基于益气活血法改善人工全膝关节置换术后早期临床疗效的研究

发布时间：2018-06-03 07:09

本文选题：益气活血法 + 人工全膝关节置换术　；参考：《中国中医科学院》2017年硕士论文

【摘要】：[目的]本研究旨在探讨益气活血法改善人工全膝关节置换术后早期的临床疗效,观察益气活血法改善术后贫血、中医证候、疼痛、肢体肿胀、关节功能的作用,以促进患者术后快速康复,为中医改善人工全膝关节置换术后早期临床症状提供临床依据。[方法]纳入60例因重度膝骨关节炎行初次单侧人工全膝关节置换术的患者,随机分为试验组、对照组各30例。两组患者手术由同一主刀医师完成,围手术期给予抗凝、预防感染、指导功能锻炼等相同的基础治疗,对照组只采用上述基础治疗,试验组则在上述基础治疗的基础上于术后第1天给予益气活血中药干预(黄芪30g,当归10g,熟地10g,白芍10g,红花10g,桃仁10g,制首乌10g,杜仲10g,牛膝10g,陈皮10g,炙甘草9g),每日1剂,分两次口服,共服药7天。分别统计两组术前年龄、性别、身高、体重、血红蛋白(Hb)、红细胞计数(RBC)、红细胞压积(HCT)、VAS评分、肢体周径、HSS评分进行基线比较。观察并记录术后第1、3、7、14天血红蛋白(Hb)、红细胞计数(RBC)、红细胞压积(HCT)、中医症状分级量化评分、VAS评分、肢体周径,以及术后3、7、14天的膝关节HSS评分,并采用SPSS 24.0软件进行数据统计分析。[结果]1、血红蛋白(Hb):术后第1天两组患者Hb平均水平降低,但试验组与对照组之间相比无统计学差异(P0.05);术后第3天Hb水平继续降低,两组数值均达到最低水平,但两组比较无统计学差异(P0.05);术后第7天患者的Hb水平开始缓慢升高,但是与对照组相比,试验组水平较高,两组有极显著统计学差异(P0.01);术后第14天患者Hb水平均逐渐恢复,试验组、对照组之间差异减小,无明显统计学差异(P0.05)。2、红细胞计数(RBC):术后第1天两组患者平均水平降低,试验组与对照组之间无统计学差异(P0.05);术后第3天试验组与对照组平均水平逐渐降低,两组比较无统计学差异(P0.05);但术后第7天两组RBC水平均有所升高,试验组较对照组升高幅度较大,两组具有统计学差异(P0.05);术后14天试验组与对照组患者RBC水平逐渐恢复,两组比较无统计学差异(P0.05)。3、红细胞压积(HCT):术后第1天两组患者HCT水平降低,试验组为34.043±2.47,对照组为33.09±2.01,两组无统计学差异(P0.05);术后第3天两组HCT平均水平均继续降低,试验组与对照组有统计学差异(P0.05);术后第7天HCT平均水平逐渐升高,试验组与对照组有统计学差异(P0.05);术后第14天两组HCT均值逐渐恢复,试验组与对照组无统计学差异(P0.05)。4、中医症状分级量化评分:术后第1天试验组与对照组之间患者中医症状分级量化评分比较无统计学差异(P0.05);术后第3天中医症状分级量化评分均有所降低,但试验组与对照组之间仍无统计学差异(P0.05);术后第7天试验组中医症状分级量化评分降低的幅度大于对照组,两组之间有极显著统计学差异(P0.01);术后14天两组差值逐渐减小,但试验组与对照组之间仍有极显著统计学差异(P0.01)。5、VAS评分:术后第1天试验组与对照组之间比较具有统计学差异(P0.05);术后第3天试验组与对照组仍无统计学差异(P0.05);术后第7天试验组与对照组相比有极显著统计学差异(P0.01);术后第14天试验组与对照组均有较大幅度的降低,两组相比有统计学差异(P0.05)。6、肢体周径:术后第1天两组之间无统计学差异(P0.05);术后第3天两组患者肢体周径均有增大,两组仍无统计学差异(P0.05);术后第7天试验组平均水平较对照组低,两组之间有统计学差异(P0.05);术后第14天两组肢体周径比较无统计学差异(P0.05)。7、HSS评分:术后第3天两组患者HSS评分相比无统计学差异(P0.05);术后第7天试验组HSS评分的平均水平高于对照组,有极显著统计学差异(P0.01);术后第14天试验组与对照组之间差距减小,两组之间有统计学差异(P0.05)。[结论]本研究表明益气活血法能够纠正TKA术后早期Hb减少,减少TKA术后失血,而达到改善TKA术后患者早期的贫血状态,并且能够减轻术后疼痛,减轻术后早期的肢体肿胀,改善关节功能,加快患者术后的快速康复。
[Abstract]:[Objective] to explore the effect of Yiqi Huoxue Method in improving the early clinical effect of artificial total knee replacement, and to observe the effect of Yiqi Huoxue Method to improve postoperative anemia, TCM syndrome, pain, limb swelling and joint function, in order to promote rapid recovery after operation, and to improve the early clinical symptoms after artificial total knee arthroplasty by traditional Chinese medicine. 60 cases of primary unilateral total knee arthroplasty due to severe knee osteoarthritis were divided into the experimental group and the control group of 30 cases. The two groups were performed by the same surgeon with the same primary surgeon. In the perioperative period, the same basic treatment, such as anticoagulant prevention, prevention of infection, guidance work, and other basic treatment, was used in the control group only. On the basis of the basic treatment, the experimental group was given the intervention of Yiqi Huoxue Chinese medicine on the basis of the above basic treatment (Radix Astragali 30g, angelica 10g, Radix Angelicae 10g, Radix Paeoniae Paeoniae 10g, safflower 10g, peach kernel 10g, made Radix Polygoni multiflorum 10g, Eucommia ulmoides 10g, Radix Achyranthes 10g, orange peel 10g, Radix Glycyrrhiza 9g), 1 doses of two times each day, taking medicine for 7 days. Statistics two groups of preoperative age, sex, sex, respectively. Difference, height, weight, hemoglobin (Hb), red blood cell count (RBC), red blood cell pressure product (HCT), VAS score, limb circumference, HSS score for baseline comparison. Observe and record the postoperative 1,3,7,14 days' hemoglobin (Hb), erythrocyte count (RBC), red blood cell pressure product (HCT), TCM symptom grading scale, VAS score, limb circumference, and 3,7,14 day after operation. HSS score of knee joint and statistical analysis of SPSS 24 software. [result]1, hemoglobin (Hb): Hb average level decreased in two groups of patients at first days after operation, but there was no statistical difference between the test group and the control group (P0.05); the level of Hb continued to fall at third days after the operation, and the two groups reached the lowest level, but the two groups had no statistical statistics. Study difference (P0.05); the Hb level of the patients began to increase slowly seventh days after operation, but compared with the control group, the level of the test group was higher and the two groups had significant statistical difference (P0.01); the level of Hb in the fourteenth days after the operation was