Abstract:

Objective To investigate the effect of Xiaoyu Tongluo fumigation moxibustion on the prevention of lower extremity DVT in patients with qi stagnation and blood stasis syndrome after major orthopedic surgery. Methods On the basis of literature review and expert meeting discussion，the intervention plan was constructed. A total of 132 patients with qi stagnation and blood stasis syndrome after major orthopedic surgery who were hospitalized in the joint department of an orthopedic hospital in Zhejiang Province from November 2021 to November 2022 were selected as the research subjects by stratified sampling method. They were divided into a Xiaoyu Tongluo fumigation moxibustion group，a moxibustion group and a control group，with 44 cases in each group. On the basis of the control group，the moxibustion group was treated with Xiaoyu Tongluo fumigation moxibustion；the moxibustion group was treated with moxibustion on the basis of the interventions in the control group，and the control group was given routine nursing measures to prevent the formation of DVT. The incidence of lower extremity DVT before discharge，coagulation function indexes on the 1st and 7th day after operation and daily pain score were compared among the 3 groups，and the intervention effect was evaluated. At the same time，the safety and feasibility of the intervention program were evaluated by the occurrence and completion rate of adverse reactions. Results There was no lower extremity DVT in the Xiaoyu Tongluo fumigation moxibustion group. The incidence of lower extremity DVT was 4.65 % in the moxibustion group and 16.67 % in the control group. The difference in the incidence of lower extremity DVT between the Xiaoyu Tongluo fumigation moxibustion group and the control group was statistically significant（P<0.05）. Before and after the intervention，there were statistically significant differences in D-dimer，activated partial thromboplastin time，fibrinogen and prothrombin time among the 3 groups（P<0.05）. After the intervention，there were significant differences in D-dimer，activated partial thromboplastin time，fibrinogen and prothrombin time among the 3 groups（F=41.885，P<0.001；F=247.377，P<0.001；F=32.626，P<0.001；F=17.056，P<0.001）. The pain scores of the 3 groups were statistically significant on the 6th and 7th day after operation（P<0.05）. There was no adverse reaction during the intervention period in the moxibustion group and the moxibustion group，and the completion rate was 97.73%. Conclusion Compared with moxibustion， Xiaoyu Tongluo fumigating moxibustion can more effectively reduce the incidence of DVT in lower limbs of patients with qi stagnation and blood stasis syndrome after major orthopedic surgery，effectively improve the hypercoagulable state of patients，and continuously relieve the pain of affected limbs. The intervention program has good safety and feasibility.

Key words: Arthroplasty, Fracture, Qi Stagnation and Blood Stasis Syndrome, Deep Vein Thrombosis, Moxibustion, Traditional Chinese Medicine Nursing

摘要：

目的 探讨消瘀通络薰条灸预防骨科大手术后气滞血瘀证患者下肢深静脉血栓形成（deep venous thrombosis，DVT）的效果。方法 在查阅文献和专家会议讨论基础上，构建干预方案。通过分层抽样法，选取2021年11月—2022年11月在浙江省某骨科医院关节科住院的132例骨科大手术后气滞血瘀证患者作为研究对象，将其分为消瘀通络薰条灸组、艾灸组和对照组，每组各44例。消瘀通络薰条灸组在常规护理基础上予消瘀通络薰条灸治疗，艾灸组在常规护理基础上予艾灸治疗，对照组实施预防DVT的常规护理措施。比较3组出院前下肢DVT发生率，术后第1、7天的凝血功能指标以及每日疼痛评分，不良反应发生情况和干预方案的完成率。结果 消瘀通络薰条灸组未发生下肢DVT，艾灸组下肢DVT发生率为4.65%，对照组为16.67%，消瘀通络薰条灸组与对照组比较，差异具有统计学意义（P<0.05），其余组间比较，差异均无统计学意义（P>0.05）。干预前后，3组患者组内D-二聚体、活化部分凝血活酶时间、纤维蛋白原以及凝血酶原时间比较，差异均具有统计学意义（均P<0.05）；干预后，3组患者组间D-二聚体、活化部分凝血活酶时间、纤维蛋白原以及凝血酶原时间比较，差异均具有统计学意义（F=41.885，P<0.001；F=247.377，P<0.001；F=32.626，P<0.001；F=17.056，P<0.001）。3组患者的疼痛评分在术后第6、7天比较，差异具有统计学意义（P<0.05）。消瘀通络薰条灸组和艾灸组干预期间无不良反应发生，且干预方案完成率均为97.73%。结论 消瘀通络薰条灸能更有效地降低骨科大手术后气滞血瘀证患者下肢DVT的发生率，有效改善患者的血液高凝状态，持续缓解患肢疼痛，且干预方案具有良好的安全性和可行性。

关键词: 关节成形术, 骨折, 气滞血瘀证, 深静脉血栓, 灸法, 中医护理学