| 摘要: |
| 目的 探讨穴位刺激联合穴位注射疗法对全膝关节置换术后下肢深静脉血栓形成的影响。方法:选取2021年1月—2022年1月于山东中医药大学附属医院关节骨科行全膝关节置换手术患者90例，随机分为穴位刺激联合穴位注射组(S组)，穴位刺激组(T组)和对照组(D组)各30例。对照组(D组)于术后常规应用低分子肝素预防DVT；穴位刺激组(T组)在对照组基础上进行穴位刺激干预；穴位刺激联合穴位注射组(S组)在对照组基础上进行穴位刺激及穴位注射高乌甲素联合干预。对比三组患者术后下肢深静脉血栓的发生率，于术前，术后1 d、3 d、7 d，采集三组患者静脉血样本检测凝血功能指标:凝血酶原时间(PT)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-dimer)，于入室后麻醉手术前、术后即刻、术后24 h采集患者静脉血样本检测血浆皮质醇(COR)、促肾上腺皮质激素水平(ACTH)。结果:三组间患者术前PT、APTT、FIB、D-dimer值差异无统计学意义(P>0.05)。而术后1、3、7 d，S组PT、APTT较T组及D组明显延长(P<0.05)，且T组PT、APTT较D组延长(在术后第1天显著延长，P<0.05)；术后1、3、7 d，S组FIB较T组及D组明显降低(P<0.05)，且T组FIB较D组明显降低(P<0.05)；术后1、3、7 d，T组和S组D-dimer较D组明显降低(P<0.05)，术后1 d，S组较T组D-dimer明显降低(P<0.05)，但术后3、7 d，S组与T组无显著性差异(P>0.05)。三组间患者入室后麻醉手术前COR、ACTH差异无统计学意义(P>0.05)。而术后即刻和术后24 h，S组COR、ACTH较T组及D组明显降低(P<0.05)，且T组COR、ACTH较D组明显降低(P<0.05)。三组患者术后DVT发生率差异无统计学意义(P>0.05)。结论:穴位刺激联合穴位注射法能够显著降低围术期应激反应水平，改善患者术后凝血功能，对于预防全膝关节置换术后下肢深静脉血栓的形成具有积极作用。 |
| 关键词: 下肢深静脉血栓 穴位刺激 穴位注射 高乌甲素 |
| DOI：10.3969/j.issn.1007-6948.2023.03.005 |
|
| 基金项目:山东省自然科学基金(ZR2020MH391);山东省自然科学基金(ZR2021MH168); 山东省自然科学基金重点项目(20142R B14219) |
|
| Effect of transcutaneous electrical acupoint stimulation combined with acupoint-injection of lappaconitine on deep venous thrombosis after total knee arthroplasty |
| MENG Xiao-qun,JI Jia-fu,ZHANG Wei-liang |
| Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine，Jinan250014，China |
| Abstract: |
| Objective To investigate the effect of transcutaneous electrical acupoint stimulation combined with acupoint-injection of lappaconitine on deep venous thrombosis after total knee arthroplasty, and to provide a new way to prevent deep vein thrombosis by combining traditional Chinese and western medicine. Methods A total of 90 patients who underwent total knee replacement surgery in the orthopedics Department of the Affiliated Hospital of Shandong University of Chinese Medicine from January 2021 to January 2022 were randomly divided into TEAS combined with acupoint injection group (group S), TEAS group (group T) and control group (group D), 30 cases each.The group D was routinely treated with LMWH sodium injection to prevent DVT. TEAS group (T group) underwent Transcutaneous electrical acupoint stimulation on the basis of control group. S group underwent transcutaneous electrical acupoint stimulation combined with acupoint-injection intervention was performed on the basis of the control group. Compared three groups of patients with postoperative incidence of deep vein thrombosis, collect three groups of patients with venous blood samples to test the coagulant function index in preoperative and postoperative 1 d, 3 d, 7 d ,including preoperative prothrombin time(PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and d-dimer (D-dimer) .Collect three groups of patients with venous blood samples to test the cortisol(COR) and adrenocorticotropic hormone(ACTH) levels in after anesthesia before surgery, postoperative immediately,24 hours after surgery. Results Color doppler ultrasonography showed that deep venous thrombosis occurred in 2/30 (6.67%) patients in group D, 1/28 (3.57%) patients in group T, and no deep venous thrombosis in group S. There was no significant difference in PT, APTT, FIB and D-dimer between the three groups (P>0.05). On day 1, 3 and 7 after surgery, PT and APTT in group S were significantly longer than those in group T and D (P<0.05), and PT and APTT in group T were significantly longer than those in group D (P<0.05). FIB in group S was significantly lower than that in group T and D (P<0.05), and FIB in group T was significantly lower than that in group D (P<0.05). D-dimer of T group and S group was significantly lower than that of D group on day 1, 3 and 7 after surgery (P<0.05), and D-dimer of S group was significantly lower than that of T group on day 1 after surgery (P<0.05), but there was no significant difference between S group and T group on day 3 and 7 after surgery (P>0.05). There was no statistically significant difference in COR and ACTH between the three groups before anesthesia surgery (P>0.05). However, COR and ACTH in the S group were significantly lower than those in the T group and the D group (P<0.05), and COR and ACTH in the T group were significantly lower than those in the D group (P<0.05). There was no significant difference in the incidence of postoperative DVT among the three groups (P>0.05). Conclusion Transcutaneous electrical acupoint stimulation combined with acupoint injection of lappaconitine can significantly reduce perioperative stress response level, improve postoperative coagulation function of patients, and play a positive role in preventing the formation of deep venous thrombosis after total knee arthroplasty. |
| Key words: Deep venous thrombosis ranscutaneous electrical acupoint stimulation acupoint-injection therapy lappaconitine |
