针灸治疗在全膝关节置换术围手术期血液管理中的影响
发布时间：2018-11-08 21:05
【摘要】：目的：探讨针灸治疗在老年人初次行全膝关节置换术(TKA)围手术期血液管理中的影响。通过客观规范地评价针灸对初次全膝关节置换术围手术期出血管理中临床疗效和安全性,为临床提供实用、有效、体现中医特色的规范化方案和新方法,探讨其临床价值及推广意义。方法：收集于2015年1月到2015年10月在广东省中医院骨科进行初次单侧全膝关节置换手术的老年膝骨关节炎患者。采用随机、对照临床试验研究。将符合研究要求的病例分为针灸组和对照组,每组35例,共70例。两组在采用相同的治疗基础上,分别采用针灸治疗和非针灸治疗方案。通过临床比较,进而观察针灸在全膝关节置换术围手术期中血液管理的影响。本研究以术前、术后当天、1、3、7天血常规包括：血色素、红细胞压积；术后引流量、输血量,计算各阶段失血量包括：实际失血总量,显性与隐性失血总量；凝血功能包括：术前、术后当天、1、3、7天凝血3项、D2聚体；局部症状包括：术前、术后第3、7天患肢疼痛评分、肿胀；关节功能包括：术前、术后第3、7天进行膝关节功能情况调查(HSS评分表)；安全性包括：患肢皮肤情况、肢端感觉、血运等；以及不良事件记录；经济效益包括：住院时间为观察项目。并用SPSS19.0统计软件对结果进行统计分析。成果：70例病例中,经统计学检验,两组红细胞比容(HCT),术后10小时内,P0.05,具有统计学意义,表示两组的术后10小时内HCT有明显差异。而术后第1、3、7天中,P0.01,具有统计学意义,表示两组的术后第1、3、7天的HCT有显著差异。血红蛋白(Hb),术前、术后10小时内和术后第1天的Hb无统计学意义(P0.05),两组Hb无明显差异。术后第三天的Hb比较,P0.05,具有统计学意义,表示两组的术后第三天Hb有明显差异。而术后第七天中,Hb比较,P0.01,具有统计学意义,表示两组的术后第七天的Hb有显著差异。失血量差异比较两组的术后10小时、术后10小时至第1天间和术后第1天至第3天间的失血量统计学意义(P0.01),两组失血量有显著差异,而在术后第3天至第7天间的失血量无统计学意义(P0.05),两组失血量无明显差异。不同时段的总失血量差异比较,两组的1天总失血量、3天的总失血量和1周的总失血量均具有统计学意义(P0.01),两组在不同时段的总失血量均有显著差异。总显性失血量和总引流量情况的差异比较,P0.05,均无统计学意义,表示针灸组与对照组之间的总显性失血量和总引流量情况无明显差异。隐性失血量差异比较,两组的3天隐性失血量和1周隐性失血量有统计学意义(P0.01),两组失血量有显著差异。凝血酶原时间(PT)、凝血酶原活动度(AT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APPT)和D-二聚体(D-dimer)情况的差异比较,P0.05,均无统计学意义,表示针灸组与对照组之间无明显差异。术后1周和术后2周的HSS评分差异比较两组的疼痛、功能、活动度、肌力有统计学意义(P0.01),两组HSS评分有显著差异。疼痛VAS评分差异比较,两组的VAS评分,除术前的VAS评分无统计学意义(P0.05),无明显差异,术后3天和术后7天的VAS评分,有统计学意义(P0.01),该时段的两组的疼痛VAS评分有显著差异。髌上10cm腿围情况的差异比较,入院第1天、术后第3天,P0.05,均无统计学意义,表示该时段的针灸组与对照组之间的髌上10cm腿围情况无明显差异,而在术后第7天,针灸组与对照组之间的髌上10cm腿围情况,P0.05,有统计学意义,表示在该时段的髌上10cm腿围情况有明显差异。小腿中部的腿围情况的差异比较,入院第1天的小腿中部的腿围,P0.05,均无统计学意义,表示该时段的针灸组与对照组之间的小腿中部的腿围情况无明显差异,而在术后第3天和第7天,针灸组与对照组之间的小腿中部的腿围情况,P0.01,有统计学意义,表示在该时段的小腿中部的腿围情况有显著差异。两组患者实验过程中未出现严重出血以及其他不适。结论：通过临床验证,针灸治疗能明显降低全膝关节置换术患者的总失血量和隐性失血量。而术后1周和2周的膝关节功能,针灸能使疼痛明显减轻,而功能、活动度、肌力也能明显改善。针灸治疗在术后的并发症上也有明显改善,除了疼痛明显减轻,下肢的肿胀也有显著改善,其中小腿的消肿速度较大腿的速度快。在经济效益上,针灸能缩短住院时间,加快医院轮转,让更多的病人受惠。
[Abstract]:Objective: To study the effect of acupuncture and moxibustion on the perioperative blood management of primary total knee arthroplasty (TKA) in the elderly. Objective To evaluate the clinical efficacy and safety of acupuncture on the management of the primary total knee arthroplasty in the perioperative period, and to provide a practical, effective and effective method for the clinical value and the popularization of the traditional Chinese medicine. Methods: The first one-sided total knee replacement surgery in the middle hospital of Guangdong Province from January 2015 to October 2015 was collected. Randomized, controlled clinical trial study. The cases in which the study requirements were met were divided into acupuncture group and control group, 35 cases in each group and 70 cases. In the two groups, acupuncture and non-acupuncture treatment were used on the basis of the same treatment. The effect of acupuncture on the management of blood during the perioperative period of total knee replacement was also observed by clinical comparison. The blood routine of the day, day, day, day, and day after operation was as follows: blood pigment, red blood cell pressure product, post-operative drainage and blood transfusion, and the amount of blood loss in each stage was calculated. The total amount of blood loss, the total amount of the dominant and the recessive blood loss were calculated, and the coagulation function included: before the operation, 3, 3 and 7 days after operation, D2 poly (s); local symptoms include: pre-operative, postoperative day 3, 7-day limb pain score, swelling; joint function including: pre-operative, postoperative day 3, 7-day knee function investigation (HSS scale); safety including limb skin condition, limb-side feel, blood transport, and the like; and the record of adverse event; the economic benefit includes: the hospital stay time is the observation project. The results were analyzed by SPSS 19.0. Results: In 70 cases, the hematocrit (HCT) of the two groups was statistically tested, and the difference of HCT in the two groups was statistically significant within 10 hours after the operation. The postoperative day 1, 3 and 7 days, P 0.01, had statistical significance, indicating that there was a significant difference in HCT between the two groups after the first, third and seventh day. Hb was no significant difference between the two groups (P0.05). The Hb in the third day of the operation was significantly different from that of the third day after the operation, and there was a significant difference in the Hb in the third day after the operation. In the seventh day of the operation, Hb was compared with that of p0.01, and there was a significant difference in Hb in the seventh day after the operation. The difference in blood loss was 10 hours after operation, 10 hours after operation and 1 to 3 days after operation (P0.01). There was a significant difference between the two groups of blood loss, and the amount of blood loss between the third and seventh day after operation was not statistically significant (P0.05). There was no significant difference between the two groups of