围术期穴位电刺激联合不同术后镇痛预防TKA后DVT形成的临床随机对照研究

Clinical Randomized Controlled Study of TEAS during Perioperative Period Combined with Different Postoperative Analgesia Methods in Preventing the Formation of DVT after TKA

目的:探讨电针联合股神经阻滞术后镇痛对深静脉血栓形成的预防效果。方法:将200例膝关节置换手术术后患者随机分为4组,每组50人,分别为静脉自控镇痛组(PCIA组)、股神经阻滞术后镇痛组(PCNA组)、静脉自控镇痛联合针刺治疗组(PCIA+A组)、股神经阻滞术后镇痛联合针刺治疗组(PCNA+A组)。观察术后下肢深静脉血栓(DVT)发生率,手术前后血小板计数、D-二聚体指数、血液流变学指数的变化情况。结果:与PCIA组比较,PCNA组、PCIA+A组、PCNA+A组深静脉血栓发生率降低,差异有统计学意义(P<0.05);与PCNA组比较,PCNA+A组深静脉血栓发生率降低,差异有统计学意义(P<0.05);与PCIA+A组比较,PCNA+A组深静脉血栓发生率降低,差异有统计学意义(P<0.05)。与术前比较,术后第1天各组血小板计数均升高,差异有统计学意义(P<0.05);与术后第1天比较,术后第7天PCIA+A组、PCNA+A组血小板计数降低,差异有统计学意义(P<0.05);术后第7天与PCIA组比较,PCNA组、PCIA+A组、PCNA+A组血小板计数降低,差异有统计学意义(P<0.05)。与术前比较,术后第1天、第7天各组D-二聚体指数均升高,差异有统计学意义(P<0.05);与术后第1天比较,术后第7天PCIA组、PCNA组D-二聚体指数升高,差异有统计学意义(P<0.05);术后第7天与PCIA组比较,PCIA+A组、PCNA+A组D-二聚体指数降低,差异有统计学意义(P<0.05)。与术后第1天比较,术后第7天PCIA+A组、PCNA+A组全血黏度低切、红细胞聚集指数降低,差异有统计学意义(P<0.05);PCNA+A组纤维蛋白原、血浆黏度降低,但差异无统计学意义P>0.05)。术后第7天与PCIA组比较,PCIA+A组全血黏度低切、红细胞聚集指数降低,差异有统计学意义(P<0.05);PCNA+A组全血黏度低切、红细胞聚集指数、纤维蛋白原、血浆黏度降低,差异有统计学意义(P<0.05)。结论:股神经连续阻滞术后镇痛与传统静脉镇痛比较能降低DVT发生率,而联合术后电针穴位刺激治疗后能进一步降低术后DVT的发生,更有利于患者的康复。

Objective: To discuss the effects of electrical acupoints combined with postoperative analgesia of femoral nerve block in the prevention of deep vein thromosis(DVT). Methods: All 200 patients after total knee arthroplasty(TKA) were randomized into four groups, 50 patients each group, they were PCIA group, PCNA group,PCIA+A group and PCNA+A group. The incidences of postoperative DVT, platelets counting before and after the surgery, D-dimer index and blood rheology indexes before and after the treating were observed. Results: Compared with PCIA group, the incidences of DVT in the PCNA group, PCIA+A group and PCNA+A group decreased, and the difference had statistical meaning(P<0.05); compared with PCNA group, the incidences of DVT lowered in the PCNA+A group, and the difference showed statistical meaning(P <0.05); Compared with PCIA+A group, the incidences of DVT in the PCNA+A group decreased, and the difference had statistical meaning(P<0.05). Compared with before the surgery, platelet counting in different groups after the surgery raised, and the difference showed statistical meaning(P<0.05); compared with the first day after the surgery, platelet counting in the PCIA+A group and the PCNA+A group decreased at the seventh day after the surgery, and the difference showed statistical meaning(P<0.05); compared with PCIA group at the seventh day after the surgery, platelet counting lowered in the PCNA group, PCIA+A group and PCNA+A group, and the difference had statistical meaning(P<0.05). Compared with before the surgery, D-dimer index at the f irst and seventh day after the surgery in different groups raised, and the difference showed statistical meaning(P<0.05); compared with the first day after the surgery, D-dimer index lifted at the seventh day after the surgery in the PCIA group and PCNA group, and the difference showed statistical meaning(P<0.05); compared with the PCIA group, D-dimer index lowered in the PCIA+A group and PCNA+A group at the seventh day after the surgery, and the difference had a significant difference(P<0.05). Compared with the first day after the surgery, low shear whole blood viscosity and red blood cells aggregation index in the PCIA+A group and PCNA+A group reduced at the seventh day after the surgery, and the difference had statistical meaning(P<0.05);fibrinogen and plasma viscosity in the PCNA+A group decreased, while the difference had no statistical meaning(P>0.05). Compared with PCIA group at the seventh day after the surgery, low shear whole blood viscosity and red blood cells aggregation index decreased in the PCIA+A group, and the difference had statistical meaning(P<0.05);low shear whole blood viscosity, red blood cells aggregation index, fibrinogen and plasma viscosity lowered in the PCNA+A group(P <0.05). Conclusion: Compared with traditional PCIA, PCNA could decrease the incidence of DVT, when it is combined with TEAS, it could further lower the incidence of DVT after the operation and benefit the rehabilitation of the patients.