人工髋膝关节置换术后应用桃红四物汤预防深静脉血栓的临床效果研究

发布时间：2018-03-13 10:04

本文选题：髋关节人工关节置换术　切入点：膝关节人工关节置换术　出处：《湖北中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过临床对比研究,探究髋膝关节关节置换术后应用桃红四物汤防治下肢深静脉血栓的临床疗效及其运用的安全性。方法:将120例入住十堰市太和医院行人工髋膝关节置换术患者作为研究对象,按照随机平均分组的原则,分为对照组(共60例患者,年龄在50-80岁之间,平均年龄(65.1±10.1)岁,男34例,女26例;髋关节置换29例,膝关节置换31例)和观察组(共60例患者,年龄在50-80岁之间,平均年龄(63.2±11.3)岁,男29例,女31例;髋、膝关节置换例数分别为33例、27例)。对照组仅给予低分子肝素钙4000iu qd皮下注射,观察组则在对照组基础上予以桃红四物汤口服,对比研究分析对照组和观察组患者,术后第7天的C-反应蛋白(CRP)、血小板计数、红细胞计数、白细胞计数;术后48小时拔除负压引流管时,对患者伤口引流量作记录;术前分别测定患者的大腿周径并记录,术后患者给药后第3天、第7天再分别测量大腿周径并记录;对患者在术后第5天的疼痛进行VAS评分;比较两组患者髋膝关节置换术后下肢深静脉血栓的发病及治疗情况。结果:观察组与对照组术前白细胞计数、红细胞计数、血小板计数、C-反应蛋白(CRP)计数、术前大腿周径的数值经方差分析,术前各项指标对比不具统计学意义。观察组较对照组患者的伤口引流量小,观察组患者在术后第3天、第7天的大腿周径均相对小于对照组。各自术后第7天较第3天所测量的大腿所减少的大腿周径,即各自消肿情况采用独立样本t检验,其差异具有统计学意义(P0.05);观察组患者在术后第5天的疼痛VAS评分均低于对照组。观察组与对照组患者在术后第7天各自的白细胞计数进行统计学分析。两组术后红细胞计数采用独立样本t检验,不具统计学意义;各自术后血小板计数具有统计学意义(P0.05);两组术后C反应蛋白数值结果具有统计学的意义(P0.05)。观察组患者未出现下肢深静脉血栓,对照组患者中6例出现下肢深静脉血栓,因不满足卡方检验条件,采用fisher精确检验,其fisher精确p值(0.027),差异具有统计学意义(P0.05)。结论:桃红四物汤可以显著的减轻患者术后炎症,并消退患者DVT患肢的肿胀状况、减轻病人术后疼痛,降低病人术后引流量等等来降低患者的风险,并且最后Doppler检查进一步验证服用桃红四物汤患者血流全部畅通,无血栓形成。综述所有临床试验结果,可以说明桃红四物汤与低分子肝素钙这两种药物联合应用防治髋膝置换术后DVT患者的效果,与单纯使用低分子肝素钙相比,采用桃红四物汤结合低分子肝素钙预防与治疗下肢深静脉血栓显然更具优势。不仅表现在术后炎症控制方面具有疗效优势,也能使患肢肿胀的消除加快,减少术后的出血量,缓解术后疼痛,从而改善术后患者的生活质量,提高其治疗的依从性,具有较好的临床疗效和一定的安全性,值得在临床推广运用。
[Abstract]:Objective: to compare the clinical characteristics of the two groups. Objective: to investigate the clinical efficacy and safety of Taohong Siwu decoction in the treatment of deep venous thrombosis of lower extremity after hip and knee arthroplasty. Methods: 120 patients underwent hip and knee arthroplasty in Taihe Hospital of Shiyan City were studied. According to the principle of randomized and average grouping, the patients were divided into control group (60 patients aged 50-80 years, mean age 65.1 卤10.1 years), male 34 cases, female 26 cases, hip replacement 29 cases, knee arthroplasty 31 cases) and observation group (60 cases). The average age was 63.2 卤11.3 years old, male 29 cases, female 31 cases, hip and knee arthroplasty were 33 cases and 27 cases respectively. The control group was only given hypodermic injection of low molecular weight heparin calcium 4000iu QD. The observation group was given Taohong Siwu decoction orally on the basis of the control group. The patients in the control group and the observation group were compared and analyzed. The patients in the control group and the observation group were treated with C-reactive protein CRP, platelet count, erythrocyte count and white blood cell count on the 7th day after operation. When the negative pressure drainage tube was removed 48 hours after the operation, the wound drainage flow was recorded, the circumference of the thigh was measured and recorded before the operation, and the circumference of the thigh was measured and recorded on the 3rd day and the 7th day after the operation. VAS score was performed on the 5th day after operation, and the incidence and treatment of deep vein thrombosis of lower extremity after hip and knee arthroplasty were compared between the two groups. Results: the white blood cell count and red blood cell count before operation in the observation group and the control group were compared. Platelet count and C-reactive protein (CRP) count, preoperative thigh circumference value were not statistically significant by ANOVA, the wound drainage flow in the observation group was smaller than that in the control group, and the patients in the observation group were treated on the 3rd day after operation. The thigh circumference on the 7th day was relatively smaller than that of the control group. The thigh circumference, which was measured on the 7th day after operation, was measured by independent sample t test. The VAS scores of the patients in the observation group were lower than those in the control group on the 5th day after operation. The white blood cell counts of the patients in the observation group and the control group were statistically analyzed on the 7th day after operation. Red blood cell count was tested by independent sample t-test. There was no statistical significance; the platelet count after operation was statistically significant; the C-reactive protein values in both groups were statistically significant; the patients in the observation group had no deep venous thrombosis in the lower extremities. In the control group, 6 patients had deep venous thrombosis of lower extremity. Because they did not meet the chi-square test condition, the accurate value of fisher was 0.027% by fisher, and the difference was statistically significant (P 0.05). Conclusion: Taohong Siwu decoction can significantly reduce postoperative inflammation. In order to reduce the risk of patients with DVT, the swelling of the affected limbs of the patients was reduced, the pain of the patients was alleviated, the drainage volume of the patients was reduced, and the final Doppler examination further verified that the blood flow of the patients taking Taohong Siwu decoction was completely unblocked. There is no thrombus. Reviewing the results of all clinical trials, it can be concluded that Taohong Siwu decoction combined with low molecular weight heparin calcium is effective in the prevention and treatment of DVT patients after hip and knee arthroplasty, compared with using low molecular weight heparin calcium alone. Using Taohong Siwu decoction combined with low molecular weight heparin calcium to prevent and treat deep venous thrombosis of lower extremities is obviously more advantageous. It not only has the advantage of curative effect in controlling inflammation after operation, but also can accelerate the elimination of swelling of affected limbs and reduce the amount of bleeding after operation. In order to relieve postoperative pain and improve the quality of life and compliance of the patients after operation, it has better clinical efficacy and safety, and is worth popularizing in clinical practice.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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