本文選題：益氣活血法 + 人工全膝關(guān)節(jié)置換術(shù)��； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：[目的]本研究旨在探討益氣活血法改善人工全膝關(guān)節(jié)置換術(shù)后早期的臨床療效,觀察益氣活血法改善術(shù)后貧血、中醫(yī)證候、疼痛、肢體腫脹、關(guān)節(jié)功能的作用,以促進(jìn)患者術(shù)后快速康復(fù),為中醫(yī)改善人工全膝關(guān)節(jié)置換術(shù)后早期臨床癥狀提供臨床依據(jù)。[方法]納入60例因重度膝骨關(guān)節(jié)炎行初次單側(cè)人工全膝關(guān)節(jié)置換術(shù)的患者,隨機(jī)分為試驗組、對照組各30例。兩組患者手術(shù)由同一主刀醫(yī)師完成,圍手術(shù)期給予抗凝、預(yù)防感染、指導(dǎo)功能鍛煉等相同的基礎(chǔ)治療,對照組只采用上述基礎(chǔ)治療,試驗組則在上述基礎(chǔ)治療的基礎(chǔ)上于術(shù)后第1天給予益氣活血中藥干預(yù)(黃芪30g,當(dāng)歸10g,熟地10g,白芍10g,紅花10g,桃仁10g,制首烏10g,杜仲10g,牛膝10g,陳皮10g,炙甘草9g),每日1劑,分兩次口服,共服藥7天。分別統(tǒng)計兩組術(shù)前年齡、性別、身高、體重、血紅蛋白(Hb)、紅細(xì)胞計數(shù)(RBC)、紅細(xì)胞壓積(HCT)、VAS評分、肢體周徑、HSS評分進(jìn)行基線比較。觀察并記錄術(shù)后第1、3、7、14天血紅蛋白(Hb)、紅細(xì)胞計數(shù)(RBC)、紅細(xì)胞壓積(HCT)、中醫(yī)癥狀分級量化評分、VAS評分、肢體周徑,以及術(shù)后3、7、14天的膝關(guān)節(jié)HSS評分,并采用SPSS 24.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計分析。[結(jié)果]1、血紅蛋白(Hb):術(shù)后第1天兩組患者Hb平均水平降低,但試驗組與對照組之間相比無統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天Hb水平繼續(xù)降低,兩組數(shù)值均達(dá)到最低水平,但兩組比較無統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天患者的Hb水平開始緩慢升高,但是與對照組相比,試驗組水平較高,兩組有極顯著統(tǒng)計學(xué)差異(P0.01);術(shù)后第14天患者Hb水平均逐漸恢復(fù),試驗組、對照組之間差異減小,無明顯統(tǒng)計學(xué)差異(P0.05)。2、紅細(xì)胞計數(shù)(RBC):術(shù)后第1天兩組患者平均水平降低,試驗組與對照組之間無統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天試驗組與對照組平均水平逐漸降低,兩組比較無統(tǒng)計學(xué)差異(P0.05);但術(shù)后第7天兩組RBC水平均有所升高,試驗組較對照組升高幅度較大,兩組具有統(tǒng)計學(xué)差異(P0.05);術(shù)后14天試驗組與對照組患者RBC水平逐漸恢復(fù),兩組比較無統(tǒng)計學(xué)差異(P0.05)。3、紅細(xì)胞壓積(HCT):術(shù)后第1天兩組患者HCT水平降低,試驗組為34.043±2.47,對照組為33.09±2.01,兩組無統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天兩組HCT平均水平均繼續(xù)降低,試驗組與對照組有統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天HCT平均水平逐漸升高,試驗組與對照組有統(tǒng)計學(xué)差異(P0.05);術(shù)后第14天兩組HCT均值逐漸恢復(fù),試驗組與對照組無統(tǒng)計學(xué)差異(P0.05)。4、中醫(yī)癥狀分級量化評分:術(shù)后第1天試驗組與對照組之間患者中醫(yī)癥狀分級量化評分比較無統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天中醫(yī)癥狀分級量化評分均有所降低,但試驗組與對照組之間仍無統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天試驗組中醫(yī)癥狀分級量化評分降低的幅度大于對照組,兩組之間有極顯著統(tǒng)計學(xué)差異(P0.01);術(shù)后14天兩組差值逐漸減小,但試驗組與對照組之間仍有極顯著統(tǒng)計學(xué)差異(P0.01)。5、VAS評分:術(shù)后第1天試驗組與對照組之間比較具有統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天試驗組與對照組仍無統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天試驗組與對照組相比有極顯著統(tǒng)計學(xué)差異(P0.01);術(shù)后第14天試驗組與對照組均有較大幅度的降低,兩組相比有統(tǒng)計學(xué)差異(P0.05)。6、肢體周徑:術(shù)后第1天兩組之間無統(tǒng)計學(xué)差異(P0.05);術(shù)后第3天兩組患者肢體周徑均有增大,兩組仍無統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天試驗組平均水平較對照組低,兩組之間有統(tǒng)計學(xué)差異(P0.05);術(shù)后第14天兩組肢體周徑比較無統(tǒng)計學(xué)差異(P0.05)。7、HSS評分:術(shù)后第3天兩組患者HSS評分相比無統(tǒng)計學(xué)差異(P0.05);術(shù)后第7天試驗組HSS評分的平均水平高于對照組,有極顯著統(tǒng)計學(xué)差異(P0.01);術(shù)后第14天試驗組與對照組之間差距減小,兩組之間有統(tǒng)計學(xué)差異(P0.05)。[結(jié)論]本研究表明益氣活血法能夠糾正TKA術(shù)后早期Hb減少,減少TKA術(shù)后失血,而達(dá)到改善TKA術(shù)后患者早期的貧血狀態(tài),并且能夠減輕術(shù)后疼痛,減輕術(shù)后早期的肢體腫脹,改善關(guān)節(jié)功能,加快患者術(shù)后的快速康復(fù)。
[Abstract]:[Objective] to explore the effect of Yiqi Huoxue Method in improving the early clinical effect of artificial total knee replacement, and to observe the effect of Yiqi Huoxue Method to improve postoperative anemia, TCM syndrome, pain, limb swelling and joint function, in order to promote rapid recovery after operation, and to improve the early clinical symptoms after artificial total knee arthroplasty by traditional Chinese medicine. 60 cases of primary unilateral total knee arthroplasty due to severe knee osteoarthritis were divided into the experimental group and the control group of 30 cases. The two groups were performed by the same surgeon with the same primary surgeon. In the perioperative period, the same basic treatment, such as anticoagulant prevention, prevention of infection, guidance work, and other basic treatment, was used in the control group only. On the basis of the basic treatment, the experimental group was given the intervention of Yiqi Huoxue Chinese medicine on the basis of the above basic treatment (Radix Astragali 30g, angelica 10g, Radix Angelicae 10g, Radix Paeoniae Paeoniae 10g, safflower 10g, peach kernel 10g, made Radix Polygoni multiflorum 10g, Eucommia ulmoides 10g, Radix Achyranthes 10g, orange peel 10g, Radix Glycyrrhiza 9g), 1 doses of two times each day, taking medicine for 7 days. Statistics two groups of preoperative age, sex, sex, respectively. Difference, height, weight, hemoglobin (Hb), red blood cell count (RBC), red blood cell pressure product (HCT), VAS score, limb circumference, HSS score for baseline comparison. Observe and record the postoperative 1,3,7,14 days' hemoglobin (Hb), erythrocyte count (RBC), red blood cell pressure product (HCT), TCM symptom grading scale, VAS score, limb circumference, and 3,7,14 day after operation. HSS score of knee joint and statistical analysis of SPSS 24 software. [result]1, hemoglobin (Hb): Hb average level decreased in two groups of patients at first days after operation, but there was no statistical difference between the test group