活血益氣利水方干預(yù)老年髖部骨折關(guān)節(jié)置換術(shù)后血液高凝狀態(tài)的研究
發(fā)布時(shí)間：2018-07-13 21:42
【摘要】：目的:研究通過(guò)對(duì)老年髖部骨折術(shù)后血液高凝狀態(tài)的患者早期予以活血益氣利水方及低分子肝素鈣進(jìn)行干預(yù)觀察評(píng)價(jià)兩者聯(lián)合使用的干預(yù)效果,為髖部骨折血液高凝狀態(tài)患者術(shù)后預(yù)防血栓形成提供臨床依據(jù)。方法:從2016年2月至2017年2月入住廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院骨科行髖部骨折手術(shù)(包括股骨頸骨折,股骨粗隆間骨折)的患者;選擇符合納入標(biāo)準(zhǔn)的患者50例,隨機(jī)分成A、B組,A組為對(duì)照組,B組為治療組,每組患者25例(n=25)。其中A組予低分子肝素鈣2500UI,皮下注射,1次/日;B組在A基礎(chǔ)上加用活血益氣利水方內(nèi)服,兩組同時(shí)予常規(guī)治療措施。所有病例觀察療程均為10天;所有病例于術(shù)后第1天、第10天觀察血漿D-二聚體、纖維蛋白原(FIB)、血漿凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)和血小板計(jì)數(shù)(PLT)的變化情況,治療前后還觀察患者的患肢周徑差值及疼痛評(píng)分。對(duì)檢查結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,采用SPSSI22統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)處理;組內(nèi)比較采用配對(duì)t檢驗(yàn),組間比較采用獨(dú)立樣本t檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)在觀察時(shí)間內(nèi),兩組患者出現(xiàn)癥狀性下肢DVT中,術(shù)后治療組(B組)DVT的發(fā)生0例(0%);對(duì)照組(A組)總共發(fā)生1例(4%)。實(shí)驗(yàn)過(guò)程中未出現(xiàn)PTE患者。(2)治療組、對(duì)照組術(shù)后第一天與術(shù)后第十天兩組患者患肢與健側(cè)肢體周徑差值及疼痛評(píng)分結(jié)果比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);且兩組患者術(shù)后第十天相比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)血液指標(biāo)方面(D-二聚體、FIB、PT、APTT、PLT):兩組患者所有指標(biāo)術(shù)后第一天與術(shù)后第十天相比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者所有指標(biāo)術(shù)后第十天相比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者所有指標(biāo)術(shù)后第一天相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)活血益氣利水方能改善髖部骨折術(shù)后的血液高凝狀態(tài),它能顯著降低血液中的Fib、PLT及D-二聚體,延長(zhǎng)APTT、PT。(2)活血益氣利水方不僅能夠降低髖部骨折術(shù)后下肢深靜脈血栓的發(fā)生率,還能減輕患者術(shù)后患肢腫脹、疼痛等癥狀,改善局部血液循環(huán)的作用,對(duì)老年髖部骨折術(shù)后深靜脈血栓形成有良好的預(yù)防效果。
[Abstract]:Objective: to observe and evaluate the effect of combined use of blood hypercoagulant and low-molecular-weight heparin calcium (LMWHC) on the elderly patients with hip fracture who were treated with Huoxue Yiqi Lishui Fang and low molecular weight heparin calcium in the early stage. To provide clinical basis for prevention of thrombosis after operation in patients with hypercoagulant state of hip fracture. Methods: from February 2016 to February 2017, patients admitted to the Department of Orthopaedics, first affiliated Hospital of Guangxi University of traditional Chinese Medicine, underwent hip fracture surgery (including femoral neck fracture and intertrochanteric fracture), and 50 patients who met the inclusion criteria were selected. Group A was randomly divided into two groups: control group (n = 25), control group (n = 25) and group B (n = 25). Group A was given low molecular weight heparin calcium (LMWH) 2500UI. Group B was given subcutaneous injection of heparin once a day on the basis of A plus internal administration of Huoxue Yiqi Lishui recipe. Both groups were given routine treatment measures at the same time. The changes of plasma D-dimer, fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count (PLT) were observed on the 1st and 10th day after operation. The difference of peripheral diameter and pain score were also observed before and after treatment. Statistical analysis of the results of the test, SPSSI22 statistical software for statistical processing; intra-group comparison using paired t-test, inter-group comparison using independent sample t-test P0.05 as the difference was statistically significant. Results: (1) in the two groups, there were 0 cases (0%) in the treatment group (group B) and 1 case (4%) in the control group (group A). There were no Pte patients in the experiment. (2) in the treatment group and the control group, the difference between the peripheral diameter of the affected and the healthy limbs and the pain score were compared between the first day after operation and the tenth day after operation. The difference was statistically significant (P0.05), and the difference was statistically significant between the two groups on the 10th day after operation (P0.05). (3) (P 0.05). All the indexes of the two groups were compared on the first day after operation and the tenth day after operation. The differences were statistically significant (P0.05); the two groups of all indicators compared with the tenth day after surgery, the differences were statistically significant (P0.05); the two groups of all indicators compared with the first day after surgery, the difference was not statistically significant (P0.05). Conclusion: (1) Huoxue Yiqi Lishui prescription can improve the blood hypercoagulability after hip fracture, and it can significantly reduce the fibrinogen PLT and D-dimer in the blood. (2) Huoxue Yiqi Lishui recipe can not only reduce the incidence of deep venous thrombosis in lower extremities after hip fracture, but also alleviate the symptoms of swelling and pain of the affected limbs, and improve the local blood circulation. It has good preventive effect on deep vein thrombosis after hip fracture in the elderly.