益氣補(bǔ)血法對人工髖關(guān)節(jié)置換術(shù)后隱性失血的影響
發(fā)布時間：2018-12-29 11:28
【摘要】：目的:人工髖關(guān)節(jié)置換(THR)手術(shù)在治療疾病的同時,也存在了大量出血及異體輸血率較高等圍手術(shù)期問題。近年來研究發(fā)現(xiàn)THR圍手術(shù)期隱性失血對術(shù)后的影響不容忽視,包括影響術(shù)口愈合,延緩關(guān)節(jié)功能恢復(fù)時間,增加異體輸血率,延長臥床時間,增加下肢深靜脈血栓形成風(fēng)險等。本課題結(jié)合中醫(yī)藥理論,運(yùn)用益氣補(bǔ)血法治療THR隱性失血,旨在評估其對THR術(shù)后隱性失血的影晌及安全性,為益氣補(bǔ)血類中藥在人工關(guān)節(jié)圍手術(shù)期中的應(yīng)用提供依據(jù)。方法:選取2016年2月至2017年2月期間,廣州市番禺中醫(yī)院骨科病區(qū)住院的患者中,符合納入標(biāo)準(zhǔn)的病例60例。將符合納入標(biāo)準(zhǔn)的合格病例60例,通過數(shù)字隨機(jī)法按1:1比例分為治療組和對照組,治療組和對照組各30例,兩組均完成術(shù)前準(zhǔn)備并行THR手術(shù),治療組行THR手術(shù)配合八珍湯治療,對照組只行THR手術(shù)治療,記錄兩組患者性別、年齡、身高、體重、術(shù)前和術(shù)后血常規(guī)、術(shù)后髖關(guān)節(jié)Harris評分等,并根據(jù)Gross及Nadler方程計算隱性失血量,分析對比兩組的指標(biāo)變化及臨床療效。結(jié)果:本次研究兩組患者術(shù)前、手術(shù)當(dāng)天、手術(shù)第1天RBC、HGB、HCT值比較差異無統(tǒng)計學(xué)意義(P0.05),兩組患者術(shù)后第3天、術(shù)后第7天RBC、HGB、HCT值比較,治療組高于對照組,差異有統(tǒng)計學(xué)意義(P0.05),且兩組RBC、HGB、HCT值均多在術(shù)后第3天達(dá)到最低值,說明THR圍手術(shù)期口服八珍湯能升高術(shù)后第3天、術(shù)后第7天RBC、HGB、HCT值。術(shù)后失血比較,兩組患者輸血率、顯性失血量方面,差異無統(tǒng)計學(xué)意義(P0.05);兩組患者隱性失血量方面,治療組低于對照組,差異有統(tǒng)計學(xué)意義(P0.05),說明THR圍手術(shù)期口服八珍湯能減少患者隱性失血量,但不能有效減少顯性失血及輸血率。術(shù)后康復(fù)方面,兩組患者術(shù)后第14天髖關(guān)節(jié)Harris評分較術(shù)后第7天明顯提高(P0.01),且治療組術(shù)后第7天、第14天髖關(guān)節(jié)Harris評分明顯較對照組高(P0.01)說明THR圍手術(shù)期口服八珍湯能加快術(shù)后功能康復(fù)。結(jié)論:髖關(guān)節(jié)置換術(shù)患者圍手術(shù)期存在著較多的隱性出血,術(shù)后RBC、HGB、HCT數(shù)值明顯下降,且多在術(shù)后第3天左右出現(xiàn)最低值。運(yùn)用益氣補(bǔ)血法(代表方劑:八珍湯)能升高患者術(shù)后第3天、術(shù)后第7天RBC、HGB、HCT值,并能減少患者隱性失血量,加快術(shù)后功能康復(fù),未見明顯不良反應(yīng),值得臨床推廣應(yīng)用。
[Abstract]:Objective: in the treatment of diseases with (THR) artificial hip replacement, there are a lot of bleeding and high rate of allogeneic blood transfusion in perioperative period. In recent years, it has been found that the influence of recessive blood loss in perioperative period of THR can not be ignored, including affecting the healing of surgical mouth, delaying the recovery time of joint function, increasing the rate of allogeneic blood transfusion, prolonging the time of bed rest, and increasing the risk of deep venous thrombosis in lower extremity, etc. Based on the theory of traditional Chinese medicine, the purpose of this paper is to evaluate the effect and safety of THR on recessive blood loss after THR, and to provide the basis for the application of traditional Chinese medicine for supplementing qi and tonifying blood in the perioperative period of artificial joint. Methods: from February 2016 to February 2017, 60 patients in the orthopedic department of Panyu Hospital of Guangzhou were selected. Sixty eligible patients who met the inclusion criteria were divided into treatment group and control group by digital random method according to 1:1 ratio, 30 cases in treatment group and 30 cases in control group. Both groups completed preoperative preparation for THR operation. The treatment group was treated with THR operation combined with Bazhen decoction, while the control group was treated with THR only. The sex, age, height, weight, blood routine before and after operation, Harris score of hip joint were recorded in the two groups. The recessive blood loss was calculated by Gross and Nadler equations, and the changes of indexes and clinical efficacy were analyzed and compared between the two groups. Results: there was no significant difference in RBC,HGB,HCT between the two groups before operation, on the day of operation and on the first day of operation (P0.05). The RBC,HGB,HCT values of the two groups were compared on the 3rd and 7th day after operation. The treatment group was higher than the control group, the difference was statistically significant (P0.05), and the RBC,HGB,HCT value of the two groups reached the lowest value on the 3rd day after operation, indicating that the THR perioperative period oral Bazhen decoction can increase the RBC,HGB, on the 3rd day and the 7th day after operation. HCT value. There was no significant difference in blood transfusion rate and dominant blood loss between the two groups (P0.05). Two groups of patients recessive blood loss, the treatment group is lower than the control group, the difference is statistically significant (P0.05), indicating that THR perioperative oral Bazhen decoction can reduce the hidden blood loss in patients, but can not effectively reduce dominant blood loss and blood transfusion rate. In terms of postoperative rehabilitation, the Harris score of hip joint in both groups was significantly higher on the 14th day after operation than on the 7th day after operation (P0.01), and on the 7th day after operation in the treatment group. On the 14th day, Harris score of hip joint was significantly higher than that of control group (P0.01). It indicated that Bazhen decoction taken orally in perioperative period of THR could accelerate postoperative functional recovery. Conclusion: during the perioperative period of hip arthroplasty, there were more recessive bleeding, and the value of RBC,HGB,HCT decreased obviously after operation, and most of the patients had the lowest value on the 3rd day after operation. The method of supplementing qi and nourishing blood (representative prescription: Bazhen decoction) can increase the RBC,HGB,HCT value of patients on the 3rd day and 7th day after operation, and can reduce the recessive blood loss of patients, accelerate the recovery of function after operation, without obvious adverse reactions. It is worth popularizing and applying in clinic.