本文選題：PFN-A + 隱性失血��； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：探討益氣活血法對股骨粗隆間骨折圍手術(shù)期血容量的影響。方法：選擇2014年12月至2016年1月來自廣東省中醫(yī)院珠海醫(yī)院住院部骨傷科符合股骨粗隆間骨折診斷入院病人,入院后并結(jié)合中醫(yī)四診合參,骨折中醫(yī)辨證為氣虛血瘀型證候；排除手術(shù)絕對禁忌癥,并適合行PFN-A內(nèi)固定定術(shù)的40例患者為受試對象。根據(jù)患者入院順序,隨機(jī)分組,按照等比例隨機(jī)分為兩組,即試驗(yàn)組(益氣活血組)和對照組(常規(guī)治療組),每組20例。試驗(yàn)組于患者入院后開始服用益氣活血湯加減,并擇期行PFN-A術(shù),術(shù)后第1天開始服用益氣活血湯加減至出院,兩組在這一過程中使用相同的骨科臨床常規(guī)治療；對照組患者行圍手術(shù)期常規(guī)治療,不予使用益氣活血湯,治療過程同樣至出院,兩組患者術(shù)后康復(fù)方案相同。記錄兩組患者的身高、體重、年齡等一般資料；記錄兩組術(shù)前血紅蛋白(Hb)、紅細(xì)胞比積(HCT),手術(shù)時(shí)間、切口長度、手術(shù)方法、術(shù)中出血量等術(shù)中記錄；記錄并計(jì)算術(shù)后第一、三、十天患者血紅蛋白及紅細(xì)胞比積,并計(jì)算隱性失血量；同時(shí)記錄兩組住院時(shí)間、費(fèi)用、輸血人數(shù)及術(shù)后10內(nèi)每天VAS評分情況,比較分析兩組的差異。結(jié)果：1.兩組各自術(shù)前與術(shù)后第一天HCT、Hb水平及各自術(shù)后第三天與第十天Hb、HCT、隱性失血量水平差異有統(tǒng)計(jì)學(xué)意義(P＜0.05),各自術(shù)后第一天Hb、HCT、隱性失血量與第三天比較差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)；兩組Hb、HCT、隱性失血量術(shù)后不同時(shí)間段比較發(fā)現(xiàn)不同時(shí)間觀察各自比較均數(shù)不同,差異水平有統(tǒng)計(jì)學(xué)意義(P＜0.05),其中不同時(shí)間與干預(yù)對Hb無交互作用(P0.05);而HCT、隱性失血量兩組對比發(fā)現(xiàn),不同的時(shí)間點(diǎn)兩組處理對其水平的影響有不同,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05),試驗(yàn)組Hb、HCT、血容量值的恢復(fù)都較對照組高。2.兩組術(shù)后第一至四天VAS評分差異無統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后第五天至第七天VAS評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),對照組高于試驗(yàn)組;第八天至第十天VAS評分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組輸血比率差異無統(tǒng)計(jì)學(xué)意義(P0.05),兩組藥物費(fèi)用、住院天數(shù)差異比較有統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組更低,兩組住院期間總費(fèi)用比較無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：圍手術(shù)期運(yùn)用益氣活血法體現(xiàn)了中醫(yī)辨證的特點(diǎn),粗隆間骨折行PFNA術(shù),術(shù)中出血少,但術(shù)后一個(gè)時(shí)間段存在Hb、HCT大幅度下降,即隱性失血,也是圍手術(shù)期血容量丟失的主要原因。在比較隱性出血量的量方面對比于對照組結(jié)果相致,提示益氣活血法并沒有減少患者隱性失血量,但運(yùn)用益氣活血法可以促進(jìn)患者術(shù)后血紅蛋白、紅細(xì)胞比積、血容量的恢復(fù),并讓術(shù)后患者整體血容量的恢復(fù)提前,隱性出血量逐漸減少并停止提前,有利患者機(jī)能恢復(fù)。益氣活血法組對比于對照組,在一定時(shí)間段上能減去患者術(shù)后疼痛強(qiáng)度,益氣活血法的運(yùn)用縮短了患者的住院時(shí)間、減少了住院費(fèi)用。
[Abstract]:Objective: to study the effect of supplementing qi and activating blood circulation method on perioperative blood volume of intertrochanteric fracture of femur. Methods: from December 2014 to January 2016, the Department of Orthopedics and Trauma of Zhuhai Hospital of traditional Chinese Medicine of Guangdong Province was selected to diagnose the femoral intertrochanteric fracture. Forty patients who excluded the absolute contraindication of operation and were suitable for PFN-A internal fixation were selected as subjects. According to the order of admission, the patients were randomly divided into two groups according to the same proportion, namely the experimental group (Yiqi Huoxue group) and the control group (routine treatment group, 20 cases in each group). The patients in the trial group began to take Yiqi Huoxue decoction after admission, and PFN-A was performed on the selected period. On the first day after operation, Yiqi Huoxue decoction was reduced to discharge. The two groups were treated with the same orthopedic clinical routine therapy in this process. The patients in the control group were treated with routine treatment during perioperative period without the use of Yiqi Huoxue decoction. The treatment process was the same as that of discharge. The rehabilitation program of the two groups was the same. To record the general data of height, weight, age and so on in the two groups, to record the preoperative hemoglobin, HCT, operative time, incision length, operative method, intraoperative bleeding volume, and to record and calculate the first and third postoperative blood loss. The hemoglobin and hematocrit of the two