus. Reviewing the results of all clinical trials, it can be concluded that Taohong Siwu decoction combined with low molecular weight heparin calcium is effective in the prevention and treatment of DVT patients after hip and knee arthroplasty, compared with using low molecular weight heparin calcium alone. Using Taohong Siwu decoction combined with low molecular weight heparin calcium to prevent and treat deep venous thrombosis of lower extremities is obviously more advantageous. It not only has the advantage of curative effect in controlling inflammation after operation, but also can accelerate the elimination of swelling of affected limbs and reduce the amount of bleeding after operation. In order to relieve postoperative pain and improve the quality of life and compliance of the patients after operation, it has better clinical efficacy and safety, and is worth popularizing in clinical practice.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 李自成,宋翠娥,曹茂銀,查仲玲,張才仁;當(dāng)歸注射液對(duì)冠心病患者血漿前列環(huán)素、血栓素 A_2 及血小板聚集的影響[J];中國醫(yī)院藥學(xué)雜志;1997年05期

2 杜麗蘋,段旭紅,楊麗紅;中西醫(yī)結(jié)合治療下肢深靜脈血栓形成[J];中國中西醫(yī)結(jié)合外科雜志;2000年01期

3 劉立;段金廒;劉培;朱敏;宿樹蘭;唐于平;史旭芹;;桃紅四物湯及配伍藥對(duì)桃仁-紅花與四物湯用于原發(fā)性痛經(jīng)作用的比較研究[J];中藥藥理與臨床;2012年01期

4 印麗莉;劉志軍;丁青;;加味桃紅四物湯預(yù)防股骨頸骨折全髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成的臨床研究[J];中醫(yī)正骨;2011年11期

，

本文編號(hào)：1605902