本文選題：歸脾湯 + PFNA��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探索歸脾湯加減對(duì)PFNA治療老年股骨粗隆間骨折術(shù)后隱性失血的影響,為臨床上治療該病提供另一種思路。方法:將30例來自江蘇省中醫(yī)院骨傷科的股骨粗隆間骨折患者分為治療組、對(duì)照組,每組各15例�；颊弑仨毞霞{入標(biāo)準(zhǔn),時(shí)間自2016年2月至2017年2月。在PFNA內(nèi)固定術(shù)后,對(duì)照組:術(shù)后給予常規(guī)的補(bǔ)液、預(yù)防感染、抗凝等基礎(chǔ)治療;治療組:在對(duì)照組常規(guī)補(bǔ)液、預(yù)防感染、抗凝等治療的基礎(chǔ)上,術(shù)后第一天開始服用加減歸脾湯(白術(shù)15g,當(dāng)歸15g,黨參15g,黃芪30g,茯苓15g,龍眼肉10g,酸棗仁(打碎)20g,遠(yuǎn)志6g,木香10g,甘草5g,阿膠(烊化)15g,山楂15g,丹參15g,大棗10g)水煎服,每天服用1劑,分兩次服用,共7劑。兩組均同時(shí)記錄患者的年齡、性別構(gòu)成、身高、體重,記錄術(shù)前1天及術(shù)后第1、3、7天的血常規(guī),記錄Hb及HCT,采用SPSS20.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,對(duì)比治療前后兩組臨床療效的變化及兩組間的療效差異。結(jié)果:一般資料比較:兩組病例的一般資料(年齡、性別構(gòu)成、體重、身高)均無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組病例顯性失血量、術(shù)中輸血人數(shù)及輸血量比較:兩組病例顯性失血量、術(shù)中輸血人數(shù)及輸血量對(duì)比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組病例手術(shù)前后Hb、HCT比較:(1)組內(nèi)對(duì)比,兩組病例術(shù)后第1、3、7天Hb、HCT水平較術(shù)前降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),表明兩組病例術(shù)后均存在隱性失血。(2)組間對(duì)比,兩組病例術(shù)后第1、3天Hb、HCT水平對(duì)比無統(tǒng)計(jì)學(xué)意義(P0.05),表明在術(shù)后第1、3天歸脾湯加減對(duì)PFNA治療老年股骨粗隆間骨折術(shù)后隱性失血的影響尚未顯現(xiàn)。(3)組間對(duì)比,兩組病例術(shù)后第7天治療組Hb、HCT高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),表明歸脾湯加減能有效減少PFNA治療老年股骨粗隆間骨折術(shù)后的隱性失血。兩組病例手術(shù)后隱性失血量的比較:(1)組內(nèi)對(duì)比,兩組病例術(shù)后1-3d的隱性失血量均較術(shù)前-術(shù)后1d降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組病例術(shù)后3-7d的隱性失血量均較術(shù)后1-3d降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),表明病例術(shù)后的隱性失血量逐漸減少。(2)組間對(duì)比,兩組病例術(shù)前-術(shù)后1d、術(shù)后1-3d隱性失血量對(duì)比無統(tǒng)計(jì)學(xué)意義(P0.05),表明在術(shù)前-術(shù)后1d、術(shù)后1-3d歸脾湯對(duì)PFNA治療老年股骨粗隆間骨折術(shù)后隱性失血的影響尚未顯現(xiàn)。(3)組間對(duì)比,兩組病例術(shù)后3-7d治療組隱性失血量少于對(duì)照組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05),表明歸脾湯加減能有效減少PFNA治療老年股骨粗隆間骨折的隱性失血。結(jié)論:歸脾湯加減能有效減少PFNA治療老年股骨粗隆間骨折術(shù)后的隱性失血。
[Abstract]:Objective: to explore the effect of Guipi decoction on the treatment of recessive blood loss after PFNA in elderly patients with intertrochanteric fracture of femur, and to provide another way of thinking for clinical treatment of this disease. Methods: thirty patients with intertrochanteric fracture of femur from Department of Orthopedics and Trauma of Jiangsu Provincial Hospital of traditional Chinese Medicine were divided into treatment group and control group with 15 cases in each group. Patients must meet inclusion criteria, from February 2016 to February 2017. After PFNA internal fixation, the control group was treated with routine rehydration, infection prevention, anticoagulant therapy and so on, while the treatment group: on the basis of routine rehydration, infection prevention, anticoagulant therapy, etc. On the first day after operation, we began to take add and subtractive spleen decoction (Atractylodes macrocephala 15g, Angelica sinensis 15g, Codonopsis 15g, Astragalus 30g, Poria cocos 15g, longan meat 10g, jujube seed 10g (smashing 20g, Yuanzhi 6g, wood 10g, licorice 5g), gelatin (closing 15g, Hawthorn 15g, salvia miltiorrhiza 15g, Dazao 10g), taking 1 dose daily, Take 7 doses in two doses. Age, sex, height, weight, blood routine, HB and HCT were recorded 1 day before operation and 3 days after operation. The data were statistically analyzed by SPSS20.0 software. The changes of clinical efficacy and the difference between the two groups before and after treatment were compared. Results: there was no significant difference in general data (age, sex composition, weight, height) between the two groups (P 0.05). There was no significant difference in the amount of dominant blood loss, the number of blood transfusions during operation and the amount of blood transfusion between the two groups. There was no significant difference between the two groups in terms of the amount of dominant blood loss, the number of blood transfusions during operation and the amount of blood transfusion. Comparison of HCT between the two groups before and after operation. The HCT levels in the two groups were significantly lower than those before and after operation on the 1st day, 3th day after operation, and the difference was statistically significant (P 0.05), which indicated that there was recessive blood loss in both groups. There was no significant difference in the level of HCT between the two groups on the 1st and 3rd day after operation, indicating that the effect of Guipi decoction on the hidden blood loss after PFNA in the treatment of senile intertrochanteric fracture of the femur was not yet apparent in the first day of operation, and there was no significant difference between the two groups in the treatment of intertrochanteric fracture of the femur. On the 7th day after operation, HCT in the treatment group was higher than that in the control group, and the difference was statistically significant (P 0.05), which indicated that Guipi decoction could effectively reduce the recessive blood loss after PFNA in the treatment of senile intertrochanteric fracture of femur. Comparison of recessive blood loss in the two groups after operation, the recessive blood loss at 1 to 3 days after operation in both groups was lower than that on the first day after operation, and the difference was statistically significant (P 0.05), and the occult blood loss at 3 to 7 days after operation in both groups was lower than that at 1 to 3 days after operation, and there was no significant difference between the two groups in the amount of recessive blood loss at 3 to 7 days after operation. The difference was statistically significant (P 0.05), which indicated that the recessive blood loss decreased gradually after operation. There was no significant difference in the amount of recessive blood loss between preoperative and postoperative 1 day and 1 to 3 days after operation in both groups. The results showed that the effect of Guipi decoction on PFNA in the treatment of senile femoral intertrochanteric fracture after operation was not significant at 1 day before and 1 day after operation, and there was no significant difference between the two groups in the treatment of senile femoral intertrochanteric fracture. The amount of recessive blood loss in the treatment group was less than that in the control group 3-7 days after operation, and the difference was statistically significant (P 0.05), which indicated that Guipi decoction could effectively reduce the recessive blood loss in the treatment of intertrochanteric fracture of the femur in elderly patients. Conclusion: Guipi decoction can effectively reduce the recessive blood loss after PFNA in the treatment of senile intertrochanteric fracture.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R274.9

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