穴位按摩预防妇科腹腔镜术后深静脉血栓发生的影响

Acupoint Massage Prevented the Occurrence of Deep Venous Thrombosis after Gynecologic Laparoscopic Surgery

目的观察穴位按摩预防妇科腹腔镜术后不同风险级别深静脉血栓(deep venous thrombosis,DVT)发生的效果。方法利用Autar深静脉风险评估量表对2014年6—12月行妇科腹腔镜手术患者术前1天及术后24h进行评估,选出中、高危患者作为研究对象,中度风险组72例,高度风险组34例。将中、高风险患者按随机区组分为对照组和试验组。对照组给予常规护理加间歇性肢体气压治疗;试验组给予常规护理加穴位按摩(上巨虚、足三里、梁丘、阴市、伏兔)。检测患者术前、术后第1天、术后第5天红细胞聚集指数和腘窝静脉血流速度及统计术后血栓发生率。结果本研究中共有4例发生下肢DVT,中、高危患者各有2例,中危患者中对照组下肢DVT发生率为5.6%(2/36),试验组为0.0%(0/36);高危患者依次为11.8%(2/17)及0.0%(0/17)。中、高危患者中试验组患者血栓发生率均明显低于对照组(P<0.05)。中、高危患者术后第1天与术前比较,红细胞聚集指数明显升高,血流速度显著降低(P<0.05)。术后第5天红细胞聚集指数较术后第1天降低,腘静脉血流速度则升高(P<0.05)。与对照组比较,试验组术后第5天红细胞聚集指数明显降低、腘静脉血流速度升高(P<0.05)。结论对于Autar评估中、高危患者,在给予常规护理的同时辅助穴位按摩有利于预防术后DVT的发生。

Objective To observe the prevention of acupoint massage for the occurrence of deep venous thrombosis （DVT） of various risk degrees after gynecologic laparoscopic surgery. Methods Using Autar deep vein risk assessment scale, patients undergoing gynecological laparoscopic surgery from June 2014 to December 2014 were assessed one day before surgery and 24 h after surgery. Pa- tients at moderate and high risks were recruited as subjects in this research by blocking method, 72 in the moderate risk group and 34 in the high risk group. Patients in the two groups were then randomly assigned to the control group and the test group respectively. Conventional care plus intermittent limb pressure treatment were performed to patients in the control group. Conventional care plus acupoint massage [ Zusanli （ ST36）, Shangjuxu （ ST37 ）, Liangqiu （ ST34）, Yinshi （ ST33）, Futo （ST32） ] were performed to patients in the test group. Red blood cell （RBC） aggregation index and popliteal vein blood flow velocity were detected before surgery, at day 1 and 5 after surgery. The postoperative thrombosis rate was statistically analyzed. Results DVT of lower limbs occurred in 4 cases of this study, 2 in the moderate risk group and 2 in the high risk group. The incidence of DVT of lower limbs was 5.6% （2/36） in the moderate risk control group and 0.0% （0/36） in the moderate risk test group, and it was 11.8%（2/17） in the high risk control group and 0.0% （0/17） in the high risk test group （P 〈0.05）. The incidence of thrombosis in recruited patients was significantly lower in the test group than in the control group （P 〈0.05）. Compared with before surgery, RBC aggregation index obviously increased and popliteal vein blood flow velocity significantly decreased in recruited patients at day 1 after surgery （P 〈0.05）. Compared with day 1 after surgery, RBC aggregation index obviously increased and popliteal vein blood flow velocity significantly decreased in all patients at day 5 after surgery （P 〈0.05）. Compared with the control group, RBC aggregation index obviously decreased and popliteal vein blood flow velocity significantly increased in the test group （P 〈0.05）. Conclusion As for moderate risk and high risk patients evaluated by Autar scale, conventional care and assisted acupoint massage was conducive to preventing postoperative DVT.