推拿疗法预防髋关节置换术后早期深静脉血栓形成的临床观察

发布时间：2018-09-07 17:21

【摘要】：目的:观察推拿疗法在人工全髋关节置换术后早期预防下肢深静脉血栓形成的疗效,探讨推拿疗法对深静脉血栓的作用机理,为临床应用提供依据。方法:选取2015年10月至2016年12月因非骨折疾病行单侧全髋关节置换术患者60例,所有患者根据就诊时间按随机数表法随机分为干预治疗组(n=30)和基础治疗组(n=30),其中男性21例,女性39例,平均年龄(59.43±4.64)岁。分别予以下治疗方案:(1)基础治疗组予常规治疗:受试者手术均为同一组医师完成,术中放置1条引流管,至常规术后24小时,不超过48小时,术后抗生素预防感染24小时,常规镇痛、消肿处理,术后12小时开始口服利伐沙班片抗凝,10mg/d,疗程5周,指导患者进行常规功能锻炼;(2)干预治疗组:常规治疗同时,于术后第1天开始,行双下肢推拿手法治疗,20min/次,2次/日,至术后2周。两组观察指标:1、静脉血D-二聚体测定;2、术后疼痛评分(VAS评分);3、双下肢彩色多普勒超声检查血栓形成;4、下肢乆静脉血流的改变;5、术后大腿周径测量。观察并记录两组术前、术后各阶段的相关评价指标,取得数据,运用SPSS软件进行统计分析。结果:(1)两组一般资料差异无明显统计学意义(P0.05),有可比性;(2)两组术后比较:术后第1、4天,D-二聚体水平无明显差异,无统计学意义,(P0.05),术后第7、10、14天,干预治疗组D-二聚体水平较基础治疗组明显降低,具有统计学意义(P0.05);术后第1、14天VAS评分无明显差异(P0.05),术后第4、7、10天VAS评分干预治疗组较基础治疗组低,有统计学意义(P0.05)。术后第1天两组受试者下肢深静脉血栓形成率无明显差异,不具有统计学意义(P0.05),术后第7、14天,干预治疗组下肢深静脉血栓发生率较基础治疗组低,具有统计学意义(P0.05)。术后第1天两组受试者双下肢乆静脉血流速度无明显差异,不具有统计学意义(P0.05),术后第7、14天,干预治疗组双下肢乆静脉血流速度较基础治疗组高,有统计学意义(P0.05)。术后第1天两组大腿周径无明显差异(P0.05),术后第4、7、14天干预治疗组的大腿周径较基础治疗组小,有统计学意义(P0.05)。结论:推拿疗法能有效的预防单侧人工髋关节置换术后早期下肢深静脉血栓的形成,并有助于术后早期下肢肿胀的消退。
[Abstract]:Objective: to observe the effect of massage therapy on the early prevention of deep vein thrombosis in lower extremity after total hip arthroplasty, to explore the mechanism of massage therapy on deep vein thrombosis, and to provide the basis for clinical application. Methods: from October 2015 to December 2016, 60 patients with unilateral total hip replacement due to non-fracture disease were randomly divided into two groups: intervention group (n = 30) and basic treatment group (n = 30). The average age of 39 female patients was (59.43 卤4.64) years old. The following treatment schemes were given respectively: (1) routine treatment was given to the basic treatment group: the operation was performed by the same group of physicians, and a drainage tube was placed during the operation until 24 hours after the operation, no more than 48 hours, and 24 hours after the operation with antibiotics to prevent infection. Routine analgesia, detumescence treatment, oral administration of rivastaban tablet 10 mg / d at 12 hours after operation for 5 weeks to guide patients to perform routine functional exercises; (2) intervention group: routine treatment at the same time, beginning on the first day after operation, The patients were treated with massage manipulation for 20 min / d until 2 weeks after operation. The two groups were observed as follows: 1: 1, venous blood D-dimer 2, postoperative pain score (VAS) 3, lower extremity color Doppler ultrasound examination of thrombus formation 4, changes of venous blood flow in lower extremities 5, thigh circumference measured after operation. The relevant evaluation indexes were observed and recorded before and after operation in both groups. The data were obtained and analyzed by SPSS software. Results: (1) there was no significant difference in general data between the two groups (P0.05), and (2) comparison between the two groups: there was no significant difference in the level of D- dimer between the two groups on the 1st day after operation (P0.05), and there was no significant difference in the level of D- dimer between the two groups on the 1st day after operation (P0.05). The level of D- dimer in the intervention group was significantly lower than that in the basic treatment group (P0.05); there was no significant difference in VAS score on the 1th day after operation (P0.05); the VAS score of the intervention group was lower than that of the basic treatment group (P0.05) on the 4th day after operation (P0.05). On the first day after operation, there was no significant difference in the rate of deep venous thrombosis between the two groups (P0.05). On the 7th day after operation, the incidence of deep vein thrombosis in the intervention group was lower than that in the basic treatment group (P0.05). On the first day after operation, there was no significant difference in the velocity of venous flow between the two groups (P0.05). On the day 714 after operation, the velocity of venous blood flow in the intervention group was higher than that in the basic treatment group (P0.05). There was no significant difference in the thigh circumference between the two groups on the first day after operation (P0.05). The thigh circumference of the intervention group was smaller than that of the basic treatment group on the 4th and 14th day after operation (P0.05). Conclusion: massage therapy can effectively prevent the formation of early deep vein thrombosis after unilateral hip arthroplasty and is helpful to the early regression of lower extremity swelling.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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