经皮穴位电刺激改善膝关节置换术后血液高凝状态疗效观察

Curative Effect of Transcutaneous Electrical Acupoint Stimulation on Improving Blood Hypercoagulability Status After Total Knee Arthroplasty

目的评价经皮穴位电刺激改善膝关节置换术术后静脉血液高凝状态的有效性及安全性。方法选择于中国中医科学院望京医院行膝关节置换术的患者60例,按随机数字表法分为治疗组和对照组各30例。对照组采用低分子肝素钙皮下注射,治疗组采用经皮穴位电刺激(TEAS)+低分子肝素钙皮下注射治疗,治疗14 d并同时观察凝血功能、血栓弹力图主要数据和静脉血栓发生情况(B超),评定临床疗效。结果两组治疗前活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、D-二聚体(D-dimer)比较,差异均无统计学意义(均P>0.05);两组治疗后APTT比较,差异无统计学意义(P>0.05);治疗后TEAS组,PT时间明显长于对照组(P<0.05),Fib及D-dimer明显低于对照组(均P<0.05)。治疗前两组反应时间(R时间)、动力时间(K时间)、最大振幅(MA值)比较,差异均无统计学意义(均P>0.05);治疗后两组R、K时间比较,差异均无统计学意义(均P>0.05),血栓弹力图主要数据MA值明显低于对照组(P<0.05)。治疗后两组深静脉血栓(DVT)发生率比较,差异无统计学意义(P>0.05)。结论经皮穴位电刺激可改善膝关节置换术后患者下肢静脉血液的高凝状态,可降低术后下肢静脉深静脉血栓的发生率。

Objective To evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation(TEAS)in improving the hypercoagulability status of venous blood after knee arthroplasty. Methods Sixty patients who planned to receive total knee replacement in our department were selected and were randomly divided into 2 groups(n=30):control group,TEAS group. The control group received anticoagulant therapy of low molecular weight heparin injection,and TEAS group received additional transcutaneous electrical acupoint stimulation therapy on the basis of the control group’s treatment methods. Fourteen days after the treatment,coagulation function test,thrombelastogram(TEG) and B-ultrasound of lower extremity vein of the two groups were observed respectively to evaluate the clinical efficacy. Results(1)Coagulation function test:There was no significantly statistical differences in APTT,PT,Fib and D-dimer between the two groups before treatment(all P>0.05). There was no significantly statistical difference in APTT between the two groups after treatment(P>0.05),PT in TEAS group was significantly longer than that in the control group after treatment(P<0.05),Fib and D-dimer in the TEAS group were significantly lower than those in the control group after treatment(all P<0.05).(2)TEG:There was no significantly statistical difference in R(reaction time),K(kinetics time)and MA(maximum amplitude)between the two groups before treatment(all P>0.05). There was no significantly statistical differences in R,K between the two groups after treatment(all P>0.05),MA in TEAS group was significantly lower than that of the control group after treatment(P<0.05).(3)Results of lower limb vein B-ultrasound:There was no significantly statistical difference in the deep venous thrombosis(DVT)morbidity between the two groups after treatment(P>0.05). Conclusion TEAS therapy can improve the hypercoagulable status of venous blood in lower extremities after knee arthroplasty,and TEAS may can reduce the morbidity of DVT after knee arthroplasty.