活血靈在老年髖部骨折圍手術(shù)期預(yù)防下肢深靜脈栓塞的臨床觀察
發(fā)布時間：2019-06-13 18:24
【摘要】：目的:通過對活血靈在老年髖部骨折圍手術(shù)期應(yīng)用預(yù)防下肢深靜脈血栓形成(DVT)的臨床觀察,分析使用活血靈對老年髖部骨折術(shù)后預(yù)防DVT的臨床療效及安全性。尋找一種最優(yōu)方案來預(yù)防老年髖部骨折術(shù)后下肢DVT,盡可能降低老年髖部手術(shù)術(shù)后下肢DVT的發(fā)生率,減少低分子肝素鈣的用量及副作用,提高患者的生活質(zhì)量。方法:選取60例老年髖部骨折患者(90周歲≥年齡≥60周歲)髖部骨折患者(股骨頸骨折及股骨轉(zhuǎn)子間骨折)隨機(jī)分為三組A組:低分子肝素鈣組;B組:活血靈加低劑量低分子肝素組;C組:活血靈組。三組納入病人各20例,用藥療程均為13天,分別是術(shù)前三天及術(shù)后10天,手術(shù)當(dāng)天不用,其中A組給予低分子肝素4100U皮下注射,每日1次;B組除使用低分子肝素2000U皮下注射外,并給予活血靈口服,每日1劑,早晚分服,每次100ml;C組僅給予活血靈口服,每日1劑,早晚分服,每次100ml。納入患者入院后行血常規(guī)、凝血五項、下肢彩色多普勒超聲等常規(guī)術(shù)前檢查,并于術(shù)后第1、2、7、14天復(fù)查血常規(guī)及D-二聚體、FIB指標(biāo),并記錄術(shù)中出血量、術(shù)后引流量、總輸血量、疼痛評分等指標(biāo)。術(shù)后復(fù)查下肢深靜脈彩色多普勒超聲檢查病人下肢是否有DVT形成。結(jié)果:1.通過R×C表卡方分析,說明三組間性別、年齡、患病部位、病種及手術(shù)方式數(shù)據(jù)樣本三組間具可比性;經(jīng)單因素方差檢驗,三組之間術(shù)前D-二聚體、FIB、血小板、血紅蛋白、患肢周徑比較差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。2.經(jīng)單因素方差分析,三組間輸血量無統(tǒng)計學(xué)意義。但從均值圖中可見輸血量:低鈣組低鈣加活血靈組活血靈組。3.經(jīng)單因素方差分析,三組數(shù)據(jù)滿足正態(tài)分布及方差齊性,其中術(shù)中出血量F=0.59,P=0.560.05,故三組間術(shù)中出血量無統(tǒng)計學(xué)意義。但從均值圖中可見術(shù)中出血量:低鈣組低鈣加活血靈組活血靈組。術(shù)后引流量f=3.84,p=0.030.05,故三組間術(shù)后引流量差異存在統(tǒng)計學(xué)意義。兩兩比較發(fā)現(xiàn),a組與b、c組比較p=0.03;0.01均0.05,差異有統(tǒng)計學(xué)意義;b,c兩組間比較p=0.950.05差異無統(tǒng)計學(xué)意義;從均值圖中可見術(shù)后引流量:低鈣組低鈣加活血靈組活血靈組。4、三組血紅蛋白數(shù)據(jù)經(jīng)重復(fù)資料的方差分析示:時間因素對各組血紅蛋白數(shù)據(jù)變化的影響存在統(tǒng)計學(xué)意義;不同時間點血紅蛋白數(shù)值隨分組的不同而不同,差異有統(tǒng)計學(xué)意義。經(jīng)snk檢驗示:術(shù)后第1、2天,b組與a組、c組間差異均無統(tǒng)計學(xué)意義,a組與c組間差異存在統(tǒng)計學(xué)意義;術(shù)后第7、14天,a組與b組、c組間差異均有統(tǒng)計學(xué)意義,b組與c組間差異不存在統(tǒng)計學(xué)意義;根據(jù)均值圖可見后期術(shù)后第7、14天b組、c組血紅蛋白較a組升高。5、三組d-二聚體數(shù)據(jù)滿足正態(tài)分布及方差齊性檢驗,重復(fù)資料的方差分析結(jié)果顯示時間因素對各組d-二聚體數(shù)據(jù)變化的影響存在統(tǒng)計學(xué)意義;不同時間點d-二聚體數(shù)值不隨分組的不同而不同,差異無統(tǒng)計學(xué)意義;大體上三組間同時間點d-二聚體差異均無統(tǒng)計學(xué)意義,但從均值圖上可見術(shù)后7天及術(shù)后14天b組較a組及c組來講,d-二聚體均數(shù)數(shù)值較低。6、三組fib數(shù)據(jù)滿足正態(tài)分布及方差齊性檢驗,重復(fù)資料的方差分析結(jié)果顯示時間因素對各組fib數(shù)據(jù)變化的影響存在統(tǒng)計學(xué)意義;不同時間點fib數(shù)值不隨分組的不同而不同,差異無統(tǒng)計學(xué)意義;三組間同時間點fib差異均無統(tǒng)計學(xué)意義,但從均值圖上可見術(shù)后14天b組較a組及c組來講,fib均數(shù)數(shù)值較低。7、三組疼痛評分?jǐn)?shù)據(jù)滿足正態(tài)分布及方差齊性檢驗,重復(fù)資料的方差分析結(jié)果顯示時間因素對各組疼痛評分變化的影響存在統(tǒng)計學(xué)意義;不同時間點疼痛評分不隨分組的不同而不同,差異無統(tǒng)計學(xué)意義;除第一天a組與c組對比,p值0.05外,a組與b組,B組與C組對比,P值均0.05,差異無統(tǒng)計學(xué)意義,在第2、7、14天同天內(nèi)B組與C組對比P值均0.05,說明兩組間差異無統(tǒng)計學(xué)意義,余A組與B組,A組與C組對比P值均0.05,說明兩組間差異存在統(tǒng)計學(xué)意義;從均值圖上可見術(shù)后B組及C組疼痛評分較同時間A組要低。綜上所述,說明BC兩組在術(shù)后第1、2天患者疼痛緩解較A組快。8、經(jīng)R×C表卡方分析三組下肢深靜脈血栓形成數(shù)據(jù)顯示:三組間下肢深靜脈血栓形成數(shù)據(jù)無統(tǒng)計學(xué)差異,下肢DVT高發(fā)于人工全髖關(guān)節(jié)置換術(shù)后患者。結(jié)論:活血靈和低分子肝素對D-二聚體、FIB指標(biāo)有明顯改善,同時活血靈能夠明顯減少術(shù)中出血量、術(shù)后引流量、改善疼痛評分,并能提高患者血紅蛋白數(shù)據(jù)指標(biāo),故將活血靈用于老年圍手術(shù)期干預(yù)骨科大手術(shù)后患者,能取得較好的預(yù)防下肢DVT的作用,且三組中活血靈與低劑量低分子肝素鈣聯(lián)合使用對D-二聚體、FIB數(shù)據(jù)指標(biāo)的改善作用最好。
[Abstract]:Objective: To observe the clinical effect and safety of the use of Huoxue Ling on the prevention of DVT after hip fracture in the elderly through the application of Huoxue Ling in the perioperative period of the old hip fracture. Find an optimal solution to prevent the lower limb DVT after the hip fracture of the old age, reduce the incidence of the lower limb DVT after the hip operation in the old age as much as possible, reduce the amount of low molecular weight heparin calcium and the side effect, and improve the quality of life of the patient. Methods:60 elderly patients with hip fracture (60 years old and 60 years old) were randomly divided into three groups: group A: low molecular weight heparin calcium group; group B: Huoxue Ling plus low dose low molecular weight