老年全膝关节置换术后中医辨证分型规律研究

Study on the Principles of Syndrome Differentiation of the Elderly Patients after Total Knee Arthroplasty

目的:探讨老年全膝关节置换术后患者的中医证候分布规律,为老年全膝关节置换术后患者的临床辨证治疗提供参考。方法:对服用中药治疗的全膝关节置换术后的患者289例运用临床流行病学调查的方法,采用自制证候信息采集表采集四诊信息并进行辨证分型。结果:术后第1天,证候按构成比大小排列依次为:气虚血瘀证、肾虚血瘀证、脾虚血瘀证、脾虚湿瘀证、气滞血瘀证、气血亏虚证。术后第4天,证候按构成比大小排列依次为:气虚血瘀证、脾虚血瘀证、脾虚湿瘀证、肾虚血瘀证、气血亏虚证、气滞血瘀证。术后第7天,证候按构成比大小排列依次为:气虚血瘀证、脾虚血瘀证、脾虚湿瘀证、气滞血瘀证、肾虚血瘀证、气血亏虚证。结论:在老年全膝关节置换术后,患者的中医证候主要有气虚血瘀证、肾虚血瘀证、脾虚血瘀证、气滞血瘀证、气血亏虚证,早期证候以虚为主,逐渐演变为虚中夹实。

Objective： To provide the reference for clinical differentiation of the elderly patients after total knee arthroplasty （TKA） by exploring the distribution of TCM syndromes of the patients after TKA. Methods： All 289 patients after TKA who were treated by herbs were investigated by clinical epidemiological method, and four diagnostic informations were collected by using selfmade syndrome information collection table, and the patients were differentiated. Results： At the first day after the operation, the syndromes ranked according to their constituent ratio： Qi-deficiency and blood stasis syndrome, kidney deficiency and blood stasis syndrome, spleen deficiency and blood stasis syndrome, spleen deficiency and dampness stagnation syndrome, Qi stagnation and blood stasis syndrome, Qi and blood depletion syndrome. At the forth day after the operation, the syndromes ranked according to their constituent ratio： Qi stagnation and blood stasis syndrome, spleen deficiency and blood stasis syndrome, spleen deficiency and dampness stagnation syndrome, kidney deficiency and blood stasis syndrome, Qi and blood depletion syndrome and Qi-deficiency and blood stasis syndrome. At the seventh day after the operation, the syndromes ranked according to their constituent ratio： Qi-deficiency and blood stasis syndrome, spleen deficiency and blood stasis syn- drome, spleen deficiency and dampness stagnation syndrome, Qi stagnation and blood stasis syndrome, kidney deficiency and blood stasis syndrome and Qi and blood depletion syndrome. Conclusion： After TKA, TCM syndromes of the patients mainly are Qi-deficiency and blood stasis syndrome, kidney deficiency and blood stasis syndrome, spleen deficiency and blood stasis syndrome, Qi stagnation and blood stasis syndrome and Qi and blood depletion syndrome, at the early time, the syndromes are of deficiency, gradually developed into deficiency complicated with excess.