益气补血法对人工髋关节置换术后隐性失血的影响

发布时间：2018-12-29 11:28

【摘要】：目的:人工髋关节置换(THR)手术在治疗疾病的同时,也存在了大量出血及异体输血率较高等围手术期问题。近年来研究发现THR围手术期隐性失血对术后的影响不容忽视,包括影响术口愈合,延缓关节功能恢复时间,增加异体输血率,延长卧床时间,增加下肢深静脉血栓形成风险等。本课题结合中医药理论,运用益气补血法治疗THR隐性失血,旨在评估其对THR术后隐性失血的影晌及安全性,为益气补血类中药在人工关节围手术期中的应用提供依据。方法:选取2016年2月至2017年2月期间,广州市番禺中医院骨科病区住院的患者中,符合纳入标准的病例60例。将符合纳入标准的合格病例60例,通过数字随机法按1:1比例分为治疗组和对照组,治疗组和对照组各30例,两组均完成术前准备并行THR手术,治疗组行THR手术配合八珍汤治疗,对照组只行THR手术治疗,记录两组患者性别、年龄、身高、体重、术前和术后血常规、术后髋关节Harris评分等,并根据Gross及Nadler方程计算隐性失血量,分析对比两组的指标变化及临床疗效。结果:本次研究两组患者术前、手术当天、手术第1天RBC、HGB、HCT值比较差异无统计学意义(P0.05),两组患者术后第3天、术后第7天RBC、HGB、HCT值比较,治疗组高于对照组,差异有统计学意义(P0.05),且两组RBC、HGB、HCT值均多在术后第3天达到最低值,说明THR围手术期口服八珍汤能升高术后第3天、术后第7天RBC、HGB、HCT值。术后失血比较,两组患者输血率、显性失血量方面,差异无统计学意义(P0.05);两组患者隐性失血量方面,治疗组低于对照组,差异有统计学意义(P0.05),说明THR围手术期口服八珍汤能减少患者隐性失血量,但不能有效减少显性失血及输血率。术后康复方面,两组患者术后第14天髋关节Harris评分较术后第7天明显提高(P0.01),且治疗组术后第7天、第14天髋关节Harris评分明显较对照组高(P0.01)说明THR围手术期口服八珍汤能加快术后功能康复。结论:髋关节置换术患者围手术期存在着较多的隐性出血,术后RBC、HGB、HCT数值明显下降,且多在术后第3天左右出现最低值。运用益气补血法(代表方剂:八珍汤)能升高患者术后第3天、术后第7天RBC、HGB、HCT值,并能减少患者隐性失血量,加快术后功能康复,未见明显不良反应,值得临床推广应用。
[Abstract]:Objective: in the treatment of diseases with (THR) artificial hip replacement, there are a lot of bleeding and high rate of allogeneic blood transfusion in perioperative period. In recent years, it has been found that the influence of recessive blood loss in perioperative period of THR can not be ignored, including affecting the healing of surgical mouth, delaying the recovery time of joint function, increasing the rate of allogeneic blood transfusion, prolonging the time of bed rest, and increasing the risk of deep venous thrombosis in lower extremity, etc. Based on the theory of traditional Chinese medicine, the purpose of this paper is to evaluate the effect and safety of THR on recessive blood loss after THR, and to provide the basis for the application of traditional Chinese medicine for supplementing qi and tonifying blood in the perioperative period of artificial joint. Methods: from February 2016 to February 2017, 60 patients in the orthopedic department of Panyu Hospital of Guangzhou were selected. Sixty eligible patients who met the inclusion criteria were divided into treatment group and control group by digital random method according to 1:1 ratio, 30 cases in treatment group and 30 cases in control group. Both groups completed preoperative preparation for THR operation. The treatment group was treated with THR operation combined with Bazhen decoction, while the control group was treated with THR only. The sex, age, height, weight, blood routine before and after operation, Harris score of hip joint were recorded in the two groups. The recessive blood loss was calculated by Gross and Nadler equations, and the changes of indexes and clinical efficacy were analyzed and compared between the two groups. Results: there was no significant difference in RBC,HGB,HCT between the two groups before operation, on the day of operation and on the first day of operation (P0.05). The RBC,HGB,HCT values of the two groups were compared on the 3rd and 7th day after operation. The treatment group was higher than the control group, the difference was statistically significant (P0.05), and the RBC,HGB,HCT value of the two groups reached the lowest value on the 3rd day after operation, indicating that the THR perioperative period oral Bazhen decoction can increase the RBC,HGB, on the 3rd day and the 7th day after operation. HCT value. There was no significant difference in blood transfusion rate and dominant blood loss between the two groups (P0.05). Two groups of patients recessive blood loss, the treatment group is lower than the control group, the difference is statistically significant (P0.05), indicating that THR perioperative oral Bazhen decoction can reduce the hidden blood loss in patients, but can not effectively reduce dominant blood loss and blood transfusion rate. In terms of postoperative rehabilitation, the Harris score of hip joint in both groups was significantly higher on the 14th day after operation than on the 7th day after operation (P0.01), and on the 7th day after operation in the treatment group. On the 14th day, Harris score of hip joint was significantly higher than that of control group (P0.01). It indicated that Bazhen decoction taken orally in perioperative period of THR could accelerate postoperative functional recovery. Conclusion: during the perioperative period of hip arthroplasty, there were more recessive bleeding, and the value of RBC,HGB,HCT decreased obviously after operation, and most of the patients had the lowest value on the 3rd day after operation. The method of supplementing qi and nourishing blood (representative prescription: Bazhen decoction) can increase the RBC,HGB,HCT value of patients on the 3rd day and 7th day after operation, and can reduce the recessive blood loss of patients, accelerate the recovery of function after operation, without obvious adverse reactions. It is worth popularizing and applying in clinic.
【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】：2017
【分类号】：R687.4

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