中医定向透药疗法联合穴位中药敷贴预防危重患者下肢深静脉血栓形成的疗效观察  

Observation on the effect of targeted penetration therapy of traditional Chinese medicine combined with acupoint application of ointment on preventing lower limb deep vein thrombosis in critically ill patients

作　　者：张凤莉 贺慧为[1] 陈志[1] 夏文翰[1] 陈小红[1] 王海燕 周倩 段娟娟 李茜雯 ZHANG Fengli;HE Huiwei;CHEN Zhi;XIA Wenhan;CHEN Xiaohong;WANG Haiyan;ZHOU Qian;DUAN Juanjuan;LI Xiwen(Department of Critical Care Medicine,Jiangxi Provincial People's Hospital(The First Affiliated Hospital of Nanchang Medical College),Nanchang 330006,China)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院)重症医学科,330006

出　　处：《中国老年保健医学》2024年第4期54-58,共5页Chinese Journal of Geriatric Care

基　　金：江西省中医药管理局科技计划一般项目(编号:2020B0040)。

摘　　要：目的采用中医定向透药疗法联合穴位中药敷贴对危重患者下肢深静脉血栓形成进行干预,为血栓高危患者寻求更有效、安全、可行预防方法。方法采用前瞻性随机对照研究方法,选取2021年1月至2022年12月入住我院重症医学科(ICU)具有下肢深静脉血栓高风险患者120例,所有患者卡普里尼(Caprini)评分≥3分。采用随机数字表法将患者随机分为3组,即定向治疗组40例、联合治疗组40例及对照组40例。每组患者均给予ICU常规治疗与护理,定向治疗组每日给予2次双下肢中医定向透药疗法,每次30分钟。联合治疗组在定向治疗组的基础上给予血府逐瘀膏方敷贴于足三里和三阴交两处穴位,每次保留12小时。记录治疗1周前后的Caprini评分、D-二聚体水平、腘静脉内径以及腘静脉血流速度。每周进行一次超声检查双下肢深静脉是否有血栓形成,共监测28天。结果治疗后定向治疗组和联合治疗组D-二聚体水平均有所下降(P=0.000),腘静脉血流速度比治疗前更快(P=0.003和P=0.000)。治疗前后三组患者的Caprini评分、腘静脉内径相比较无统计学差异(P>0.05)。治疗后联合治疗组的D-二聚体水平相比对照组有显著下降(P=0.002),定向治疗组较对照组的腘静脉流速增快(P=0.010),而联合治疗组的腘静脉流速较定向治疗组改善更明显,差异有统计学意义(P=0.042)。在治疗过程中,对照组发生了3例深静脉血栓,其中1例发生了肺动脉分支的血栓栓塞,定向治疗组有1例患者发生了深静脉血栓,而联合治疗组未发生深静脉血栓以及肺动脉栓塞事件。结论中医定向透药疗法联合穴位中药敷贴能有效地预防危重患者下肢深静脉血栓形成。Objective Using targeted penetration therapy of traditional Chinese medicine combined with acupoint application to intervene in critically ill patients,seeking more effective,safe,and feasible methods for preventing deep vein thrombosis in high-risk patients.Methods Using a prospective randomized controlled study method,120 patients with high risk of deep vein thrombosis admitted to our intensive care unit(ICU)from January 2021 to December 2022 were included,with a Caprini score of≥3.Patients were randomly divided into a targeted treatment group(40 cases),a combination treatment group(40 cases),and a control group(40 cases)though a random number table method.All patients received routine ICU treatment and care,while the patients in targeted treatment group received two times a day of targeted penetration therapy of traditional Chinese medicine for both lower limbs,each lasting for 30 minutes.On the basis of the targeted treatment group,the combined treatment group was treated with Xuefu Zhuyu ointment applied to the Zusanli and Sanyinjiao acupoints for 12 hours a day.Record the Caprini score,D-dimer,popliteal vein diameter,and popliteal vein blood flow velocity before and after 1 week of treatment.Perform weekly ultrasound examination for thrombosis in the deep veins of both lower limbs until 28 days.Results After treatment,both the targeted treatment group and the combination treatment group showed a decrease in D-dimer(P=0.000),and the popliteal vein flow rate was faster than that before treatment(P=0.003 and P=0.000).There was no statistically significant difference in Caprini score and popliteal vein diameter among the three groups of patients after treatment(P>0.05).The D-dimer in the combination therapy group showed a significant decrease compared to the control group(P=0.002),while the popliteal vein flow rate in the targeted therapy group increased compared to the control group(P=0.010).The popliteal vein flow rate in the combination therapy group improved more significantly compared to the targeted the

关 键 词：中医定向透药 穴位敷贴 血府逐瘀膏方 深静脉血栓 卡普里尼评分 

分 类 号：R278[医药卫生—中医学]