穴位贴敷疗法联合低分子肝素预防THA术后DVT形成的疗效观察

发布时间：2018-01-02 02:21

  本文关键词：穴位贴敷疗法联合低分子肝素预防THA术后DVT形成的疗效观察　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 穴位贴敷疗法 桃红四物汤 全髋关节置换术 深静脉血栓

【摘要】：目的:观察穴位贴敷疗法联合低分子肝素在全髋关节置换术后预防下肢深静脉血栓形成的临床疗效和安全性,为临床中进一步应用提供依据。方法:按照病例选择的诊断、纳入、排除标准,收集2015-12-1至2016-12-1期间在南京军区福州总医院骨二科因股骨颈骨折或股骨头缺血性坏死初次行单侧全髋关节置换术的患者70例,随机分成对照组和试验组,各35例。试验方案如下:对照组:在术后12h皮下注射低分子肝素(速碧林),每天1次,连续使用10d,同时术后12h开始应用穴位贴剂(安慰剂)贴敷于膈俞、委中、足三里、血海和三阴交,左右共10个刺激点,每次时间持续6h,每天2次,6点和18点使用,连续使用10d。试验组:术后常规应用低分子肝素(具体操作同对照组)。同时术后12h也开始使用穴位贴剂(桃红四物汤加减)贴敷于患者的膈俞、委中、足三里、血海和三阴交(具体操作同对照组)。记录两组患者术前资料(性别、年龄、身高、体重、体重指数、患髋部位、两类疾病及术前合并症)和术中资料(手术时间、麻醉时间、出血量)的分布情况,检查并记录术前1d及术后第2、6、10d的主要观察指标(血栓弹力图、D-二聚体和下肢深静脉彩超)、辅助观察指标(红细胞压积、血红蛋白浓度、红细胞计数、血小板计数、大腿周径、术后引流量及术后输血情况)。观察术后不良反应的发生情况,分析其与本项研究的关联。收集数据并建立数据库,运用SPSS20.0对两组的各项对比资料的差异性进行统计学分析。结果:①本次临床试验过程中,对照组终止2例,最终完成33例,试验组终止1例,最终完成34例。两组患者术前资料(性别、年龄、身高、体重指数、患髋部位、术前合发症和两类疾病的病人分布情况)的比较均无统计学意义(P0.05),具有可比性;两组患者术中资料(手术时间、麻醉时间及出血量)的比较均无统计学意义(P0.05),也具备可比性。②两组病例的R值、K值、CI值、α角和MA值术后第2、6、10d与术前比较具有统计学意义(P0.05);两组病例的K值、α角在术后第6d的组间比较具有统计学意义(P0.05),MA值和CI值在术后第6、10d的组间比较均有统计学意义(P0.05);术后第6d和第10d试验组中血液高凝状态比例明显低于对照组,差异具有统计学意义(P0.05)。③ 在术后第6、1Od试验组D-二聚体明显低于对照组,且比较具有统计学意义(P0.05)。④对照组术后并发2例DVT,试验组无并发DVT,对照组的深静脉血栓发生(5.71%)高于试验组(0.00%)。⑤两组病例RBC、HB、HCT、PLT术后第2、6、10d与术前的比较有统计学意义(P0.05),RBC、HB、HCT在手术前后各时间点的组间比较均无统计学意义(P0.05),而PLT在术后第2、6d的组间比较差异具有统计学意义(P0.05)。⑥术后第6、10d试验组大腿肿胀消退较试验组明显,且两组病例大腿周径比较具有统计学差异(P0.05)。⑦两组患者术后引流量、术后输血人数及输血量比较无统计学差异(P0.05)。⑧对照组并发2例切口脂肪液化、2例泌尿系感染和1例压疮,而试验组并发1例切口脂肪液化、1例泌尿系感染、1例压疮和1例皮肤过敏,比较无统计学差异(P0.05)。结论:穴位贴敷疗法联合低分子肝素可显著的改善THA患者术后血液高凝状态,进一步降低DVT形成的风险,同时还可改善患髋下肢的肿胀程度,具备良好的安全性,操作简便,患者依从性高。
[Abstract]:Objective: To observe the effect of acupoint therapy combined with low molecular heparin in the prevention of clinical efficacy and safety of deep venous thrombosis of the lower limbs in total hip arthroplasty, provide the basis for further application in clinic. Methods: according to the diagnosis, selection of cases included, exclusion criteria, collection of 2015-12-1 to 2016-12-1 during the 70 Nanjing General Hospital of Fuzhou military command two with femoral neck fracture or bone avascular necrosis of the femoral head underwent primary unilateral total hip replacement surgery were randomly divided into control group and experimental group, 35 cases each. The test plan is as follows: the control group: the subcutaneous injection of low molecular heparin 12h after surgery (Fraxiparine), 1 times a day, continuous use of 10d, at the same time operation 12h after application of acupoint patch (placebo) sticking to the Commission, Geshu and Zusanli, Xuehai and Sanyinjiao, about a total of 10 stimuli, each time lasted 6h, 2 times a day, 6 points and 18 points, using 10d. test The experimental group: low molecular weight heparin after routine applications (specific operation with the control group). At the same time after 12h began using Acupoint Plaster (Taohongsiwutang) sticking to the patients with Geshu, Weizhong, Zusanli, Xuehai and Sanyinjiao (specific operation with the control group). The two groups of patients were recorded before operation data (gender, age, height, weight, body mass index, hip part, two kinds of disease and preoperative complications) and intraoperative data (operation time, anesthesia time, blood loss) distribution, check and record the preoperative 1D and postoperative observation of the main 2,6,10d index (Thrombelastogram two, D- dimer and lower extremity deep venous ultrasound), auxiliary indexes (blood transfusion hematocrit, hemoglobin concentration, red blood cell count, platelet count, thigh circumference, postoperative drainage and postoperative adverse reactions). Postoperative observation, analysis of its relationship with the study. Collect data and build 绔嬫暟鎹�搴�,杩愮敤SPSS20.0瀵逛袱缁勭殑鍚勯」瀵规瘮璧勬枡鐨勫樊寮傛，

本文编号：1367264