heparin group; Group C: Huoxue Ling group. The three groups were included in 20 of the patients, and the course of treatment was 13 days, which were three days before operation and 10 days after operation. The operation day was not required, in which group A was given low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (2000U) for oral administration. The daily dose of 1 agent is taken in the morning and evening, and 100 ml each time; the C group only gives the Huoxue oral solution, and the daily dose of 1 agent is taken in the morning and evening, and the dosage is 100 ml each time. The routine pre-operative examinations such as blood routine, blood coagulation and color Doppler ultrasound of lower limbs were included in the patient's admission, and the blood routine and D-dimer and FIB index were re-examined at the 1st, 2nd, 7th and 14th day after operation, and the amount of blood loss, postoperative drainage, total blood transfusion, and pain score were recorded. After the operation, the lower limb deep vein color Doppler ultrasound was re-examined to see if the lower limb of the patient was formed with DVT. Results:1. The three groups of data samples of sex, age, disease, disease and operation were analyzed by R-C table chi-square analysis, and the three groups of data samples of sex, age, disease, disease and operation were comparable to each other, and D-dimer, FIB, platelets and hemoglobin were pre-operative among the three groups. There was no significant difference in the peripheral diameter of the affected limb (P0.05). One-factor analysis of variance, no statistical significance between the three groups. However, the blood transfusion volume is visible from the mean graph: the low-calcium group is low-calcium and the blood-activating and blood-activating group is used for promoting blood circulation. One-factor analysis of variance and three groups of data met the normal distribution and the homogeneity, and the amount of blood loss in the three groups was 0.59, P = 0.560.05, so the amount of blood loss in the three groups was not statistically significant. But the intraoperative blood loss is seen from the mean figure: the low-calcium group, the low-calcium and the blood-activating group, and the blood-activating group. The postoperative drainage flow was f = 3.84, p = 0.030.05, so there was a significant difference between the three groups. The results showed that the difference of group a and group b and c was p = 0.03, 0.01 was 0.05, the difference was statistically significant, and b, c, p = 0.950.05, there was no significant difference between the two groups. The analysis of variance of the repeated data of the three groups of hemoglobin data showed that the time factor had a statistical significance on the change of hemoglobin data in each group, and the hemoglobin values at different time points were different from those of the group, and the difference was of statistical significance. The results showed that there was no significant difference between group a and c between group b and group b after operation, and there was no statistical difference between group a and group c, and there was no statistical significance between group b and c. In group 7,14 and b after that post-operation, the mean of group c was increased in group b, and the d-dimer data of the three groups met the normal distribution and the homogeneity test. The results of variance analysis of the repeated data show that the time factor has a statistical significance on the change of d-dimer data in each group; the value of d-dimer at different time points does not differ from that of the group, and