【摘要】 目的观察中医围手术期临床路径干预在老年人髋部骨折中的临床疗效。方法选择2011年1月至2015年3月因髋部骨折在本院行手术治疗的老年患者120例,随机分为对照组和观察组,各60例。两组患者入院后完善相关检查并对症治疗基础病,按照骨折不同类型实施不同手术,观察组在围手术期采用中医临床路径干预方法治疗,包括静注血栓通,口服活血止痛胶囊及外用紫桃伤科油剂。结果观察组术后优良率为83.33%,显著高于对照组的75.00%(P<0.05);与术前相比较,两组患者术后1、2、6个月Harris评分均升高(P<0.05),且观察组升高程度在各时间段均显著优于对照组(P<0.05)。术后1 d至术后2周,两组患者DDimer、CRP及静脉返流率均升高,术后2周至术后4周,两组患者各指标逐渐降低但仍高于术前,差异均具有统计学意义(P<0.05);在此过程中观察组波动幅度始终小于对照组(P<0.05)。术后1 d至术后4周,观察组患者DVT发生率为18.33%,显著低于对照组的30.00%(P<0.05)。虽然观察组不良反应发生率高于对照组(P<0.05),但症状均较轻微,不影响治疗。结论中医围手术期临床路径干预可促进老年患者髋部骨折后恢复,提高患者Harris评分,显著减低术后深静脉血栓形成风险,且安全性高。更多还原

【Abstract】 Objective: To Explore TCM clinical path around the operation of the application to intervene in the elderly hip fracture. Methods: January 2011-March 2015 due to hip fractures in elderly hospital surgical treatment, 120 patients were randomly divided into control group and observation group, 60 patients, two groups of patients after admission and symptomatic improvement of relevant inspection treatment of underlying disease, according to the different types of implementing different fracture surgery, the observation group in perioperative use of Chinese clinical pathway intervention treatment, including intravenous Xueshuantong, oral capsules and topical Huoxuezhitong purple peach traumatology oil. Postoperative clinical efficacy were observed and the use of hip score(Harris score) evaluated patients with surgery, a month after 2 months, 6 months after hip function recovery degree, were observed before surgery, after 1 d,after 1 week, after 2 weeks, 4 weeks after the D-dimer(D-dimer), C-reactive protein(CRP) and the use of ultrasound venous reflux rate, lower extremity statistics deep vein thrombosis(DVT) incidence, the occurrence of adverse reactions recorded. Results: After good observation group(83.33%), good control group were 75.00%, which appraised the observation group was significantly higher, the difference was statistically significant(P < 0.05); compared with the preoperative, two groups of patients after 1,2,6 months Harris scores were increased, and the observation group increased extent in each of the periods were significantly better than the control group, the differences were statistically significant(P < 0.05). 1 d to 2 weeks after surgery, patients were D-Dimer, CRP and venous reflux ratio showed a tendency to increase from 2 weeks to 4 weeks after surgery, the index showed a decreasing trend, while the observation group fluctuations less than the control group, the difference was statistically significant(P < 0.05), and from postoperative 1d to 4weeks after surgery was observed in patients DVT rate 18.33%, significantly lower than the control group(30.00%), a statistically significant difference(P < 0.05). Although the incidence of adverse reactions observation group was higher(P < 0.05), but the symptoms were mild, does not affect the treatment. Conclusion: TCM clinical path around the operative intervention can promote elderly patients after hip fracture recovery and improve patient Harris score, and significantly reduce the risk of postoperative deep vein thrombosis, and safe, so there is some reference for clinical treatment.更多还原