中药敷脐对人工全膝关节置换术后疼痛影响的临床研究

发布时间：2019-01-27 14:18

【摘要】：目的:本研究通过观察人工全膝关节置换术(TKA)后患者的VAS评分、关节活动度及相关血清指标,评价龙发伤科七味片加减敷脐治疗人工全膝关节置换术后疼痛的临床疗效,初步探讨其作用机制,为此技术应用推广提供临床依据。方法:本课题选取2015年10月至2016年12月期间就治于泉州市正骨医院,诊断为晚期膝关节骨性关节炎,且首次行人工全膝关节置换术的70例患者为研究对象,根据诊断、纳入、排除标准,参照随机数字表将病人随机分成两组,分别为治疗组和对照组,每组各35例。治疗组病人术后连续两周予中药敷脐治疗;对照组术后连续两周予生理盐水敷脐治疗。比较两组患者术前及术后第1、2、3、5、7、10、14天的VAS疼痛评分,术前及术后第1、3、7、14天的膝关节主动活动度,术前及术后第7、14天进行膝关节HSS功能评分。术前1天及术后第1、3、7、14天抽静脉血查血常规、血沉、CRP。在术后第14天,采用HSS功能评分进行总疗效的评定。并在整个疗程中进行安全性记录及分析。最后所得数据采用软件SPSS 20.0进行统计分析,设定P0.05具有统计学意义。结果:1.本研究共纳入70例患者,其中治疗组脱落2例,对照组脱落2例,最后共66例完成了临床观察,脱落率为5.71%。2.治疗组与对照组的VAS评分、膝关节活动度、HSS评分、白细胞计数、血沉、CRP在治疗前后自身对比均有统计学差异(P0.05)。两组间VAS评分在术后第1、2、14天无统计学差异(P0.05),在术后第3、5、7、10天有统计学差异(P0.05)。关节活动度在术后第1、14天无统计学差异(P0.05),在术后第3、7天有统计学差异(P0.05)。HSS评分在术后第7、14天有统计学差异(P0.05)。白细胞计数、血沉、CRP在术后第1、14天无统计学差异(P0.05),在术后3、7天有统计学差异(P0.05)。3.治疗组2例患者在治疗过程中出现脐部皮肤发红、瘙痒,诊断过敏反应,不良事件的发生率为5.71%;对照组无发生不良反应。结论:中药敷脐可减轻人工全膝关节置换术后的疼痛程度及改善术后活动度,对促进患者早期康复锻炼具有重要意义,其临床效果满意,可进一步在临床中推广应用。
[Abstract]:Objective: to evaluate the clinical effect of the treatment of pain after total knee arthroplasty (TKA) by observing the VAS score, the range of joint motion and the related serum indexes after total knee arthroplasty (TKA). The mechanism of its action was preliminarily discussed, and the clinical basis for its application and popularization was provided. Methods: from October 2015 to December 2016, 70 patients who were diagnosed as advanced knee osteoarthritis and underwent total knee arthroplasty for the first time from October 2015 to December 2016 in Quanzhou Zhenggu Hospital were selected as the study objects. The patients were randomly divided into treatment group and control group with 35 cases in each group. The patients in the treatment group were treated with traditional Chinese medicine for two weeks, while the patients in the control group were treated with normal saline for two weeks. The VAS pain score of the patients before and after operation was compared with that of the patients before and after the operation. The active motion of the knee joint was measured on the 1st day and the 3rd day after the operation. The knee joint HSS function score was performed before and after the operation on the 714 days. Venous blood samples were taken 1 day before operation and 714 days after operation for examination of blood routine, erythrocyte sedimentation rate, CRP. On the 14th day after operation, HSS functional score was used to evaluate the total curative effect. Safety records and analysis were performed during the whole course of treatment. Finally, the data were analyzed by software SPSS 20.0, set P0.05 has statistical significance. Results: 1. A total of 70 patients were included in the study, including 2 cases in the treatment group and 2 cases in the control group, and 66 cases completed the clinical observation. The abscission rate was 5.71. 2. The VAS score, knee motion, HSS score, white blood cell count, ESR and CRP were significantly different between the treatment group and the control group before and after treatment (P0.05). There was no significant difference in VAS score between the two groups on the 214th day after operation (P0.05), but there was statistical difference on the 3rd and 5th day after operation (P0.05). There was no significant difference in joint motion on the 1st day after operation (P0.05), but there was a statistical difference on the 3rd day (P0.05). (P0.05). HSS score was significantly different on the 7th day (P0.05). White blood cell count, erythrocyte sedimentation rate and CRP had no statistical difference on the 1st day after operation (P0.05), but on the 7th day after operation, there were statistical differences (P0.05). In the treatment group, 2 cases had redness and itching of umbilical skin during the treatment, and the incidence of adverse events was 5.71, while in the control group, there were no adverse reactions. Conclusion: the application of traditional Chinese medicine can relieve the pain after total knee arthroplasty and improve the postoperative activity. It is of great significance to promote the early rehabilitation and exercise of the patients, and its clinical effect is satisfactory. It can be further popularized and applied in clinical practice.
【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

【相似文献】