下足部热敷合并穴位推拿在预防老年女性患者髋部骨折术后发生深静脉血栓的效果

Effect of Thenar Hot Compress and Massage on Prevention of Deep Vein Thrombosis in Elderly Female Patients after Hip Fracture Surgery

目的探讨下足部热敷合并穴位推拿在预防老年女性患者髋部骨折术后发生深静脉血栓(deep venous thrombosis,DVT)的效果。方法采用非随机对照实验方法,便利抽样法选取2016年7月至2017年5月在上海中医药大学附属普陀医院骨一区和骨二区行髋部骨折手术的老年女性患者111例为研究对象。以骨一区患者为观察组,共56例;骨二区的患者为对照组,共55例。对照组患者采用常规护理方法,而观察组患者在常规护理基础上采用足底热敷合并穴位推拿。比较两组患者术后第1、3、7天及出院前DVT的发生情况,同时收集两组患者术前及术后第1、3、7天及出院前平均血小板体积(mean platelet volume,MPV)、D-二聚体值(D-Dimer,D-Dim)。此外,术前及出院时采用简化舒适状况量表(general comfort questionnaire,GCQ)评价两组患者的舒适度。结果两组患者的基线值差异均无统计学意义(均P>0.05)。实施干预后,两组均未发生症状性DVT,但对照组在术后7d有2例患者于腘静脉处发现了无症状性DVT。MPV的时间因素主效应(P=0.07),差异无统计学意义;但干预方式主效应(P=0.043)、交互效应(P=0.029)间差异均有统计学意义。D-Dim的干预方式主效应(P=0.017)、时间因素主效应(P=0.032)、交互效应(P<0.001),差异均有统计学意义。出院前,两组患者舒适度评分差异亦有统计学意义(P<0.001)。结论下足部热敷合并穴位推拿可以有效改善老年女性髋部骨折术后患者的MPV及D-Dim水平,并可提高其舒适度。

Objective To evaluate the effect of thenar hot compress and massage on the prevention of deep venous thrombosis（DVT）after hip fracture surgery in elderly women.Methods By convenience sampling method,111 cases were selected and randomly divided into observation group（n=56）and control group（n=55）.The control group received routine nursing method,while the observation group received thenar hot compress and massage on the basis of conventional nursing.The incidence of DVT,mean platelet volume（MPV）and D-Dimer（D-Dim）before surgery,1,3,7 days after surgery and before discharge were collected.The comfort level of patients in the two groups was assessed by the general comfort questionnaire before surgery and at the time of discharge.Results No statistical significance of the baseline value was found between two groups（all P〉0.05）.After intervention,no incidence of DVT was found in both groups,while 2 cases had asymptomatic DVT on 7 th postoperative day around the popliteal vein.Time was the main influencing factor for MPV（P=0.07）,no statistical significance was found.The statistical significance of the main effect of intervention method（P=0.043）and interactive effect（P=0.029）were found between two groups.The differences between the main effect of D-Dim count（P=0.017）,time（P〈0.001）and interactive effect（P=0.032）were statistically significant.Before discharge,statistical significance of the comfort level was found between two groups（P〈0.001）.Conclusions Thenar hot compress and massage can effectively improve the level of MPV and D-Dim in elderly women after hip fracture surgery and improve the comfort level of patients.