groups were calculated at the same time, the hospitalization time, the cost, the number of blood transfusions and the VAS score of 10 days after operation were recorded, and the differences between the two groups were compared and analyzed. The result is 1: 1. There was significant difference between the two groups in HCThb level before operation and on the first day after operation, and in HCT on the third and tenth day after operation. There was significant difference in the hidden blood loss between the two groups (P < 0.05), but there was no significant difference in HCT between the first day of operation and the third day after operation, and there was no significant difference in the hidden blood loss between the two groups on the first day after operation and on the third day after operation. There were significant differences in the mean of HCT between the two groups, and the difference of the mean of HCT between the two groups in the different time period after the operation, and the difference of the mean value of the two groups in different time after operation. The difference level was statistically significant (P < 0.05), in which there was no interaction between different time and intervention on HB, while HCT, recessive blood loss were different in two groups. The difference was statistically significant (P < 0.05). The recovery of HCT and blood volume in the test group was higher than that in the control group (P < 0.05). There was no significant difference in VAS score between the two groups from the first to the fourth day after operation (P 0.05), but there was no significant difference between the VAS scores from the fifth to the seventh day after operation (P 0.05). The VAS score in the control group was higher than that in the trial group, and there was no significant difference in the VAS score between the eighth day and the tenth day. There was no significant difference in blood transfusion ratio between the two groups (P 0.05). The difference of drug cost and hospitalization days between the two groups was statistically significant (P 0.05), and that in the test group was lower than that in the control group. There was no significant difference in the total cost during hospitalization between the two groups (P 0.05). Conclusion: during the perioperative period, the method of supplementing qi and activating blood circulation reflects the characteristics of TCM syndrome differentiation. The intertrochanteric fracture has less bleeding during the operation, but there is a significant decrease of HCT in the period after operation, that is, recessive blood loss. It is also the main cause of perioperative blood volume loss. Comparing the quantity of recessive blood loss with that of the control group, it suggests that the method of supplementing qi and activating blood circulation does not reduce the amount of recessive blood loss in patients, but it can promote the recovery of hemoglobin, hematocrit and blood volume of patients after operation by using the method of supplementing qi and activating blood circulation. The recovery of whole blood volume and recessive blood loss were reduced and stopped earlier, which was beneficial to the recovery of patients' function. Compared with the control group, the group of supplementing qi and activating blood circulation can subtract the postoperative pain intensity in a certain time, and the application of the method of supplementing qi and activating blood circulation shortens the hospitalization time and reduces the cost of hospitalization.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉云霞,申淑敏,米慶海;益氣活血法治療冠狀動(dòng)脈粥樣硬化性心臟病心絞痛84例[J];河北中醫(yī);2002年06期

