益气活血法对股骨粗隆间骨折围手术期血容量的影响

发布时间：2018-05-11 13:14

本文选题：PFN-A + 隐性失血　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：探讨益气活血法对股骨粗隆间骨折围手术期血容量的影响。方法：选择2014年12月至2016年1月来自广东省中医院珠海医院住院部骨伤科符合股骨粗隆间骨折诊断入院病人,入院后并结合中医四诊合参,骨折中医辨证为气虚血瘀型证候；排除手术绝对禁忌症,并适合行PFN-A内固定定术的40例患者为受试对象。根据患者入院顺序,随机分组,按照等比例随机分为两组,即试验组(益气活血组)和对照组(常规治疗组),每组20例。试验组于患者入院后开始服用益气活血汤加减,并择期行PFN-A术,术后第1天开始服用益气活血汤加减至出院,两组在这一过程中使用相同的骨科临床常规治疗；对照组患者行围手术期常规治疗,不予使用益气活血汤,治疗过程同样至出院,两组患者术后康复方案相同。记录两组患者的身高、体重、年龄等一般资料；记录两组术前血红蛋白(Hb)、红细胞比积(HCT),手术时间、切口长度、手术方法、术中出血量等术中记录；记录并计算术后第一、三、十天患者血红蛋白及红细胞比积,并计算隐性失血量；同时记录两组住院时间、费用、输血人数及术后10内每天VAS评分情况,比较分析两组的差异。结果：1.两组各自术前与术后第一天HCT、Hb水平及各自术后第三天与第十天Hb、HCT、隐性失血量水平差异有统计学意义(P＜0.05),各自术后第一天Hb、HCT、隐性失血量与第三天比较差异没有统计学意义(P0.05)；两组Hb、HCT、隐性失血量术后不同时间段比较发现不同时间观察各自比较均数不同,差异水平有统计学意义(P＜0.05),其中不同时间与干预对Hb无交互作用(P0.05);而HCT、隐性失血量两组对比发现,不同的时间点两组处理对其水平的影响有不同,差异有统计学意义(P＜0.05),试验组Hb、HCT、血容量值的恢复都较对照组高。2.两组术后第一至四天VAS评分差异无统计学意义(P0.05),术后第五天至第七天VAS评分比较差异无统计学意义(P0.05),对照组高于试验组;第八天至第十天VAS评分差异无统计学意义(P0.05)。3.两组输血比率差异无统计学意义(P0.05),两组药物费用、住院天数差异比较有统计学意义(P0.05),试验组更低,两组住院期间总费用比较无统计学意义(P0.05)。结论：围手术期运用益气活血法体现了中医辨证的特点,粗隆间骨折行PFNA术,术中出血少,但术后一个时间段存在Hb、HCT大幅度下降,即隐性失血,也是围手术期血容量丢失的主要原因。在比较隐性出血量的量方面对比于对照组结果相致,提示益气活血法并没有减少患者隐性失血量,但运用益气活血法可以促进患者术后血红蛋白、红细胞比积、血容量的恢复,并让术后患者整体血容量的恢复提前,隐性出血量逐渐减少并停止提前,有利患者机能恢复。益气活血法组对比于对照组,在一定时间段上能减去患者术后疼痛强度,益气活血法的运用缩短了患者的住院时间、减少了住院费用。
[Abstract]:Objective: to study the effect of supplementing qi and activating blood circulation method on perioperative blood volume of intertrochanteric fracture of femur. Methods: from December 2014 to January 2016, the Department of Orthopedics and Trauma of Zhuhai Hospital of traditional Chinese Medicine of Guangdong Province was selected to diagnose the femoral intertrochanteric fracture. Forty patients who excluded the absolute contraindication of operation and were suitable for PFN-A internal fixation were selected as subjects. According to the order of admission, the patients were randomly divided into two groups according to the same proportion, namely the experimental group (Yiqi Huoxue group) and the control group (routine treatment group, 20 cases in each group). The patients in the trial group began to take Yiqi Huoxue decoction after admission, and PFN-A was performed on the selected period. On the first day after operation, Yiqi Huoxue decoction was reduced to discharge. The two groups were treated with the same orthopedic clinical routine therapy in this process. The patients in the control group were treated with routine treatment during perioperative period without the use of Yiqi Huoxue decoction. The treatment process was the same as that of discharge. The rehabilitation program of the two groups was the same. To record the general data of height, weight, age and so on in the two groups, to record the preoperative hemoglobin, HCT, operative time, incision length, operative method, intraoperative bleeding volume, and to record and calculate the first and third postoperative blood loss. The hemoglobin and hematocrit of the two groups were calculated at the same time, the hospitalization time, the cost, the number of blood transfusions and the VAS score of 10 days after operation were recorded, and the differences between the two groups were compared and analyzed. The result is 1: 1. There was significant difference between the two groups in HCThb level before operation and on the first day after operation, and in HCT on the third and tenth day after operation. There was significant difference in the hidden blood loss between the two groups (P < 0.05), but there was no significant difference in HCT between the first day of operation and the third day after operation, and there was no significant difference in the hidden blood loss between the two groups on the first day after operation and on the third day after operation. There were significant differences in the mean of HCT between the two groups, and the difference of the mean of HCT between the two groups in the different time period after the operation, and the difference of the mean value of the two groups in different time after operation. The difference level was statistically significant (P < 0.05), in which there was no interaction between different time and intervention on HB, while HCT, recessive blood loss were different in two groups. The difference was statistically significant (P < 0.05). The recovery of HCT and blood volume in the test group was higher than that in the control group (P < 0.05). There was no significant difference in VAS score between the two groups from the first to the fourth day after operation (P 0.05), but there was no significant difference between the VAS scores from the fifth to the seventh day after operation (P 0.05). The VAS score in the control group was higher than that in the trial group, and there was no significant difference in the VAS score between the eighth day and the tenth day. There was no significant difference in blood transfusion ratio between the two groups (P 0.05). The difference of drug cost and hospitalization days between the two groups was statistically significant (P 0.05), and that in the test group was lower than that in the control group. There was no significant difference in the total cost during hospitalization between the two groups (P 0.05). Conclusion: during the perioperative period, the method of supplementing qi and activating blood circulation reflects the characteristics of TCM syndrome differentiation. The intertrochanteric fracture has less bleeding during the operation, but there is a significant decrease of HCT in the period after operation, that is, recessive blood loss. It is also the main cause of perioperative blood volume loss. Comparing the quantity of recessive blood loss with that of the control group, it suggests that the method of supplementing qi and activating blood circulation does not reduce the amount of recessive blood loss in patients, but it can promote the recovery of hemoglobin, hematocrit and blood volume of patients after operation by using the method of supplementing qi and activating blood circulation. The recovery of whole blood volume and recessive blood loss were reduced and stopped earlier, which was beneficial to the recovery of patients' function. Compared with the control group, the group of supplementing qi and activating blood circulation can subtract the postoperative pain intensity in a certain time, and the application of the method of supplementing qi and activating blood circulation shortens the hospitalization time and reduces the cost of hospitalization.
【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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