the difference is not significant; There was no significant difference in d-dimer between the three groups, but the mean value of d-dimer was lower in group A and group c after 7 days after operation and 14 days after operation. The results of variance analysis of the repeated data show that the effect of time factor on the change of the fib data in each group is of statistical significance; the fib values of the different time points do not differ from those of the group, and the difference is not significant; the difference of the three groups of time point fib is not statistically significant, However, in group a and c, that mean number of fib was lower in the 14-day b group after operation, and the three groups of pain score data met the normal distribution and the homogeneity test. The results of variance analysis of repeated data show that the effect of time factors on the change of pain scores in each group is of statistical significance; the pain scores of different time points do not differ from those of the group, and the difference is not significant; in addition to the comparison between the first and the second groups, the p-value is 0.05, and the groups a and b, In group B, there was no significant difference between group B and group C, and the difference between group B and group C was 0.05. There was no statistical difference between group A and group B. The difference between group A and group B was 0.05, and the difference between the two groups was statistically significant. The pain scores of group B and group C were lower than that in group A after operation. To sum up, in the first and second days after the operation, the pain relief of the two groups was faster than that in group A.8. The data of deep vein thrombosis of lower limbs was analyzed by R-C-meter-square analysis. There was no statistical difference between three groups of lower limb deep vein thrombosis. The high incidence of DVT in the lower limb is higher than that of the patients after the total hip replacement. Conclusion: Huoxue Ling and low molecular weight heparin can obviously improve the D-dimer and FIB index, while the Huoxue Ling can obviously reduce the intraoperative blood loss, post-operative drainage, improve the pain score, and improve the hemoglobin data index of the patient. Therefore, Huoxue Ling is used in the post-operative intervention of the old patients, and the effect of the lower limb DVT can be effectively prevented, and the combination of the Huoxue and the low-dose low-molecular heparin calcium in the three groups has the best effect on the improvement of the D-dimer and the FIB data index.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R274.1
本文編號：2498719
[Abstract]:Objective: To observe the clinical effect and safety of the use of Huoxue Ling on the prevention of DVT after hip fracture in the elderly through the application of Huoxue Ling in the perioperative period of the old hip fracture. Find an optimal solution to prevent the lower limb DVT after the hip fracture of the old age, reduce the incidence of the lower limb DVT after the hip operation in the old age as much as possible, reduce the amount of low molecular weight heparin calcium and the side effect, and improve the quality of life of the patient. Methods:60 elderly patients with hip fracture (60 years old and 60 years old) were randomly divided into three groups: group A: low molecular weight heparin calcium group; group B: Huoxue Ling plus low dose low molecular weight heparin group; Group C: Huoxue Ling group. The three groups were included in 20 of the patients, and the course of treatment was 13 