活血消肿方对踝关节骨折围手术期肿胀疼痛的影响

发布时间：2018-03-05 12:19

本文选题：踝关节骨折　切入点：活血消肿方　出处：《安徽中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本课题通过对踝关节骨折的病因病机、诊疗、并发症等认识,观察比较活血消肿方组和七叶皂苷钠组、活血消肿方加七叶皂苷钠组治疗踝关节骨折后软组织早期肿胀疼痛的临床疗效,分析和评价踝关节骨折后早期运用活血消肿方的临床意义,为其在临床上进一步推广使用提供依据。方法:本课题研究纳入病例均为2015年2月至2015年12月期间在安徽中医药大学第一附属医院骨伤科住院患者,选择符合标准的病例总计60例,其中,男性38例,女性22例,年龄区间18~64岁,平均(38.77±3.86)岁。随机分为三组,每组各20例,分别是活血消肿方组(下文简称为中药组)、七叶皂苷钠组、活血消肿方加七叶皂苷钠组(下文简称为联合用药组)。三组均予以相同的常规处理,同时,中药组于患者入院后第一天开始予以口服活血消肿方,一日一剂,至手术当天停用;七叶皂苷钠组于患者入院后第一天开始予以静脉滴注七叶皂苷钠,一日一次,至手术当天停用;联合用药组于患者入院后第一天开始予以口服活血消肿方加静脉滴注七叶皂苷钠,用药方法及剂量同前,至手术当天停用。分别观察并记录三组受试者在治疗前、治疗第3天、治疗第5天、治疗第7天时踝关节软组织肿胀程度评分、肿胀度、疼痛程度(VAS评分)、术前等待时间、患肢深静脉血栓形成例数、围手术期并发症发生例数以及治疗前后肝肾功能主要指标变化等方面。将60例受试者所有的临床数据运用统计学软件SPSS 19.0进行数据处理,分析比较三组观察指标的变化情况,评估三组的临床疗效。结果:1、本课题纳入的三组受试对象治疗前在性别、年龄、病因、骨折部位、患肢踝关节肿胀程度等一般资料经统计分析处理后,均无统计学差异(P0.05),提示三组之间存在可比性。2、踝关节软组织肿胀积分方面:治疗前三组比较差异无显著性(P0.05);治疗第3天联合用药组与治疗前比较差异显著(P0.05),但其他两组差异无统计学意义(P0.05);治疗第5天、第7天三组与治疗前比较差异明显(P0.05、P0.01),对三组分别行SNK-q检验,两两比较差异均有显著性(P0.05、P0.01)。其中联合用药组降低的幅度明显优于单一用药组,疗效最显著,中药组次之。3、踝关节软组织肿胀度方面:治疗前三组比较差异无显著性(P0.05);治疗第3天联合用药组、中药组与治疗前比较有统计学意义(P0.05),但七叶皂苷钠组差异无统计学意义(P0.05);治疗第5天、第7天三组与治疗前比较差异显著(P0.05、P0.01),对三组分别行SNK-q检验,两两比较均有显著差异(P0.05、P0.01)。其中联合用药组消肿的速度更迅速,起效更快,疗效显著优于单一用药组;而中药组随着治疗时间的增加,消肿效果也优于七叶皂苷钠组。4、踝关节消肿疗效方面:治疗第3天,三组消肿临床疗效比较,差异无显著性(P0.05);治疗第5天、第7天三组治疗前后消肿临床疗效比较差异显著(P0.05、P0.01),治疗第7天中药组与七叶皂苷钠组比较差异存在显著性(P0.05)。其中联合用药组在治疗第5、7天时达到优、良的受试者人数明显高于单一用药组,消肿的临床疗效最显著,中药组疗效次之。5、踝关节疼痛VAS积分方面:治疗前三组比较差异无显著性(P0.05);治疗第3天、第5天、第7天三组与治疗前比较均有显著差异(P0.05、P0.01),行SNK-q检验发现治疗第3天中药组与七叶皂苷钠组比较差异无统计学意义(P0.05),其余不同时间点两两比较均存在差异(P0.05、P0.01)。其中联合用药组止痛的效果更明显,尤其是在治疗第5、7天,明显优于单一用药组,且随着治疗时间的增加,中药组止痛的疗效也较七叶皂苷钠组明显。6、术前等待时间方面:三组比较差异有显著性(P0.05),行SNK-q检验提示联合用药组与七叶皂苷钠组、中药组比较差异显著(P0.01、P0.05),中药组与七叶皂苷钠组比较差异存在统计学意义(P0.05)。其中联合用药组能够显著缩短术前消肿过程,疗效最明显,而中药组次之。7、DVT阳性率方面:三组比较差异无统计学意义(P0.05)。8、围手术期并发症方面:联合用药组、中药组与七叶皂苷钠组比较差异有统计学意义(P0.05)。结论:活血消肿方能够有效的消除踝关节骨折后软组织早期肿胀疼痛、缩短术前消肿周期、降低围手术期并发症的发生率,有利于软组织尽早修复,临床疗效显著,使用安全。活血消肿方是临床治疗踝关节骨折后软组织早期肿胀疼痛行之有效的方剂,经济实用、安全有效,具有良好的临床应用价值,值得临床推广运用。
[Abstract]:Objective: this topic through the diagnosis and treatment of etiology and pathogenesis of ankle fractures, complications were compared between the understanding of Chinese medicinal decoction group and seven sodium aescinate group, the clinical curative effect of early soft tissue swelling and pain of Chinese medicinal decoction plus seven sodium aescinate group for the treatment of ankle fractures and clinical significance of early application of Chinese medicinal decoction analysis and evaluation of ankle fracture, the clinical use to provide the basis for further promotion. Methods: This study included patients during the period from February 2015 to December 2015 in the orthopedic department of the First Affiliated Hospital of Anhui College of traditional Chinese medicine patients, choose the standard case of a total of 60 cases, among them, male 38 cases, female 22 cases. The age range of 18~64 years, the average (38.77 + 3.86) years old were randomly divided into three groups, 20 cases in each group, respectively blood swelling group (hereinafter referred to as the Chinese medicine group), seven sodium aescinate group, Chinese medicinal decoction plus seven leaf soap Glycoside sodium group (hereinafter referred to as the combination group). The three groups were given conventional treatment, the same at the same time, Chinese medicine group in patients admitted to the hospital after the first day of oral Chinese medicinal decoction, one dose daily, on the day of surgery to stop; seven Ye Zaogan sodium group patients were admitted to hospital after the first day of the beginning of intravenous infusion seven yezao sodium, once a day, until the day of surgery disabled; combined treatment group patients were admitted to hospital after the first day of oral Chinese medicinal decoction combined with intravenous drip of seven sodium aescinate, treatment methods and the same dose, to the day of surgery were discontinued. Observe and record the three groups of subjects before treatment, treatment the third day, for fifth days, seventh days of treatment of ankle soft tissue swelling degree, swelling degree, pain degree (VAS score), the waiting time before surgery, limb deep venous thrombosis cases, perioperative complications and the number of cases before and after treatment, liver and kidney function The main indicators of change. The subjects were 60 patients with clinical data of all using SPSS 19 statistical software for data processing, analysis of changes between the three groups were observed, to evaluate the clinical efficacy of three groups. Results: 1. The research included three groups of subjects before treatment in gender, age, etiology, the