and the control group (P0.05); the level of Hb continued to fall at third days after the operation, and the two groups reached the lowest level, but the two groups had no statistical statistics. Study difference (P0.05); the Hb level of the patients began to increase slowly seventh days after operation, but compared with the control group, the level of the test group was higher and the two groups had significant statistical difference (P0.01); the level of Hb in the fourteenth days after the operation was gradually restored, the difference between the experimental group and the control group was reduced, there was no significant statistical difference (P0.05).2, and the erythrocyte count (RBC): after the operation: after the operation. In the first day, the average level of the two groups was reduced, and there was no statistical difference between the test group and the control group (P0.05). The average level of the test group and the control group decreased gradually on the third day after the operation, and there was no statistical difference between the two groups (P0.05), but the level of RBC in the two groups was higher in the seventh day after the operation, and the experimental group was higher than the control group, and the two groups had statistical difference. The RBC level of the experimental group and the control group gradually recovered 14 days after the operation. There was no statistical difference between the two groups (P0.05).3 and the hematocrit (HCT): the level of HCT in the first day group was 34.043 + 2.47, the control group was 33.09 + 2.01, and the two groups had no statistical difference (P0.05), and the average level of HCT in group two continued on third days after the operation. There was a statistical difference between the experimental group and the control group (P0.05), and the average level of HCT increased gradually on the seventh day after the operation, and there was a statistical difference between the experimental group and the control group (P0.05); the mean HCT of the two groups was gradually restored on the fourteenth day after the operation, and there was no statistical difference between the experimental group and the control group (P0.05).4, and the TCM symptom classification was quantified: the experimental group and the control group after the operation. There was no statistical difference (P0.05) between the TCM symptom grading and quantitative scores (P0.05), but there was no significant difference between the TCM symptom grading and the control group (P0.05) after third days of operation, and the reduction of TCM symptom grading scores in the seventh days after the operation was greater than that of the control group, and there was a very significant difference between the two groups. Statistical difference (P0.01), 14 days after the operation, the difference between the two groups gradually decreased, but there was still significant statistical difference between the test group and the control group (P0.01).5, VAS score: first days after the operation, there was a statistical difference between the test group and the control group (P0.05), and there was no statistical difference between the experimental group and the control group (P0.05) after the operation (P0.05), and the seventh day group after the operation. There was significant difference in Statistics (P0.01) compared with the control group (P0.01), and there was a significant reduction in the two groups (P0.05).6. There was no statistical difference between the two groups (P0.05) on the first day after the operation (P0.05), and the limb circumference increased on the third day after the operation, and there was no statistical difference between the two groups (P 0.05); the average level of the experimental group was lower than the control group at seventh days after the operation (P0.05), and there was no statistical difference between the two groups on the fourteenth day after the operation (P0.05).7, and the HSS score was not statistically significant (P0.05) in two groups of patients after the operation (P0.05); the average level of HSS score in the experimental group was higher than that of the control group at seventh days after the operation, There was a very significant statistical difference (P0.01); the gap between the test group and the control group decreased fourteenth days after the operation, and there was a statistical difference between the two groups (P0.05). [Conclusion] this study showed that the supplementing qi and activating blood method can correct the early Hb reduction after TKA operation, reduce the blood loss after TKA, and improve the early anemia status of the patients after TKA operation, and can reduce the postoperative period. Pain relieved early postoperative limb swelling, improved joint function and accelerated postoperative rehabilitation.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9

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