days, which were three days before operation and 10 days after operation. The operation day was not required, in which group A was given low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (2000U) for oral administration. The daily dose of 1 agent is taken in the morning and evening, and 100 ml each time; the C group only gives the Huoxue oral solution, and the daily dose of 1 agent is taken in the morning and evening, and the dosage is 100 ml each time. The routine pre-operative examinations such as blood routine, blood coagulation and color Doppler ultrasound of lower limbs were included in the patient's admission, and the blood routine and D-dimer and FIB index were re-examined at the 1st, 2nd, 7th and 14th day after operation, and the amount of blood loss, postoperative drainage, total blood transfusion, and pain score were recorded. After the operation, the lower limb deep vein color Doppler ultrasound was re-examined to see if the lower limb of the patient was formed with DVT. Results:1. The three groups of data samples of sex, age, disease, disease and operation were analyzed by R-C table chi-square analysis, and the three groups of data samples of sex, age, disease, disease and operation were comparable to each other, and D-dimer, FIB, platelets and hemoglobin were pre-operative among the three groups. There was no significant difference in the peripheral diameter of the affected limb (P0.05). One-factor analysis of variance, no statistical significance between the three groups. However, the blood transfusion volume is visible from the mean graph: the low-calcium group is low-calcium and the blood-activating and blood-activating group is used for promoting blood circulation. One-factor analysis of variance and three groups of data met the normal distribution and the homogeneity, and the amount of blood loss in the three groups was 0.59, P = 0.560.05, so the amount of blood loss in the three groups was not statistically significant. But the intraoperative blood loss is seen from the mean figure: the low-calcium group, the low-calcium and the blood-activating group, and the blood-activating group. The postoperative drainage flow was f = 3.84, p = 0.030.05, so there was a significant difference between the three groups. The results showed that the difference of group a and group b and c was p = 0.03, 0.01 was 0.05, the difference was statistically significant, and b, c, p = 0.950.05, there was no significant difference between the two groups. The analysis of variance of the repeated data of the three groups of hemoglobin data showed that the time factor had a statistical significance on the change of hemoglobin data in each group, and the hemoglobin values at different time points were different from those of the group, and the difference was of statistical significance. The results showed that there was no significant difference between group a and c between group b and group b after operation, and there was no statistical difference between group a and group c, and there was no statistical significance between group b and c. In group 7,14 and b after that post-operation, the mean of group c was increased in group b, and the d-dimer data of the three groups met the normal distribution and the homogeneity test. The results of variance analysis of the repeated data show that the time factor has a statistical significance on the change of d-dimer data in each group; the value of d-dimer at different time points does not differ from that of the group, and the difference is not significant; There was no significant difference in d-dimer between the three groups, but the mean value of