不同温度肿胀液对下肢静脉曲张术后患者康复影响的研究

doi:10.3761/j.issn.0254-1769.2022.02.002

摘要/Abstract

摘要：

目的探讨不同温度的肿胀液冷疗对硬膜外麻醉联合局部肿胀麻醉下的下肢静脉曲张术后患者的康复效果。方法采用便利抽样法,选取2019年12月—2021年3月在福州市某三级甲等医院血管外科住院的接受硬膜外麻醉联合局部肿胀麻醉,实施下肢静脉曲张手术的101例患者作为研究对象,按随机数字法随机分为3组：试验组A 34例,为其提供4~9 ℃的肿胀液;试验组B 34例,为其提供10~15 ℃的肿胀液;对照组33例,为其提供18~24 ℃的肿胀液,观察对比3组术后3 d患侧肢体疼痛线性视觉模拟评分、患侧肢体瘀斑面积、皮下发生血肿例数。结果 3组基线资料比较,差异无统计学意义（P>0.05）,具有可比性;术后3 d疼痛线性视觉模拟评分2个试验组均低于对照组,差异具有统计学意义（P<0.05）;3组术后第3天患侧肢体瘀斑面积比较,2个试验组均小于对照组,差异具有统计学意义（P=0.001）;3组术后第3天皮下血肿发生例数比较,差异无统计学意义（P=0.278）。结论使用4~9 ℃或10~15 ℃肿胀液对下肢静脉曲张患者进行术中冷疗均可以减轻术后3 d疼痛程度、减少术后术肢瘀斑面积。

关键词: 冷冻疗法, 温度, 肿胀麻醉液, 静脉曲张, 随机对照试验, 护理

Abstract:

Objective To investigate the rehabilitation effect of swelling fluid cold therapy at different temperatures on patients with lower extremity varicose veins（LEVV） under epidural anesthesia and local swelling anesthesia. Methods 101 patients undergoing epidural anesthesia and local swelling LEVV in a tertiary A hospital in Fuzhou for vascular surgery from December 2019 to March 2021 were selected as study subjects by convenient sampling method. They were randomly divided into 3 groups according to random numbers,namely test group A with 34 cases provided with 4~9 ℃ of swelling fluid,test group B with 34 cases provided with 10~15 ℃ of swelling fluid,the control group with 33 cases provided with 18~24 ℃ of swelling fluid. The rehabilitation of surgical limb pain value,ecchymosis area,the number of hematoma occurrence and complications in the 3 days of the 3 groups were observed. Results The differences of baseline data between the 3 groups were not statistically significant（P>0.05）;the pain scores of the 2 test groups were lower than those of the control group（P<0.05）. The skin ecchymosis area on the 3rd day after the surgery in the 2 test groups was lower than it in the control group with statistically significant differences（P=0.001）. There was no significant difference in the hematoma of the 3 groups on postoperative 3rd day（P=0.278） and no adverse reactions occurred in the 3 groups. Conclusion Intraoperative cold treatment with 4~9 ℃ or 10~15 ℃ swelling fluid in patients with LEVV can reduce the pain and ecchymosis area of postoperative 3 d.

Key words: Cryotherapy, Temperature, Tumescent Anesthetic Solution, Varicose Veins, Randomized Controlled Trial, Nursing Care

靳彩云, 陈璟, 张彩鑫, 欧阳艳艳, 朱美霖, 李姝漫, 陈幸. 不同温度肿胀液对下肢静脉曲张术后患者康复影响的研究[J]. 中华护理杂志, 2022, 57(2): 140-145.

JIN Caiyun, CHEN Jing, ZHANG Caixin, OUYANG Yanyan, ZHU Meilin, LI Shuman, CHEN Xing. Study on the effects of different temperature swelling fluid on the rehabilitation of patients after lower extremity varicose veins surgery[J]. Chinese Journal of Nursing, 2022, 57(2): 140-145.

图/表 3

表1 3组研究对象的一般资料比较[例（百分比,%）]

Table 1 Comparison of general data for three groups[case（percent,%）]

表2 3组疼痛线性视觉模拟评分的广义估计方程模型效应检验[分,M（P25,P75）]

Table 2 Groups of pain linear visual simulation score with generalized model effect tests of estimated equations[score,M（P25,P75）]