blood loss. The total blood loss in the two groups was statistically significant (P0.01), and the total blood loss in the two groups was significantly different from the total blood loss in different periods (P0.01). There was no significant difference between the total dominant blood loss and the total flow rate, and there was no significant difference between the total dominant blood loss and the total flow rate between the acupuncture group and the control group. There was a significant difference between the two groups (P0.01), and the two groups had significant difference in the amount of blood loss. The difference of prothrombin time (PT), prothrombin activity (AT), fibrinogen (FIB), activated partial thromboplastin time (APPT) and D-dimer was not statistically significant, indicating no significant difference between the acupuncture group and the control group. There was a significant difference between the two groups of HSS scores after 1 week and 2 weeks after the operation (P 0.01). The VAS scores of the two groups were not significant (P0.05). There was no significant difference in the VAS scores before and after the operation (P0.05). There was no significant difference between the two groups. The VAS scores of the two groups were statistically significant (P0.01). There was no significant difference between the acupuncture group and the control group on the first day, the third day after the operation, and the difference of the 10 cm leg circumference between the acupuncture group and the control group, and the case of the 10cm leg circumference between the acupuncture group and the control group on the 7th day after the operation. P0.05, there was a statistical significance, indicating that there was a significant difference in the circumference of the 10cm leg during the period. The leg circumference in the middle of the lower leg in the middle of the lower leg of the lower leg of the lower leg of the lower leg of the lower leg was not statistically significant, and there was no significant difference between the acupuncture group and the control group in the middle of the lower leg of the lower leg, and the leg circumference in the middle of the lower leg between the acupuncture group and the control group was not significantly different between the acupuncture group and the control group, and at the third and seventh days after the operation, The leg circumference in the middle of the lower leg between the acupuncture group and the control group was significantly different from that in the middle of the lower leg of the control group. No serious bleeding and other discomfort occurred during the course of the two groups of patients. Conclusion: The total blood loss and the recessive blood loss in patients with total knee replacement can be significantly reduced by clinical verification. and the function, activity and muscle strength of the knee joint can be obviously improved after 1 and 2 weeks after the operation. Acupuncture and moxibustion also have a significant improvement in the postoperative complications. In addition to the obvious reduction of the pain, the swelling of the lower limbs also has a marked improvement, in which the swelling speed of the lower leg is higher than that of the legs. In the economic benefit, the acupuncture can shorten the hospital stay time, accelerate the hospital rotation, and let more patients benefit.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9
[Abstract]:Objective: To study the effect of acupuncture and moxibustion on the perioperative blood management of primary total knee arthroplasty (TKA) in the elderly. Objective To evaluate the clinical efficacy and safety of acupuncture on the management of the primary total knee arthroplasty in the perioperative period, and to provide a practical, effective and effective method for the clinical value and the popularization of the traditional Chinese medicine. Methods: The first one-sided total knee replacement surgery in the middle hospital of Guangdong Province from January 2015 to October 2015 was collected. Randomized, controlled clinical trial study. The cases in which the study requirements were met were divided into acupuncture group and control group, 35 cases in each group and 70 cases. In the two groups, acupuncture and non-acupuncture treatment were used on the basis of the same treatment. The effect of acupuncture on the management of blood during the perioperative period of total knee replacement was also observed by clinical comparison. The blood routine of the day, day, day, day, and day after operation was as follows: blood pigment, red blood cell pressure product, post-operative drainage and blood transfusion, and the amount of blood loss in each stage was calculated. The total amount of blood loss, the total amount of the dominant and the recessive blood loss were calculated, and the coagulation function included: before the operation, 3, 3 and 7 days after operation, D2 poly (s); local symptoms include: pre-operative, postoperative day 3, 7-day limb pain score, swelling; joint