fracture site, with general data of ankle joint swelling degree by statistical analysis, there was no significant difference (P0.05), suggesting the presence of comparable.2 between the three groups, soft tissue swelling of ankle joint points: the difference between the three groups before treatment had no significant difference (P0.05); third days of treatment and combined treatment group before treatment was significantly different (P0.05), but no statistical significance between the two groups (P0.05); for fifth days, seventh days and the difference between the three groups before treatment significantly (P0.05, P0.01), the three groups underwent SNK-q examination, 22 had significant differences (P0.05 , P0.01). Which is to reduce the combination group was significantly better than the single drug group, the most significant effect, traditional Chinese medicine group.3, ankle soft tissue swelling: the differences between the three groups before treatment had no significant difference (P0.05); third days of treatment in combination group, Chinese medicine group before treatment were statistically significant (P0.05), but there was no significant difference between the seven sodium aescinate group (P0.05); for fifth days, seventh days between the three groups before and after treatment was significant (P0.05, P0.01), the three groups were compared by SNK-q test, there were significant differences between the 22 (P0.05, P0.01). The combination group swelling rate rapidly, faster onset and the curative effect was significantly better than the single drug group and Chinese medicine group; with the increase of treatment time, swelling effect is better than seven sodium aescinate group.4, side effects of ankle swelling: third days of treatment, three groups of detumescence clinical curative effect comparison, no significant difference (P0.05); treatment The fifth day, the seventh day of the three groups before and after treatment and clinical efficacy significant difference (P0.05, P0.01), seventh days of treatment with traditional Chinese medicine group and seven sodium aescinate group there is significant difference (P0.05). The combined treatment group to achieve excellent in the treatment of the first 5,7 days, the number of subjects were significantly higher than the single good the medication group, the most significant swelling of the clinical curative effect of traditional Chinese medicine, the.5 pain VAS ankle score: the difference between the three groups before treatment had no significant difference (P0.05); for third days, fifth days, seventh days, three groups compared with before treatment had significant difference (P0.05, P0.01), SNK-q test found that no significant difference was found in third days of treatment with traditional Chinese medicine group and seven sodium aescinate group (P0.05), the remaining 22 different time points there were differences (P0.05, P0.01). The combination group, the analgesic effect is more obvious, especially in the treatment of the first 5,7 days, significantly better than the single drug group, and With the increase of treatment time, the effect of traditional Chinese medicine group also had analgesic seven sodium aescinate group was.6, the preoperative waiting time: there were significant differences between three groups (P0.05), SNK-q test combined treatment group and seven sodium aescinate group, Chinese medicine group was significantly different (P0.01, P0.05), Chinese medicine group and seven sodium aescinate group compared the difference was statistically significant (P0.05). The combined treatment group can significantly shorten the preoperative swelling process, the most obvious effect, and the traditional Chinese medicine group.7, DVT positive rate: three groups had no statistically significant difference (P0.05.8), perioperative complications: combined treatment group and there was a significant difference between the Chinese medicine group and seven sodium aescinate group (P0.05). Conclusion: Chinese medicinal decoction can eliminate early soft tissue swelling and pain after ankle fracture effectively, shorten preoperative swelling period, reduce the incidence of perioperative complications, favorable Early repair of soft tissue has significant clinical effect and safety. Huoxue swelling prescription is an effective prescription for the treatment of early soft tissue swelling and pain after ankle fracture. It is economical, practical, safe and effective, and has good clinical application value. It is worthy of clinical promotion and application.

【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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