人工膝关节置换后老年患者应用桃红四物汤联合穴位灸法的康复满意度

Rehabilitation satisfaction of Taohong Siwu Decoction combined with acupoint moxibustion applied in older adults after total knee arthroplasty

背景:随着"生物-心理-社会"医学模式的转变,人工膝关节置换术后康复治疗由以"疾病"为中心,转变为以"患者"为中心,提高手术安全性和患者满意度是每位骨科医师努力的方向。现代加速康复理念核心则是以人为本观念的体现,是医学人文关怀的具体实践。怎样立足国情,关注置换后患者的心理康复、疼痛消除、功能恢复,提高治疗的舒适度,有待于骨科医师推陈创新,深入研究。目的:探讨人工全膝关节置换后应用桃红四物汤联合穴位灸法治疗的患者康复满意度。方法:选择2015年1月至2016年12月解放军兰州总医院收治的老年全膝关节置换后患者186例,随机分为3组,常规治疗组在骨科常规护理和术后康复训练基础上给予低分子肝素钙4 000 U 1次/d皮下注射,塞来昔布200 mg口服2次/d治疗,7 d为一完整疗程;桃红四物汤组在常规治疗组基础上给予桃红四物汤煎取药液400 mL,分2次早晚温服1剂/d,7 d为一完整疗程;联合治疗组在桃红四物汤组治疗基础上给予穴位灸法促进康复。分别于置换前、置换后第7天及第90天评估各组患者的疼痛指数并记录;比较置换后90 d各组患者Spitzer生活质量指数及QLQC-30生活质量评分,以评估生活质量和康复满意度。结果与结论:(1)与常规治疗组相比,桃红四物汤组和联合治疗组患者在置换后第7天及第90天疼痛指数明显下降,差异有显著性意义(P<0.01);桃红四物汤组和联合治疗组之间各指标在不同时间段比较,差异均有显著性意义(P<0.01);(2)与常规治疗组相比,桃红四物汤组和联合治疗组患者的置换后生活质量和康复满意度有明显提高(P<0.01),但桃红四物汤组和联合治疗组之间各指标比较差异均无显著性意义(P﹥0.05);(3)提示桃红四物汤联合穴位灸法可降低老年全膝关节置换患者疼痛,提高置换后康复满意度及生活质量。在常规使用低分子肝素钙预防深静脉血栓形成的基础上,联合使用桃红四物汤及穴位灸法在提高患者置换后生活质量和康复满意度方面具有明显优势。

BACKGROUND： With the “Bio-Psycho-Social” paradigm, rehabilitation after total knee arthroplasty （TKA） has shifted from “Disease” to “Patient-Centered” to improve surgical safety and patient satisfaction. The core concept of modern rapid rehabilitation is based on the concept of people-oriented, and is the concrete practice of medical and humane care. How to pay more attention to the psychological rehabilitation of patients after replacement, elimination of pain, functional recovery, improve the comfort of treatment, orthopedic physicians need to push innovation and research in depth in our country. OBJECTIVE： To investigate the effect of acupoint moxibustion combined with Taohong Siwu Decoction on the rehabilitation satisfaction of the patients after TKA. METHODS： Totally 186 older adults after undergoing TKA were enrolled at Lanzhou General Hospital of PLA from January 2015 to December 2016. The patients were divided into three groups： conventional group, Taohong Siwu Decoction group and combination group. The conventional group was given subcutaneous injection of low molecular weight heparin calcium, 4 000 U, once daily, conventional nurse and rehabilitation, oral administration of 200 mg of celecoxib, twice daily （7 days a course）. The Taohong Siwu Decoction group received the same treatment with the conventional group, and was given Taohong Siwu Decoction （400 mL）, twice daily. The combination group was given acupuncture and moxibustion on the basis of the first two treatments. The pain index was recorded at baseline, 7 and 90 days postoperatively. The Spitzer quality of life and QLQ-C30 scores at postoperative 90 days were compared among groups to assess the quality of life and rehabilitation satisfaction. RESULTS AND CONCLUSION： （1） Compared with the conventional group, the pain index in the Taohong Siwu Decoction and combination groups was significantly decreased at 7 and 90 days postoperatively （P 〈 0.01）. There was significant difference in each index between Taohong Siwu Decoction and combination groups at different time points （P 〈 0.01）. （2） Compared with the conventional group, the quality of life and rehabilitation satisfaction of the patients in the Taohong Siwu Decoction and combination groups were significantly improved （P 〈 0.01）, but there was no significant difference between Taohong Siwu Decoction and combination groups （P 〉 0.05）. （3） In summary, Taohong Siwu Decoction combined with acupoint moxibustion can alleviate the pain, and improve satisfaction and quality of life of the patients undergoing TKA. Based on the conventional treatment of low molecular weight heparin calcium for preventing deep venous thrombosis, the combination of Taohong Siwu Decoction and acupoint moxibustion exhibits excellent results in improving quality of life and satisfaction.