function including: pre-operative, postoperative day 3, 7-day knee function investigation (HSS scale); safety including limb skin condition, limb-side feel, blood transport, and the like; and the record of adverse event; the economic benefit includes: the hospital stay time is the observation project. The results were analyzed by SPSS 19.0. Results: In 70 cases, the hematocrit (HCT) of the two groups was statistically tested, and the difference of HCT in the two groups was statistically significant within 10 hours after the operation. The postoperative day 1, 3 and 7 days, P 0.01, had statistical significance, indicating that there was a significant difference in HCT between the two groups after the first, third and seventh day. Hb was no significant difference between the two groups (P0.05). The Hb in the third day of the operation was significantly different from that of the third day after the operation, and there was a significant difference in the Hb in the third day after the operation. In the seventh day of the operation, Hb was compared with that of p0.01, and there was a significant difference in Hb in the seventh day after the operation. The difference in blood loss was 10 hours after operation, 10 hours after operation and 1 to 3 days after operation (P0.01). There was a significant difference between the two groups of blood loss, and the amount of blood loss between the third and seventh day after operation was not statistically significant (P0.05). There was no significant difference between the two groups of blood loss. The total blood loss in the two groups was statistically significant (P0.01), and the total blood loss in the two groups was significantly different from the total blood loss in different periods (P0.01). There was no significant difference between the total dominant blood loss and the total flow rate, and there was no significant difference between the total dominant blood loss and the total flow rate between the acupuncture group and the control group. There was a significant difference between the two groups (P0.01), and the two groups had significant difference in the amount of blood loss. The difference of prothrombin time (PT), prothrombin activity (AT), fibrinogen (FIB), activated partial thromboplastin time (APPT) and D-dimer was not statistically significant, indicating no significant difference between the acupuncture group and the control group. There was a significant difference between the two groups of HSS scores after 1 week and 2 weeks after the operation (P 0.01). The VAS scores of the two groups were not significant (P0.05). There was no significant difference in the VAS scores before and after the operation (P0.05). There was no significant difference between the two groups. The VAS scores of the two groups were statistically significant (P0.01). There was no significant difference between the acupuncture group and the control group on the first day, the third day after the operation, and the difference of the 10 cm leg circumference between the acupuncture group and the control group, and the case of the 10cm leg circumference between the acupuncture group and the control group on the 7th day after the operation. P0.05, there was a statistical significance, indicating that there was a significant difference in the circumference of the 10cm leg during the period. The leg circumference in the middle of the lower leg in the middle of the lower leg of the lower leg of the lower leg of the lower leg of the lower leg was not statistically significant, and there was no significant difference between the acupuncture group and the control group in the middle of the lower leg of the lower leg, and the leg circumference in the middle of the lower leg between the acupuncture group and the control group was not significantly different between the acupuncture group and the control group, and at the third and seventh days after the operation, The leg circumference in the middle of the lower leg between the acupuncture group and the control group was significantly different from that in the middle of the lower leg of the control group. No serious bleeding and other discomfort occurred during the course of the two groups of patients. Conclusion: The total blood loss and the recessive blood loss in patients with total knee replacement can be significantly reduced by clinical verification. and the function, activity and muscle strength of the knee joint can be obviously improved after 1 and 2 weeks after the operation. Acupuncture and moxibustion also have a significant improvement in the postoperative complications. In addition to the obvious reduction of the pain, the swelling of the lower limbs also has a marked improvement, in which the swelling speed of the lower leg is higher than that of the legs. In the economic benefit, the acupuncture can shorten the hospital stay time, accelerate the hospital rotation, and let more patients benefit.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9
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