穴位针刺治疗在预防高龄髋部骨折患者下肢深静脉血栓和提升锻炼依从性的应用效果

Application Effect of Acupuncture Treatment on Preventing Deep Venous Thrombosis of Lower Limbs and Improving Exercise Compliance of Elderly Patients with Hip Fracture

摘要: 目的：探讨穴位针刺治疗在预防骨科髋部骨折下肢深静脉血栓和提升锻炼依从性方面的效果。方法：选择我科2019年8月1日至2020年9月30日收治的高龄髋部骨折患者，根据相应标准纳入136人，采用随机数字法分为试验组和对照组，剔除患者总共为7例，最终纳入数据分析的高龄髋部骨折患者均为129例。对照组执行基础预防 + 物理预防 + 药物的方案，试验组在对照组基础上进行穴位针刺治疗。记录两组发生肌间静脉丛血栓(muscular calf vein thrombosis, MCVT)的病例数、血栓数量及分布情况，下肢瘀斑发生情况，全血粘度切值，凝血相关指标和康复锻炼依从性。结果：两组MCVT在术后第3 d和第5 d的例数和第5 d最大直径差异具有统计学意义(P < 0.05)，且所有患者MCVT直径均 < 7 mm，下肢瘀斑情况未呈现出统计学上的差异(P > 0.05)。两组的全血粘度自术前开始有明显下降趋势，至术后第3 d~5 d开始升高，两组在术后第5 d的高切值有统计学差异(P < 0.05)，低切值在术后第3 d和第5 d有统计学差异(P < 0.05)。凝血方面，两组的PT和DDi均有逐步上升趋势，APTT先升后降，PLT先降后升；PT和PLT在术后第5 d出现统计学差异(P < 0.05)，而APTT全程并未出现统计学差异(P > 0.05)，DDi在术后第3 d和第5 d的差异出现统计学意义(P < 0.05)。锻炼依从性方面，两组在包括踝泵运动和股四头肌等长收缩在内的全部项目上，试验组明显高于对照组(P < 0.05)，而术后第6周只有肺康复等项目较优。结论：穴位针刺治疗措施能够一定程度上抑制血小板的过度增生和红细胞的黏集，改善高凝状态，减少下肢MCVT的产生，同时能够提升患者的院外康复锻炼依从性，为加速康复措施的完善提供了新的参考。

Abstract: Objective: To explore the effect of acupuncture treatment on the prevention of lower limbs deep venous thrombosis in hip fracture and the im-provement of exercise compliance. Methods: 136 elderly patients with hip fracture treated in our department from August 1, 2019 to September 30, 2020 were included according to the corre-sponding standards. They were randomly divided into experimental group and control group. A to-tal of 7 patients were excluded, and 129 elderly patients with hip fracture were finally included in the data analysis. The control group implemented the scheme of basic prevention + physical pre-vention + drugs, and the experimental group was treated with acupuncture treatment on the basis of the control group. The number of patients with muscular calf vein thrombosis (MCVT), the num-ber and distribution of thrombosis, the occurrence of lower limb ecchymosis, the cut-off value of whole blood viscosity, coagulation related indexes and the compliance of rehabilitation exercise were recorded. Results: The number of cases and the maximum diameter of MCVT on the 3rd and 5th day after operation in the two groups were statistically significant (P < 0.05), and the diameter of MCVT in all patients was < 7 mm. There was no significant difference in the condition of lower limb ecchymosis (P > 0.05). The whole blood viscosity of the two groups decreased significantly from preoperative to postoperative 3 d~5 d, and there was significant difference between the two groups in the high shear value on the 5th day after operation (P < 0.05), and there was significant differ-ence in the low shear value on the 3rd and 5th day after operation (P < 0.05). In terms of coagula-tion, PT and DDi increased gradually in both groups, APTT increased first and then decreased, PLT decreased first and then increased. There was significant difference between PT and PLT on the 5th day after operation (P < 0.05). But there was no significant difference in the whole process of APTT (P > 0.05). There was significant difference in DDi on the 3rd and 5th day after operation (P < 0.05). In terms of exercise compliance, the experimental group was significantly higher than the control group in all items including ankle pump exercise and isometric contraction of quadriceps femoris (P < 0.05). Only items such as lung rehabilitation were better on the control group in the sixth week after operation. Conclusion: Acupuncture treatment can inhibit the excessive proliferation of plate-lets and the adhesion of red blood cells to a certain extent, improve the hypercoagulable state, re-duce the production of MCVT of lower limbs, and improve the compliance of patients with out of hospital rehabilitation exercise, which provides a new reference for accelerating the improvement of rehabilitation measures.