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4
本文編號：2394768
[Abstract]:Objective: in the treatment of diseases with (THR) artificial hip replacement, there are a lot of bleeding and high rate of allogeneic blood transfusion in perioperative period. In recent years, it has been found that the influence of recessive blood loss in perioperative period of THR can not be ignored, including affecting the healing of surgical mouth, delaying the recovery time of joint function, increasing the rate of allogeneic blood transfusion, prolonging the time of bed rest, and increasing the risk of deep venous thrombosis in lower extremity, etc. Based on the theory of traditional Chinese medicine, the purpose of this paper is to evaluate the effect and safety of THR on recessive blood loss after THR, and to provide the basis for the application of traditional Chinese medicine for supplementing qi and tonifying blood in the perioperative period of artificial joint. Methods: from February 2016 to February 2017, 60 patients in the orthopedic department of Panyu Hospital of Guangzhou were selected. Sixty eligible patients who met the inclusion criteria were divided into treatment group and control group by digital random method according to 1:1 ratio, 30 cases in treatment group and 30 cases in control group. Both groups completed preoperative preparation for THR operation. The treatment group was treated with THR operation combined with Bazhen decoction, while the control group was treated with THR only. The sex, age, height, weight, blood routine before and after operation, Harris score of hip joint were recorded in the two groups. The recessive blood loss was calculated by Gross and Nadler equations, and the changes of indexes and clinical efficacy were analyzed and compared between the two groups. Results: there was no significant difference in RBC,HGB,HCT between the two groups before operation, on the day of operation and on the first day of operation (P0.05). The RBC,HGB,HCT values of the two groups were compared on the 3rd and 7th day after operation. The treatment group was higher than the control group, the difference was statistically significant (P0.05), and the RBC,HGB,HCT value of the two groups reached the lowest value on the 3rd day after operation, indicating that the THR perioperative period oral Bazhen decoction can increase the RBC,HGB, on the 3rd day and the 7th day after operation. HCT value. There was no significant difference in blood transfusion rate and dominant blood loss between the two groups (P0.05). Two groups of patients recessive blood loss, the treatment group is lower than the control group, the difference is statistically significant (P0.05), indicating that THR perioperative oral Bazhen decoction can reduce the hidden blood loss in patients, but can not effectively reduce dominant blood loss and blood transfusion rate. In terms of postoperative rehabilitation, the Harris score of hip joint in both groups was significantly higher on the 14th day after operation than on the 7th day after operation (P0.01), and on the 7th day after operation in the treatment group. On the 14th day, Harris score of hip joint was significantly higher than that of control group (P0.01). It indicated that Bazhen decoction taken orally in perioperative period of THR could accelerate postoperative functional recovery. Conclusion: during the perioperative period of hip arthroplasty, there were more recessive bleeding, and the value of RBC,HGB,HCT decreased obviously after operation, and most of the patients had the lowest value on the 3rd day after operation. The method of supplementing qi and nourishing blood (representative prescription: Bazhen decoction) can increase the RBC,HGB,HCT value of patients on the 3rd day and 7th day after operation, and can reduce the recessive blood loss of patients, accelerate the recovery of function after operation, without obvious adverse reactions. It is worth popularizing and applying in clinic.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4
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