d-dimer was lower in group A and group c after 7 days after operation and 14 days after operation. The results of variance analysis of the repeated data show that the effect of time factor on the change of the fib data in each group is of statistical significance; the fib values of the different time points do not differ from those of the group, and the difference is not significant; the difference of the three groups of time point fib is not statistically significant, However, in group a and c, that mean number of fib was lower in the 14-day b group after operation, and the three groups of pain score data met the normal distribution and the homogeneity test. The results of variance analysis of repeated data show that the effect of time factors on the change of pain scores in each group is of statistical significance; the pain scores of different time points do not differ from those of the group, and the difference is not significant; in addition to the comparison between the first and the second groups, the p-value is 0.05, and the groups a and b, In group B, there was no significant difference between group B and group C, and the difference between group B and group C was 0.05. There was no statistical difference between group A and group B. The difference between group A and group B was 0.05, and the difference between the two groups was statistically significant. The pain scores of group B and group C were lower than that in group A after operation. To sum up, in the first and second days after the operation, the pain relief of the two groups was faster than that in group A.8. The data of deep vein thrombosis of lower limbs was analyzed by R-C-meter-square analysis. There was no statistical difference between three groups of lower limb deep vein thrombosis. The high incidence of DVT in the lower limb is higher than that of the patients after the total hip replacement. Conclusion: Huoxue Ling and low molecular weight heparin can obviously improve the D-dimer and FIB index, while the Huoxue Ling can obviously reduce the intraoperative blood loss, post-operative drainage, improve the pain score, and improve the hemoglobin data index of the patient. Therefore, Huoxue Ling is used in the post-operative intervention of the old patients, and the effect of the lower limb DVT can be effectively prevented, and the combination of the Huoxue and the low-dose low-molecular heparin calcium in the three groups has the best effect on the improvement of the D-dimer and the FIB data index.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R274.1
【相似文獻(xiàn)】
相關(guān)期刊論文 前10條
1 蔡立民;桑傳蘭;譚志超;袁勝超;曾勤;王蕭;;活血靈片對創(chuàng)傷性肢體深靜脈血栓模型兔的影響[J];廣州中醫(yī)藥大學(xué)學(xué)報;2013年04期
2 李瑾章;黨根喜;張作華;;活血靈治療缺血性腦血管病的療效研究[J];中風(fēng)與神經(jīng)疾病雜志;1989年01期
3 胡振玉，郭武印，王瑞，王小平，劉玉林，，施新猷，婁清林;活血靈－B治療造血功能障礙的實驗及臨床研究[J];河南中醫(yī);1995年01期
4 曾勤;蔡立民;黃中強(qiáng);;活血靈干預(yù)大鼠跟腱異位骨化的實驗研究[J];新中醫(yī);2009年09期
5 蔡立民;桑傳蘭;譚志超;袁勝超;曾勤;王蕭;;活血靈片對兔創(chuàng)傷性肢體深靜脈血栓形成的干預(yù)[J];中華關(guān)節(jié)外科雜志(電子版);2013年04期
6 馮朝暉;臧企;陳慶魁;;活血靈-B治療視網(wǎng)膜靜脈阻塞的實驗研究[J];眼科新進(jìn)展;1991年02期
7 沈素紅;郭艷幸;席占國;陳柯;;洛陽正骨傳統(tǒng)方藥活血靈預(yù)防骨科術(shù)后下肢深靜脈血栓形成的臨床研究[J];中國中醫(yī)骨傷科雜志;2011年03期
8 許文;曲煜霞;施春梅;;解毒飲、活血靈濕敷緩解幼兒導(dǎo)尿拔管后尿痛24例[J];中醫(yī)藥導(dǎo)報;2013年03期
9 吉志清,孫民德,藺世龍;活血靈對眼球結(jié)膜微循環(huán)的影響[J];中國微循環(huán);1999年04期
10 孟輝;;活血靈片治療創(chuàng)傷性股骨頭壞死臨床分析[J];中國醫(yī)學(xué)工程;2013年12期
相關(guān)碩士學(xué)位論文 前3條
1 張延召;活血靈在老年髖部骨折圍手術(shù)期預(yù)防下肢深靜脈栓塞的臨床觀察[D];安徽中醫(yī)藥大學(xué);2016年
2 肖署陽;活血靈干預(yù)骨科大手術(shù)后深靜脈血栓形成的臨床觀察[D];廣州中醫(yī)藥大學(xué);2010年
3 沈素紅;活血靈預(yù)防骨科大手術(shù)后下肢深靜脈血栓形成的臨床研究[D];湖南中醫(yī)藥大學(xué);2012年
本文編號：2498719
本文鏈接：http://sikaile.net/zhongyixuelunwen/2498719.html
最近更新
教材專著