2 孟永利,唐玲華,馮德華,崔云,王偉;益氣活血法在肺心病急性發(fā)作期的應(yīng)用體會(huì)[J];中國中醫(yī)藥信息雜志;2003年02期

3 俞企望;益氣活血法治療椎-基底動(dòng)脈供血不足性眩暈72例[J];實(shí)用中醫(yī)藥雜志;2004年04期

4 張少華;益氣活血法治療慢性肺原性心臟病45例[J];河南中醫(yī);2004年07期

5 何紅濤;汪慰寒;;益氣活血法治療病態(tài)竇房結(jié)綜合征50例[J];實(shí)用中醫(yī)內(nèi)科雜志;2008年12期

6 黃自存;益氣活血法治療十二指腸球部潰瘍68例報(bào)告[J];新醫(yī)學(xué);1983年03期

7 王宗強(qiáng);;益氣活血法的臨床應(yīng)用及研究[J];山東中醫(yī)雜志;1989年04期

8 程德紅,楊鳳常;益氣活血法治療慢性充血性心力衰竭60例[J];四川中醫(yī);1998年12期

9 王忠范,邵麗娜,蔡宇慧;益氣活血法治療慢性肺心病38例療效觀察[J];黑龍江醫(yī)藥科學(xué);1999年02期

10 鄧軼,陳航,林欣潮;益氣活血法治療亞急性非化膿性甲狀腺炎25例[J];中國醫(yī)藥學(xué)報(bào);2000年04期

相關(guān)會(huì)議論文 前10條

1 代瑩;劉鳳榮;郭薇;;運(yùn)用益氣活血法治療內(nèi)科疾病的體會(huì)[A];中國中醫(yī)藥學(xué)會(huì)建會(huì)20周年學(xué)術(shù)年會(huì)專輯(下)[C];1999年

2 呂海濤;羅翌;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的臨床觀察[A];全國危重病急救醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2007年

3 羅翌;呂海濤;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的臨床觀察[A];2008年廣東省中醫(yī)熱病、急癥、中西醫(yī)結(jié)合急救、危重病、災(zāi)害醫(yī)學(xué)學(xué)術(shù)會(huì)議學(xué)術(shù)論文集[C];2008年

4 羅翌;呂海濤;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的臨床觀察[A];2008全國中西醫(yī)結(jié)合危重病、急救醫(yī)學(xué)學(xué)術(shù)會(huì)議學(xué)術(shù)論文集[C];2008年

5 呂海濤;羅翌;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的實(shí)驗(yàn)研究[A];2008年廣東省中醫(yī)熱病、急癥、中西醫(yī)結(jié)合急救、危重病、災(zāi)害醫(yī)學(xué)學(xué)術(shù)會(huì)議學(xué)術(shù)論文集[C];2008年

6 呂海濤;羅翌;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的實(shí)驗(yàn)研究[A];2008全國中西醫(yī)結(jié)合危重病、急救醫(yī)學(xué)學(xué)術(shù)會(huì)議學(xué)術(shù)論文集[C];2008年

7 廖奕歆;鐘學(xué)文;;益氣活血法在周圍血管病治療中的應(yīng)用[A];中華中醫(yī)藥學(xué)會(huì)周圍血管病分會(huì)第四屆學(xué)術(shù)大會(huì)暨中華中醫(yī)藥學(xué)會(huì)周圍血管病分會(huì)25年會(huì)慶論文集[C];2011年

8 呂海濤;羅翌;;益氣活血法對缺血性中風(fēng)急性期腦保護(hù)作用的實(shí)驗(yàn)研究[A];2009年全國危重病急救醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2009年

9 夏菁;;益氣活血法在臨床的應(yīng)用[A];中華中醫(yī)藥學(xué)會(huì)學(xué)術(shù)年會(huì)——?jiǎng)?chuàng)新優(yōu)秀論文集[C];2002年

10 楊曉萍;;益氣活血法治療高血壓病早期腎損害30例臨床觀察[A];第十一屆全國中西醫(yī)結(jié)合腎臟病學(xué)術(shù)會(huì)議論文匯編[C];2010年

相關(guān)重要報(bào)紙文章 前9條

1 羅翌 葉燁 梅廣源;益氣活血法治療急性缺血性腦卒中[N];中國醫(yī)藥報(bào);2005年

2 冰山;益氣活血法治療穩(wěn)定型心絞痛[N];農(nóng)村醫(yī)藥報(bào)（漢）;2007年

3 楊六香邋李學(xué)燕;他有一顆善良的心[N];中國醫(yī)藥報(bào);2007年

4 安徽中醫(yī)學(xué)院 王鍵 郜巒 胡建鵬 何玲 唐巍;益氣活血法促進(jìn)神經(jīng)再生的研究思路和方法[N];中國中醫(yī)藥報(bào);2012年