gradually restored, the difference between the experimental group and the control group was reduced, there was no significant statistical difference (P0.05).2, and the erythrocyte count (RBC): after the operation: after the operation. In the first day, the average level of the two groups was reduced, and there was no statistical difference between the test group and the control group (P0.05). The average level of the test group and the control group decreased gradually on the third day after the operation, and there was no statistical difference between the two groups (P0.05), but the level of RBC in the two groups was higher in the seventh day after the operation, and the experimental group was higher than the control group, and the two groups had statistical difference. The RBC level of the experimental group and the control group gradually recovered 14 days after the operation. There was no statistical difference between the two groups (P0.05).3 and the hematocrit (HCT): the level of HCT in the first day group was 34.043 + 2.47, the control group was 33.09 + 2.01, and the two groups had no statistical difference (P0.05), and the average level of HCT in group two continued on third days after the operation. There was a statistical difference between the experimental group and the control group (P0.05), and the average level of HCT increased gradually on the seventh day after the operation, and there was a statistical difference between the experimental group and the control group (P0.05); the mean HCT of the two groups was gradually restored on the fourteenth day after the operation, and there was no statistical difference between the experimental group and the control group (P0.05).4, and the TCM symptom classification was quantified: the experimental group and the control group after the operation. There was no statistical difference (P0.05) between the TCM symptom grading and quantitative scores (P0.05), but there was no significant difference between the TCM symptom grading and the control group (P0.05) after third days of operation, and the reduction of TCM symptom grading scores in the seventh days after the operation was greater than that of the control group, and there was a very significant difference between the two groups. Statistical difference (P0.01), 14 days after the operation, the difference between the two groups gradually decreased, but there was still significant statistical difference between the test group and the control group (P0.01).5, VAS score: first days after the operation, there was a statistical difference between the test group and the control group (P0.05), and there was no statistical difference between the experimental group and the control group (P0.05) after the operation (P0.05), and the seventh day group after the operation. There was significant difference in Statistics (P0.01) compared with the control group (P0.01), and there was a significant reduction in the two groups (P0.05).6. There was no statistical difference between the two groups (P0.05) on the first day after the operation (P0.05), and the limb circumference increased on the third day after the operation, and there was no statistical difference between the two groups (P 0.05); the average level of the experimental group was lower than the control group at seventh days after the operation (P0.05), and there was no statistical difference between the two groups on the fourteenth day after the operation (P0.05).7, and the HSS score was not statistically significant (P0.05) in two groups of patients after the operation (P0.05); the average level of HSS score in the experimental group was higher than that of the control group at seventh days after the operation, There was a very significant statistical difference (P0.01); the gap between the test group and the control group decreased fourteenth days after the operation, and there was a statistical difference between the two groups (P0.05). [Conclusion] this study showed that the supplementing qi and activating blood method can correct the early Hb reduction after TKA operation, reduce the blood loss after TKA, and improve the early anemia status of the patients after TKA operation, and can reduce the postoperative period. Pain relieved early postoperative limb swelling, improved joint function and accelerated postoperative rehabilitation.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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