中医特色护理联合基础护理对骨盆骨折腹膜后血肿的影响随机平行对照研究

The Random Parallel Control Study of Characteristics of Traditional Chinese Medicine Nursing Joint Basis for Pelvic Fractures Retroperitoneal Hematoma

[目的]观察中医特色联合基础护理对骨盆骨折后腹膜后血肿效果。[方法]使用随机平行对照方法,将60例住院患者按就诊顺序编号方法简单随机分为两组。对照组30例常规护理,饮食指导：入院后进食清淡、易消化流质饮食,忌辛辣、刺激、油腻食物;心理护理：制定个体化方案,针对焦虑心理状态进行心理疏导;腹部自主按摩：针对腹膜后血肿刺激症状,引导患者按一定方向按摩腹部,15~20min/次,2~3次/d;功能锻炼：每日固定时间进行功能锻炼,指导患者在床上适当活动,预防肌肉萎缩,促进肢体功能恢复,按摩及关节被动运动,运动量循序渐进,恢复自主运动,动作轻柔,避免二次损伤;正确卧位：定时轴线翻身,预防压疮、下肢深静脉血栓等。治疗组30例入院后评估：受伤时间、生命体征、腹部不适、认知清晰、饮食和排便习惯、既往史等,实施个性化中医特色护理：①中药超微颗粒调敷肚脐及脐周,三七、芒硝超微颗粒各50g,适量黄酒调制成糊状,不流动为宜,适量敷于肚脐中和脐周,医用胶条封住每隔8h更换,如感到不适,可根据情况适时调整时间更换;②穴位敷贴,中脘、关元、气海穴,背部大肠俞敷贴清热解毒、活血化瘀贴,每日更换,正常排便后停用;㈢大承气汤（大黄10g,厚朴、枳实各12g,芒硝6g,桃仁12g,红花9g）,浓煎80~100m L,30~50m L/次,3次/d,口服,观察腹部腹膜后血肿刺激,肠鸣音,肛门排气,有排便频数、性状及量调整药物剂量和服药次数,正常排便后停药;④服用汤药3d后仍不能自行排便,大承气汤保留灌肠;基础护理同对照组。连续治疗15d为1疗程。观测临床症状、腹膜后血肿、排气、腹胀、呃逆、嗳气、脐周压痛、腹围、肠鸣音、腹壁紧张度、腹部凹凸、不良反应。治疗1疗程,判定疗效。[结果]临床疗效治疗组优于对照组（P〈0.05）,腹胀、腹痛治疗组优于对照组（P〈0.05）,排便两组无显著差异（P〉0.05）。[结论]中医特色联合基础护干预骨盆骨折后腹膜后血肿,效果满意,无严重不良反应,值得推广。

[Objective] To observe The random parallel control study of characteristics of traditional Chinese medicine nursing joint basis for pelvic fractures retroperitonea] hematoma. [Methods] Using random parallel control method, 60 cases of pelvic fractures retroperitoneal hematoma patients diagnosed in our hospital were randomly divided into two groups. The 30 cases of patients of control group were given routine nursing. Diet guidance： after admission to eat light, digestible liquid diet, avoid acrimony, exciting; greasy food; Psychological nursing： to develop individualized programs, in relation to the psychological counseling of the anxiety state; Independent massage abdomen： retroperitoneal hematoma irritation, guide the patient in a certain direction to massage abdomen, 15-20 mirdtimes, 2-3/d; Functional exercise： a fixed time every day to do their guide patients in bed appropriate activities, prevent muscle atrophy, promote the limb function recovery, massage and passive joints movement, exercise step by step, and restore the voluntary movement, gentle, avoid secondary injury; Correct decubitus： time axis turn, prevention of pressure ulcers, lower extremity deep vein thrombosis, etc. The 30 cases of patients of the treatment group were evaluated. Admission assessment： injury time, vital signs, abdominal discomfort, cognitive clear past history, diet and bowel habits, such as, the implementation of personalized characteristic of traditional Chinese medicine nursing： （1） Given Chinese medicine superfine particles adjustable apply navel and periumbilical, notoginseng, glauber＇s salt superfine particles each 50 g; a moderate amount of rice wine were made into paste, flow not advisable, apply appropriate amount to the navel and periumbilical medicinal strip seal change every 8 h, such as discomfort, time can be adjusted according to circumstance timely replacement; （2） Given acupoint sticking, chung wan, guan yuan, qi hal, back rubs apply post, heat-clearing and detoxifying, promoting blood circulation to remove blood stasis change daily and normal defecation; （3） Given large bearing gas soup （rheum 10 g, 12 g magnolia bark, acid-insoluble ash, glauber＇s salt 6 g, 12 g, peach kernel, safflower 9 g）, thick and 80-100 ml, 30-50 ml/time, 3 times/d, oral, observe abdominal retroperitoneal hematoma, bowel sounds, anal exhaust, defecate frequency, characters and adjust drug doses and the number of drugs, normal defecation after drug withdrawal; （4） Given big bearing gas soup retention enema, after taking liquid form 3 d is still unable to defecate, and basic nursing with the control group of 15 d continuous treatment for 1 course of treatment. The clinical symptoms, retroperitoneal hematoma, exhaust, abdominal distension, hiccups, belching, periumbilical tenderness, bowel sounds, abdominal wail tension, abdomen concave and convex, and adverse reactions were observed. As a course treatment, the curative effect was evaluated. [Result] The clinical efficacy of the treatment group was better than that of control group （P〈0.05）, the abdominal distension and the abdominal pain of the treatment group was better than that of control group （P〈0.05）, the defecate of the two groups had no significant difference （P〉0.05）. [Conclusion] The characteristics of traditional Chinese medicine combined pelvic fractures after retroperitoneal hematoma, effect is satisfied, no serious adverse reactions, worthy of promotion. The application of characteristics of traditional Chinese medicine nursing joint basis for pelvic fractures retroperitoneal hematoma is satisfied, no serious adverse reactions, worthy of promotion.