5 熊相明 曲竹秋;清熱利濕益氣活血法對腎損害有保護(hù)作用[N];中國醫(yī)藥報(bào);2005年

6 周 穎;“與狼共舞”降癌魔[N];中國中醫(yī)藥報(bào);2005年

7 本報(bào)記者 胡迎新;從“根”上治癌[N];健康時(shí)報(bào);2004年

8 首都醫(yī)科大學(xué)附屬北京中醫(yī)醫(yī)院 徐詠梅;內(nèi)虛為本 分型辨治[N];中國中醫(yī)藥報(bào);2014年

9 本報(bào)記者 于麗珊;東北人就醫(yī)好去處[N];中國中醫(yī)藥報(bào);2002年

相關(guān)博士學(xué)位論文 前7條

1 吳文靜;糖尿病腎臟病氣虛血瘀病機(jī)及其臨床特征和益氣活血法作用機(jī)制研究[D];北京中醫(yī)藥大學(xué);2016年

2 鄧奕輝;滋陰益氣活血法抗糖尿病合并腦梗塞的臨床與實(shí)驗(yàn)研究[D];湖南中醫(yī)學(xué)院;2001年

3 楊華升;溫陽化飲、益氣活血法防治充血性心力衰竭的實(shí)驗(yàn)研究[D];黑龍江中醫(yī)藥大學(xué);2003年

4 楊清峰;補(bǔ)腎益氣活血法對老年2型糖尿病頸動(dòng)脈硬化及內(nèi)皮功能影響的研究[D];山東中醫(yī)藥大學(xué);2013年

5 陳晶;溫陽化飲益氣活血法對慢性心功能不全大鼠心室舒縮功能、神經(jīng)內(nèi)分泌及心肌重塑的影響[D];黑龍江中醫(yī)藥大學(xué);2005年

6 陳光明;通腑泄?jié)�、益氣活血法治療慢性腎衰竭的臨床研究[D];廣州中醫(yī)藥大學(xué);2012年

7 龍銦;王宗仁教授治療冠心病的學(xué)術(shù)經(jīng)驗(yàn)研究[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2009年

相關(guān)碩士學(xué)位論文 前10條

1 許銘;益氣活血法治療慢性心力衰竭的療效觀察[D];南京中醫(yī)藥大學(xué);2013年

2 王欣;溫陽益氣活血法聯(lián)合化療治療中晚期非小細(xì)胞肺癌的臨床觀察[D];成都中醫(yī)藥大學(xué);2015年

3 王森林;益氣活血法預(yù)防髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成（DVT）的臨床觀察[D];成都中醫(yī)藥大學(xué);2015年

4 侯維維;益氣活血法治療氣虛血瘀型頸動(dòng)脈粥樣硬化形成的臨床療效觀察[D];成都中醫(yī)藥大學(xué);2015年

5 黃杰;健脾補(bǔ)腎，益氣活血法治療早期糖尿病腎病的臨床與實(shí)驗(yàn)研究[D];山東中醫(yī)藥大學(xué);2015年

6 張麗君;益氣活血法對糖尿病大血管病變保護(hù)機(jī)制的臨床觀察及實(shí)驗(yàn)研究[D];山東中醫(yī)藥大學(xué);2015年

7 魏莎;益氣活血法改善老年晚期非小細(xì)胞肺癌患者化療生存質(zhì)量的臨床研究[D];山東中醫(yī)藥大學(xué);2015年

8 趙艷;益氣活血法綜合治療2型糖尿病周圍神經(jīng)病變的臨床研究[D];北京中醫(yī)藥大學(xué);2016年

9 彭佳;應(yīng)用益氣活血法早期長期干預(yù)冠心病前臨床心力衰竭的初步研究[D];北京中醫(yī)藥大學(xué);2016年

10 何倩偉;益氣活血法對老年股骨轉(zhuǎn)子間骨折術(shù)后隱性失血的影響[D];廣州中醫(yī)藥大學(xué);2016年

，

本文編號(hào)：1874073