人工膝关节表面置换术后应用穴位灸法联合桃红四物汤的临床疗效

摘要

Objective To investigate the effect of acupoint moxibustion combined with Taohong Siwu decoction on patients with total knee arthroplasty (TKA).Methods Totally 186 patients who had TKA from January 2014 to December 2016 in Lanzhou Military Region General Hospital were randomly divided into 3 groups:conventional treatment group had low-molecular-weight heparin calcium subcutaneous injection,4 000 U/time,1 time/d and took celecoxib,200 mg/time,2 times/d;Taohong Siwu decoction group took Taohong Siwu decoction on the basis of conventional treatment,1 dose/d (400 ml,twice a day in the morning and before bedtime);combined treatment group had acupoint moxibustion on the tsusanli acupoint on the basis of Taohong Siwu decoction,3 moxa cones/time,1 time/d;1 course of treatment was 7 d.The maximum amplitude index of thrombelastogram,levels of D-dimer,platelet count,erythrocyte count,leukocyte count and C-reactive protein,circumferential diameter of thigh and score of the Visual Analogue Scale(VAS) for pain were recorded before and 7 d after treatment.The Hospital for Special Surgery Knee Score(HSS score) and incidence of deep vein thrombosis (DVT) were analyzed in 8 weeks after discharge.Results There were no significant differences of maximum amplitude index of thrombelastogram,D-dimer,platelet count,erythrocyte count,leukocyte count and C-reactive protein levels among groups before treatment (P ＞ 0.05).After treatment,maximum amplitude index of thrombelastogram,D-dimer,erythrocyte count,leukocyte count and C-reactive protein levels in Taohong Siwu decoction group and combined treatment group showed significant differences compared to those in conventional treatment group[(62±7),(55 ±6)mm vs (71 ±8)mm;(0.67 ±0.01),(0.51 ±0.06)mg/L.vs (0.89 ±0.08)mg/L;(3.8±0.3),(3.9±0.4) × 1012/L vs (3.1 ±0.3) × 1012/L;(9.2±0.7),(8.1 ±0.8) × 109/L vs (10.0 ± 0.9) × 109/L;(10.0 ± 1.2),(9.0 ± 1.0) mg/L vs (11.0 ± 1.1) mg/L];there were significant differences between Taohong Siwu decoction group and combined treatment group (P ＜ 0.01);platelet count after treatment had no significant difference among groups (P ＞ 0.05).There were no significant differences of circumferential diameter of thigh and the VAS score among groups before treatment (P ＞ 0.05).After treatment,circumferential diameter of thigh and the VAS score in Taohong Siwu decoction group and combined treatment group were significantly lower than those in conventional treatment group [(32 ± 4),(30 ± 3) cm vs (35 ± 4) cm;(4.6 ± 1.5),(3.6 ± 1.2)points vs (5.2 ± 1.0)points];there were also significant differences between Taohong Siwu decoction group and combined treatment group(P ＜0.01).The HSS score had no significant difference among groups before treatment(P ＞0.05).After 8 weeks of follow-up,the HSS score in Taohong Siwu decoction group and combined treatment group was significantly higher than that in conventional treatment group [(78 ± 7),(81 ± 5)points vs (72 ± 6)points];the HSS score in combined treatment group was significantly higher than that in Taohong Siwu decoction group(P ＜ 0.01).Incidence of DVT in Taohong Siwu decoction group and combined treatment group was significantly lower than that in conventional treatment group[4.8％ (3/62),0.0％ (0/62) vs 8.1％ (5/62)] (P ＜ 0.01).Conclusion Taohong Siwu decoction combined with acupoint moxibustion can reduce pain and prevent occurrence of DVT in patients with TKA.%目的 探讨人工膝关节表面置换术(TKA)后应用穴位灸法联合桃红四物汤的临床疗效.方法 选取2014年1月至2016年12月于兰州军区兰州总医院行TKA治疗的患者186例,应用随机数字表将患者分为3组,常规治疗组在骨科常规护理和术后康复训练基础上给予低分子肝素钙4 000 U 1次/d皮下注射,塞来昔布200 mg口服2次/d,7d为一完整疗程;桃红四物汤组在常规治疗组基础上给予桃红四物汤1剂/d,煎取药液400 ml,分2次早晚温服,7d为一完整疗程;联合治疗组在桃红四物汤组治疗基础上给予穴位灸法,以中药饼放置足三里穴上,点燃艾柱,3柱/次,1次/d,7d为一完整疗程.对3组患者入院24h内和术后第7天的血栓弹力图最大振幅指数、D-二聚体、血小板计数、红细胞计数、白细胞计数及C反应蛋白进行比较;分别于术前和术后治疗第7天测量3组患者的大腿周径,应用疼痛视觉模拟量表(VAS)进行疼痛评分;比较出院8周3组患者美国特种外科医院膝关节评分(HSS评分)、下肢深静脉血栓(DVT)发生率.结果 治疗前3组患者血栓弹力图最大振幅指数、D-二聚体、血小板计数、红细胞计数、白细胞计数及C反应蛋白比较差异均无统计学意义(均P ＞0.05);治疗7d后,桃红四物汤组和联合治疗组患者的血栓弹力图最大振幅指数、D-二聚体、红细胞计数、白细胞计数及C反应蛋白与常规治疗组比较差异均有统计学意义[(62±7)、(55±6)mm比(71±8) mm,(0.67±0.01)、(0.51±0.06) mg/L比(0.89±0.08) mg/L,.(3.8±0.3)、(3.9±0.4)×1012/L比(3.1±0.3)×1012/L,(9.2 ±0.7)、(8.1 ±0.8) ×109/L比(10.0±0.9)×109/L,(10.0±1.2)、(9.0±1.0)mg/L比(11.0±1.1) mg/L],且桃红四物汤组与联合治疗组比较差异均有统计学意义(均P＜0.01);而3组间血小板计数差异无统计学意义(P＞0.05).治疗前,3组患者大腿周径和VAS评分比较差异均无统计学意义(均P＞0.05);治疗7d后,桃红四物汤组和联合治疗组大腿周径及VAS评分与常规治疗组比较均降低[(32±4)、(30±3)cm比(35±4)cm,(4.6±1.5)、(3.6±1.2)分比(5.2±1.0)分],且联合治疗组低于桃红四物汤组,差异均有统计学意义(均P＜0.01).治疗前,3组患者HSS评分比较差异无统计学意义(P＞0.05);术后8周随访发现,桃红四物汤组和联合治疗组患者的HSS评分均高于常规治疗组[(78±7)、(81±5)分比(72±6)分],且联合治疗组高于桃红四物汤组,差异均有统计学意义(均P＜0.01).术后8周随访时桃红四物汤组、联合治疗组DVT发生率均低于常规治疗组[4.8％ (3/62)、0.0％ (0/62)比8.1％ (5/62)],且联合治疗组低于桃红四物汤组,差异均有统计学意义(均P＜0.01).结论 桃红四物汤联合穴位灸法可降低行TKA患者的疼痛评分,有效预防DVT发生.