归脾汤加减对PFNA治疗老年股骨粗隆间骨折术后隐性失血的影响

发布时间：2018-05-04 00:16

本文选题：归脾汤 + PFNA　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:探索归脾汤加减对PFNA治疗老年股骨粗隆间骨折术后隐性失血的影响,为临床上治疗该病提供另一种思路。方法:将30例来自江苏省中医院骨伤科的股骨粗隆间骨折患者分为治疗组、对照组,每组各15例。患者必须符合纳入标准,时间自2016年2月至2017年2月。在PFNA内固定术后,对照组:术后给予常规的补液、预防感染、抗凝等基础治疗;治疗组:在对照组常规补液、预防感染、抗凝等治疗的基础上,术后第一天开始服用加减归脾汤(白术15g,当归15g,党参15g,黄芪30g,茯苓15g,龙眼肉10g,酸枣仁(打碎)20g,远志6g,木香10g,甘草5g,阿胶(烊化)15g,山楂15g,丹参15g,大枣10g)水煎服,每天服用1剂,分两次服用,共7剂。两组均同时记录患者的年龄、性别构成、身高、体重,记录术前1天及术后第1、3、7天的血常规,记录Hb及HCT,采用SPSS20.0统计软件对数据进行统计学分析,对比治疗前后两组临床疗效的变化及两组间的疗效差异。结果:一般资料比较:两组病例的一般资料(年龄、性别构成、体重、身高)均无统计学差异(P0.05)。两组病例显性失血量、术中输血人数及输血量比较:两组病例显性失血量、术中输血人数及输血量对比,差异无统计学意义(P0.05)。两组病例手术前后Hb、HCT比较:(1)组内对比,两组病例术后第1、3、7天Hb、HCT水平较术前降低,差异具有统计学意义(P0.05),表明两组病例术后均存在隐性失血。(2)组间对比,两组病例术后第1、3天Hb、HCT水平对比无统计学意义(P0.05),表明在术后第1、3天归脾汤加减对PFNA治疗老年股骨粗隆间骨折术后隐性失血的影响尚未显现。(3)组间对比,两组病例术后第7天治疗组Hb、HCT高于对照组,差异具有统计学意义(P0.05),表明归脾汤加减能有效减少PFNA治疗老年股骨粗隆间骨折术后的隐性失血。两组病例手术后隐性失血量的比较:(1)组内对比,两组病例术后1-3d的隐性失血量均较术前-术后1d降低,差异具有统计学意义(P0.05);两组病例术后3-7d的隐性失血量均较术后1-3d降低,差异具有统计学意义(P0.05),表明病例术后的隐性失血量逐渐减少。(2)组间对比,两组病例术前-术后1d、术后1-3d隐性失血量对比无统计学意义(P0.05),表明在术前-术后1d、术后1-3d归脾汤对PFNA治疗老年股骨粗隆间骨折术后隐性失血的影响尚未显现。(3)组间对比,两组病例术后3-7d治疗组隐性失血量少于对照组,且差异有统计学意义(P0.05),表明归脾汤加减能有效减少PFNA治疗老年股骨粗隆间骨折的隐性失血。结论:归脾汤加减能有效减少PFNA治疗老年股骨粗隆间骨折术后的隐性失血。
[Abstract]:Objective: to explore the effect of Guipi decoction on the treatment of recessive blood loss after PFNA in elderly patients with intertrochanteric fracture of femur, and to provide another way of thinking for clinical treatment of this disease. Methods: thirty patients with intertrochanteric fracture of femur from Department of Orthopedics and Trauma of Jiangsu Provincial Hospital of traditional Chinese Medicine were divided into treatment group and control group with 15 cases in each group. Patients must meet inclusion criteria, from February 2016 to February 2017. After PFNA internal fixation, the control group was treated with routine rehydration, infection prevention, anticoagulant therapy and so on, while the treatment group: on the basis of routine rehydration, infection prevention, anticoagulant therapy, etc. On the first day after operation, we began to take add and subtractive spleen decoction (Atractylodes macrocephala 15g, Angelica sinensis 15g, Codonopsis 15g, Astragalus 30g, Poria cocos 15g, longan meat 10g, jujube seed 10g (smashing 20g, Yuanzhi 6g, wood 10g, licorice 5g), gelatin (closing 15g, Hawthorn 15g, salvia miltiorrhiza 15g, Dazao 10g), taking 1 dose daily, Take 7 doses in two doses. Age, sex, height, weight, blood routine, HB and HCT were recorded 1 day before operation and 3 days after operation. The data were statistically analyzed by SPSS20.0 software. The changes of clinical efficacy and the difference between the two groups before and after treatment were compared. Results: there was no significant difference in general data (age, sex composition, weight, height) between the two groups (P 0.05). There was no significant difference in the amount of dominant blood loss, the number of blood transfusions during operation and the amount of blood transfusion between the two groups. There was no significant difference between the two groups in terms of the amount of dominant blood loss, the number of blood transfusions during operation and the amount of blood transfusion. Comparison of HCT between the two groups before and after operation. The HCT levels in the two groups were significantly lower than those before and after operation on the 1st day, 3th day after operation, and the difference was statistically significant (P 0.05), which indicated that there was recessive blood loss in both groups. There was no significant difference in the level of HCT between the two groups on the 1st and 3rd day after operation, indicating that the effect of Guipi decoction on the hidden blood loss after PFNA in the treatment of senile intertrochanteric fracture of the femur was not yet apparent in the first day of operation, and there was no significant difference between the two groups in the treatment of intertrochanteric fracture of the femur. On the 7th day after operation, HCT in the treatment group was higher than that in the control group, and the difference was statistically significant (P 0.05), which indicated that Guipi decoction could effectively reduce the recessive blood loss after PFNA in the treatment of senile intertrochanteric fracture of femur. Comparison of recessive blood loss in the two groups after operation, the recessive blood loss at 1 to 3 days after operation in both groups was lower than that on the first day after operation, and the difference was statistically significant (P 0.05), and the occult blood loss at 3 to 7 days after operation in both groups was lower than that at 1 to 3 days after operation, and there was no significant difference between the two groups in the amount of recessive blood loss at 3 to 7 days after operation. The difference was statistically significant (P 0.05), which indicated that the recessive blood loss decreased gradually after operation. There was no significant difference in the amount of recessive blood loss between preoperative and postoperative 1 day and 1 to 3 days after operation in both groups. The results showed that the effect of Guipi decoction on PFNA in the treatment of senile femoral intertrochanteric fracture after operation was not significant at 1 day before and 1 day after operation, and there was no significant difference between the two groups in the treatment of senile femoral intertrochanteric fracture. The amount of recessive blood loss in the treatment group was less than that in the control group 3-7 days after operation, and the difference was statistically significant (P 0.05), which indicated that Guipi decoction could effectively reduce the recessive blood loss in the treatment of intertrochanteric fracture of the femur in elderly patients. Conclusion: Guipi decoction can effectively reduce the recessive blood loss after PFNA in the treatment of senile intertrochanteric fracture.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

【相似文献】