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R274.9
[Abstract]:Objective: to observe and evaluate the effect of combined use of blood hypercoagulant and low-molecular-weight heparin calcium (LMWHC) on the elderly patients with hip fracture who were treated with Huoxue Yiqi Lishui Fang and low molecular weight heparin calcium in the early stage. To provide clinical basis for prevention of thrombosis after operation in patients with hypercoagulant state of hip fracture. Methods: from February 2016 to February 2017, patients admitted to the Department of Orthopaedics, first affiliated Hospital of Guangxi University of traditional Chinese Medicine, underwent hip fracture surgery (including femoral neck fracture and intertrochanteric fracture), and 50 patients who met the inclusion criteria were selected. Group A was randomly divided into two groups: control group (n = 25), control group (n = 25) and group B (n = 25). Group A was given low molecular weight heparin calcium (LMWH) 2500UI. Group B was given subcutaneous injection of heparin once a day on the basis of A plus internal administration of Huoxue Yiqi Lishui recipe. Both groups were given routine treatment measures at the same time. The changes of plasma D-dimer, fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count (PLT) were observed on the 1st and 10th day after operation. The difference of peripheral diameter and pain score were also observed before and after treatment. Statistical analysis of the results of the test, SPSSI22 statistical software for statistical processing; intra-group comparison using paired t-test, inter-group comparison using independent sample t-test P0.05 as the difference was statistically significant. Results: (1) in the two groups, there were 0 cases (0%) in the treatment group (group B) and 1 case (4%) in the control group (group A). There were no Pte patients in the experiment. (2) in the treatment group and the control group, the difference between the peripheral diameter of the affected and the healthy limbs and the pain score were compared between the first day after operation and the tenth day after operation. The difference was statistically significant (P0.05), and the difference was statistically significant between the two groups on the 10th day after operation (P0.05). (3) (P 0.05). All the indexes of the two groups were compared on the first day after operation and the tenth day after operation. The differences were statistically significant (P0.05); the two groups of all indicators compared with the tenth day after surgery, the differences were statistically significant (P0.05); the two groups of all indicators compared with the first day after surgery, the difference was not statistically significant (P0.05). Conclusion: (1) Huoxue Yiqi Lishui prescription can improve the blood hypercoagulability after hip fracture, and it can significantly reduce the fibrinogen PLT and D-dimer in the blood. (2) Huoxue Yiqi Lishui recipe can not only reduce the incidence of deep venous thrombosis in lower extremities after hip fracture, but also alleviate the symptoms of swelling and pain of the affected limbs, and improve the local blood circulation. It has good preventive effect on deep vein thrombosis after hip fracture in the elderly.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R274.9
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 張海龍;王紹輝;李蕊;張宏軍;;加味桃紅四物湯口服減少全髖關(guān)節(jié)置換術(shù)后低分子肝素鈣用量的臨床觀察[J];風(fēng)濕病與關(guān)節(jié)炎;2016年11期
2 黃樹(shù)勇;鄭臣校;李緒松;林小永;;八味傷科活血片對(duì)髖部周?chē)钦酆笱焊吣隣顟B(tài)影響的臨床研究[J];廣州中醫(yī)藥大學(xué)學(xué)報(bào);2016年05期
3 陳金雄;余海波;盧紹q，
本文編號(hào)：2120827
本文鏈接：http://sikaile.net/zhongyixuelunwen/2120827.html
最近更新
教材專(zhuān)著
