活血化瘀法对老年髋部骨折创伤后炎症反应的影响

发布时间：2018-03-18 09:16

本文选题：老年　切入点：髋部骨折　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：髋部骨折是骨科的常见损伤之一,作为一种创伤,髋部骨折后或手术后患者体内会产生一定的炎症反应,这种炎症反应给人体带来积极的生理病理作用的同时也会对免疫系统、凝血系统等其他方面产生不利影响,故在整个围手术期,对于患者体内的炎症反应水平应该要有良好的评估与控制方案。本研究通过观察在活血化瘀法的干预下老年髋部骨折患者围手术期炎症指标变化情况,探索活血化瘀法对老年髋部骨折患者围手术期体内炎症反应的影响,为临床上关于如何控制炎症反应提供参考意见；并且对年龄与炎症反应的相关性进行分析,探索在老年人群当中,炎症指标的不同是否与年龄的大小存在关系,进而为临床上分析不同年龄患者的炎症指标检查结果提供参考依据。方法：本研究为前瞻性研究,收集自2015年4月至2016年2月间,诊断为单侧髋部骨折(含股骨颈骨折或者股骨转子间骨折)在广州中医药大学第一附属医院住院行手术治疗的病例。按照研究期间是否予服用理伤消肿口服液将病例分为活血化瘀组与对照组。记录病例的一般资料及入院第1天、入院第4天、手术后第1天及手术后第4天的白细胞计数(WBC)、中性粒细胞百分比(N%)、红细胞沉降率(ESR)、C反应蛋白(CRP)以及在治疗过程中有无出现发热。利用SPSS 19.0统计学软件分析各指标每次检测结果活血化瘀组与对照组的差异性、两组间术前各指的标变化值差异性、术后各指标变化值的差异性,并分析对照组中年龄与术前及术后炎症指标水平高低的相关性。成果：共收集了60例符合纳入标准的病例,其中2人因入院后发生感染而被剔除,最后纳入研究分析的共58例。其中活血化瘀组30例,对照组28例。活血化瘀组中性粒细胞百分比、红细胞沉降率、C反应蛋白在入院第4天显著低于对照组(P0.05),其中血沉在术后第4天也显著低于对照组(P0.05)；活血化瘀组术前白细胞计数、中性粒细胞百分比、红细胞沉降率、C反应蛋白的升高值以及术后白细胞计数、红细胞沉降率的升高值显著低于对照组(P0.05)：两组的发热率对比无显著性差异(P0.05)：年龄与红细胞沉降率、C反应蛋白的术前平均值呈显著相关(P0.05),相关系数分别为0.787、1.181,均大于0,呈正相关。结论：在骨折早期应用活血化瘀法控制老年髋部骨折创伤后炎症反应可取得良好的临床效果；创伤后炎症反应的程度随着年龄的增大而增加,主要体现在术前红细胞沉降率及C反应蛋白两个指标,故在对这两个指标进行分析时需要考虑年龄的影响,在60至90岁的老年髋部骨折患者中,根据线性回归公式,年龄相对较大的患者可适当放宽判读标准,而年龄较小者的判读标准则需相对严格。
[Abstract]:Objective: hip fracture is one of the common injuries in orthopedic department. This inflammatory reaction not only brings positive physiological and pathological effects to the human body, but also adversely affects the immune system, the coagulation system, and other aspects, so throughout the perioperative period, In this study, we observed the changes of inflammatory indexes in elderly patients with hip fracture during perioperative period under the intervention of promoting blood circulation and removing blood stasis. To explore the effect of the method of activating blood circulation and removing blood stasis on the inflammation in the body of the elderly patients with hip fracture during perioperative period, to provide reference for clinical practice on how to control the inflammatory reaction, and to analyze the correlation between age and inflammatory reaction. To explore whether there is a relationship between the inflammation index and the age in the elderly population, and to provide a reference for the clinical analysis of the inflammatory index of patients of different ages. Methods: this study is a prospective study. Collected from April 2015 to February 2016, Cases diagnosed as unilateral hip fractures (including femoral neck fractures or intertrochanteric fractures) were hospitalized in the first affiliated hospital of Guangzhou university of traditional Chinese medicine for surgical treatment. The patients were divided into two groups: the group of promoting blood circulation and removing blood stasis, and the control group. The general data of the cases and the first day of admission were recorded. On the fourth day of admission, WBC count, neutrophil percentage, erythrocyte sedimentation rate and fever in the first day of operation and the fourth day after operation were analyzed by SPSS 19.0 software. The difference between the blood circulation and blood stasis group and the control group was observed. The difference of the standard change value of each finger before operation and the change value of each index after operation between the two groups, and the correlation between age and the level of inflammatory index before and after operation in the control group were analyzed. Results: 60 patients who met the inclusion criteria were collected. Two of them were excluded because of infection after admission, and 58 cases were included in the study, including 30 cases in the group of promoting blood circulation and removing blood stasis, 28 cases in the control group, and the percentage of neutrophils in the group of promoting blood circulation and removing blood stasis. The erythrocyte sedimentation rate was significantly lower than that of the control group on the 4th day after admission, and the erythrocyte sedimentation rate was also significantly lower than that of the control group on the 4th day after operation, and the leukocyte count and neutrophil percentage in the Huoxue Huayu group were significantly lower than those in the control group. The erythrocyte sedimentation rate and the increase of C-reactive protein and the white blood cell count after operation, The increase of erythrocyte sedimentation rate was significantly lower than that of the control group (P 0.05). There was no significant difference in the febrile rate between the two groups (P 0.05). There was a significant correlation between age and the preoperative mean value of erythrocyte sedimentation rate and C-reactive protein (P 0.05), the correlation coefficient was 0.7871.181, which was higher than that of the control group. Conclusion: the method of promoting blood circulation and removing blood stasis can be used to control the post-traumatic inflammatory reaction of the elderly hip fracture in the early stage of fracture. The degree of post-traumatic inflammatory response increased with age, mainly reflected in the erythrocyte sedimentation rate and C-reactive protein before operation, so the influence of age should be taken into account in the analysis of these two indexes. In the elderly patients with hip fracture aged 60 to 90 years, according to the linear regression formula, the relatively older patients can relax the interpretation standard properly, while the younger ones need to be relatively strict.
【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】：2016
【分类号】：R274.1

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