表3 疼痛线性视觉模拟评分值广义估计方程参数估计

Table 3 Generalized estimation of the equation parameter estimation for VAS

参考文献 22

[1]	下肢浅静脉曲张诊治共识微循环专家组. 下肢浅静脉曲张诊治微循环专家共识[J]. 中华老年多器官疾病杂志, 2020, 19(1):1-6.
	Microcirculation expert group on the diagnosis and treatment of shallow varicose veins of the lower limbs. Expert consensus on microcirculation in the diagnosis and treatment of lower limb shallow varicose veins[J]. Chin J Mult Organ Dis Elderly, 2020, 19(1):1-6.
[2]	赵刚, 李令根. 周围血管病基础与临床[M]. 北京: 人民军医出版社, 2015: 97.
	Zhao G, Li LG. Foundation and clinical practice of peripheral vascular disease[M]. Beijing: People’s Military Medical Press, 2015: 97.
[3]	陆信武, 蒋米尔. 临床血管外科学[M]. 5版. 北京: 科学出版社, 2018:511-514.
	Lu XW, Jiang ME. Clinical vascular surgery[M]. 5th ed. Beijing: Scientific Press, 2018:511-514.
[4]	Klein JA. The Tumescent technique for liposuction surgery[J]. A Jour O Cosm Surg, 1987, 4(4):263-267.
[5]	梅娜, 李俊杰. 下肢静脉曲张腔内激光治疗开展日间手术的流程化管理[J]. 中国血管外科杂志(电子版), 2019, 11(1):56-57.
	Mei N, Li JJ. Process management of day surgery for lower limb varicose lumen laser the-rapy[J]. Chin J Vasc Surg(Electronic Version), 2019, 11(1):56-57.
[6]	Wittens C, Davies AH, Bækgaard N, et al. Editor’s choice-management of chronic venous disease:clinical practice guidelines of the European Society for Vascular Surgery(ESVS)[J]. Eur J Vasc Endovasc Surg, 2015, 49(6):678-737. DOI URL
[7]	朱红梅, 诸纪华, 郑智慧, 等. 加速康复外科理念在围手术期患儿中的应用进展[J]. 中华护理杂志, 2021, 56(4):628-634.
	Zhu HM, Zhu JH, Zheng ZH, et al. Progress of accelerated application of rehabilitation surgery concept in perioperative children[J]. Chin J Nurs, 2021, 56(4):628-634.
[8]	Torres R, Ribeiro F, Alberto Duarte J, et al. Evidence of the physiotherapeutic interventions used currently after exerciseinduced muscle damage:systematic review and meta-analysis[J]. Phys Ther Sport, 2012, 13(2):101-114. DOI PMID
[9]	林松斌. 冰敷在大隐静脉曲张高位结扎并剥脱术后的临床疗效[D]. 福州:福建医科大学, 2013.
	Lin SB. Clinical efficacy of ice application after high ligation and peeling[D]. Fuzhou:Fujian Medical University, 2013.
[10]	Talal I, Grahame T. The effects of different dressing on the skin temperature of the knee during cryotherapy[J]. Knee, 2005, 12:21-23. DOI URL
[11]	罗丽华, 陈柱, 肖恩华, 等. 肿胀麻醉液温度对腔内激光消融治疗下肢静脉曲张术中及术后疼痛的影响[J]. 中南大学学报(医学版), 2018, 43(6):651-655.
	Luo LH, Chen Z, Xiao EH, et al. Effect of swelling anesthesia temperature on intraminal laser ablation on intraoperative and postoperative pain in lower varicose limbs[J]. J Cent South Univ(Med Sci), 2018, 43(6):651-655.
[12]	Bleakley C, Mcdonough S, MacAuleg D. The use of ice in the treatment of acute softtissue injury:a systematic review of randomized controlled trial[J]. AMJ Sport Med, 2004, 32(1):251-261.
[13]	Meyer-Marcotty M, Jungling O, Vaske B, et al. Standardized combined cryotherapy and compression using cryo/cuff after wrist arthroscopy[J]. Knee S Sports Tra, 2011, 19(2):314-319.
[14]	叶建芳, 庄美华, 冯桂莲, 等. 改良型冷疗仪对胫腓骨骨折患者术后肿痛的护理效果[J]. 中国实用护理杂志, 2019, 35(15):1147-1150.
	Ye JF, Zhuang MH, Feng GL, et al. Nursing effect of improved cold therapy on postoperative swelling and pain in patients with tibial fibula fracture[J]. Chin J Prac Nurs, 2019, 35(15):1147-1150.
[15]	Schroder D, Passler HH. Combination of cold and cpmpression after knee surgery. A prospective randomized study[J]. Knee Surg Sports Traumatol Arthrosc, 1994, 2:158-165. DOI URL
[16]	Maxwell C. Sensitivity and accuracy of the visual analogue scale:a psychophysical classroom experiment[M]// The elementary school curriculum. Dept. Of Superintendence of the National Education Association of the United States, 2012.
[17]	蒋寅, 刘岩, 商洪才, 等. CONSORT 2010声明:针对随机先导性和可行性试验的扩展[J]. 中国循证医学杂志, 2021, 21(3):313-337.
	Jiang Y, Liu Y, Shang HC, et al. CONSORT 2010 statement:extension for randomized lead and feasibility tests[J]. Chin J of Evidence-Based Med, 2021, 21(3):313-337.
[18]	陈英超, 刘素霞, 杨春英, 等. 全膝关节置换术患者应用加压持续冷疗袋的效果观察[J]. 中华关节外科杂志(电子版), 2020, 14(4):512-515.
	Chen YC, Liu SX, Yang CY, et al. Effect of pressurized continuous cold therapy bag in patients with total knee replacement[J]. Chin J of Join Surg(Electronic Edition), 2020, 14(4):512-515.
[19]	江燕, 李佳, 李娟. 下颌骨截骨术后局部间歇冷热疗与持续冷热疗效果的观察[J]. 中华护理杂志, 2013, 48(9):777-778.
	Jiang Y, Li J, Li J,. Observation of local intermittent cold and cold therapy and continuous cold and cold effect after mandibular osteotomy[J]. Chin J Nurs, 2013, 48(9):777-778.
[20]	Knobloch K, Grasemann R, Spies M, et al. Midportion achillestendon microcirculation after intermittent combined cryotherapy and compression compared with cryotherapy alone:a randomized trial[J]. Am J Sports Med, 2008, 36:2128-2138. DOI PMID
[21]	赖才灿, 郑建仙. 低温按压止血夹在桡动脉采血后加压止血中的应用效果[J]. 中西医结合护理(中英文), 2019, 5(9):113-114.
	Lai CC, Zheng JX. Application effect of low-temperature compression hemostasis clamp in pressurized hemostasis after radial blood collection[J]. Inte Trad Chin and West Mede Nurs(English), 2019, 5(9):113-114.
[22]	Sadoghi Patrick, Hasenhütl Sandro, et al. Impact of a new cryotherapy device on early rehabilitation after primary total knee arthroplasty(TKA:a prospective randomised controlled trial[J]. Int orts, 2018, 42(6).