培元固本合回阳补气法对老年患者髋/膝关节置换术后应激反应的影响
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摘要
目的:探讨术前培元固本与术后回阳补气合用对老年患者髋/膝关节置换术后应激反应的影响。方法:择期行髋关节或膝关节置换术的老年患者120例,性别不限,年龄65～77岁,美国麻醉师协会(ASA)分级Ⅱ或Ⅲ级,采用随机数字表法分为中药组和对照组各60例。中药组术前给予四逆加人参汤加山萸肉,日1剂,连用3剂;术后给予补中益气汤,日1剂,连用3剂。对照组术前和术后均口服同等剂量的生理盐水。选取L2～L3椎间隙穿刺行连续蛛网膜下腔阻滞,麻醉平面控制在T10以下。术后两组均采用经静脉患者自控镇痛。分别于麻醉前(T0)、术后即刻(T1)、24 h(T2)、48 h(T3)、72 h(T4)时抽取静脉血,测定血清游离皮质醇(COR)和血糖(GLU)。术后24 h、48 h、72 h(T2～T4)时采用静态视觉模拟评分法(VAS)记录患者评分,记录恶心、呕吐、谵妄和下肢深静脉血栓形成等术后并发症的发生率。结果:术后各时点(T1～T4)中药组患者COR明显低于对照组(P<0.05);T1与T2时点中药组患者GLU明显低于对照组。与T0时比较,术后各时点(T1～T4)两组患者COR及GLU均明显升高(P<0.05)。两组患者术后VAS评分比较差异无统计学意义。中药组术后恶心呕吐、谵妄和下肢深静脉血栓形成等并发症的发生率明显低于对照组(P<0.05)。结论:术前培元固本联合术后回阳补气可减轻老年患者髋/膝关节置换术后的应激反应,降低术后并发症的发生率。
Objective:To investigate the effect of preoperative Peiyuan Guben combined with postoperative Huiyang Buqi on postoperative stress response in elderly patients after hip/knee replacement. Methods:A total of 120 elderly patients of both sexes,aged 65～77 yr,of American Society of Anesthesiologists,ASA) status Ⅱ or Ⅲ were scheduled for elective total hip arthroplasty or knee arthroplasty. They were divided into 2 groups(n=60) by using a random number table:traditional Chinese medicine(TCM) group and control group. In the TCM group,Renshen Sini Decoction combined with shanyurou(cornus) was given preoperatively,once a day,three times in total. Buzhong Yiqi Decoction was given postoperatively,once a day,three times in total. In the control group,the same dasage of saline was given before and after the operation. Continuous subarachnoid block was performed Via L2 ～3 gap. Patients in the two groups were connected to intravenous self-control analgesia pump. Venous blood was drawn to measure serum free cortisol(COR) and blood glucose(GLU)before anesthesia(T0),immediately after operation,24 h,48 h,72 h(T1～4) respectively. The visual analog scale(VAS) score of the two groups were recorded at the time point of 24 h,48 h,72 h(T2～4) after operation. The postoperative complications such as nausea,vomiting,delirium and deep vein thrombosis were also recorded. Results:At all time after operation(T1～4),COR in the TCM group was significantly lower than that in the control group(P<0.05). At T1 and T2,GLU in the TCM group was significantly lower than that in the control group. Compared with T0,COR and GLU in both groups were significantly increased at T1～T4(P <0.05). There was no statistical significance in VAS scores between the two groups. The incidence of postoperative nausea and vomiting,delirium and deep venous thrombosis in the TCM group was significantly lower than that in the control group(P <0.05). Conclusion:Preoperative Peiyuan Guben combined with postoperative Huiyang Buqi can reduce the elder patients' postoperative stress response and the incidence of postoperative complications.
Objective:To investigate the effect of preoperative Peiyuan Guben combined with postoperative Huiyang Buqi on postoperative stress response in elderly patients after hip/knee replacement. Methods:A total of 120 elderly patients of both sexes,aged 65～77 yr,of American Society of Anesthesiologists,ASA) status Ⅱ or Ⅲ were scheduled for elective total hip arthroplasty or knee arthroplasty. They were divided into 2 groups(n=60) by using a random number table:traditional Chinese medicine(TCM) group and control group. In the TCM group,Renshen Sini Decoction combined with shanyurou(cornus) was given preoperatively,once a day,three times in total. Buzhong Yiqi Decoction was given postoperatively,once a day,three times in total. In the control group,the same dasage of saline was given before and after the operation. Continuous subarachnoid block was performed Via L2 ～3 gap. Patients in the two groups were connected to intravenous self-control analgesia pump. Venous blood was drawn to measure serum free cortisol(COR) and blood glucose(GLU)before anesthesia(T0),immediately after operation,24 h,48 h,72 h(T1～4) respectively. The visual analog scale(VAS) score of the two groups were recorded at the time point of 24 h,48 h,72 h(T2～4) after operation. The postoperative complications such as nausea,vomiting,delirium and deep vein thrombosis were also recorded. Results:At all time after operation(T1～4),COR in the TCM group was significantly lower than that in the control group(P<0.05). At T1 and T2,GLU in the TCM group was significantly lower than that in the control group. Compared with T0,COR and GLU in both groups were significantly increased at T1～T4(P <0.05). There was no statistical significance in VAS scores between the two groups. The incidence of postoperative nausea and vomiting,delirium and deep venous thrombosis in the TCM group was significantly lower than that in the control group(P <0.05). Conclusion:Preoperative Peiyuan Guben combined with postoperative Huiyang Buqi can reduce the elder patients' postoperative stress response and the incidence of postoperative complications.
引文
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[2]薛婧,代蓉,董柳慧,等.四逆汤君药之辨析[J].云南中医学院学报,2013,36(2):90-94.
[3]王军梅.加味四逆汤对心肾阳虚型慢性心衰患者中医证候及心功能的影响[J].四川中医,2016,34(1):78-80.
[4]盛阳辉.四逆加人参汤改善心肌梗死后无症状性心肌缺血临床研究[J].亚太传统医药,2015,11(14):111-112.
[5]雷国奇.四逆汤类方证治规律及临床应用研究[D].武汉:湖北中医药大学,2010.
[6]王尚均.四逆汤加味治疗阳虚寒盛型头痛34例临床观察[J].海南医学,2006,17(4):113-114.
[7]邓中甲.方剂学[M].北京:中国中医药出版社,2003:154-155.
[8]刘进娜,谢鸣.补中益气汤及其不同配伍对脾虚发热模型的退热作用比较[J].中华中医药杂志,2014,29(6):1814-1818.
[9]田虎,王素改.补中益气汤加减治疗慢性疲劳综合征32例[J].江西中医药,2012,43(8):26-27.
[10]王少臣.补中益气法治疗脾虚气陷型痞满的临床观察[J].中国社区医师,2016,32(10):102-103.
[11]施旭光,邓淙友,翟理祥,等.补中益气汤及益气升阳配伍对脾气虚大鼠药理效应的影响[J].广州中医药大学学报,2012,29(3):271-274.
[12] NATER U M,SKOLUDA N,STRAHLER J. Biomarkers of stress in behavioural medicine[J]. Curr Opin Psychiatry,2013,26(5):440-445.
[13]蔡炜,唐旭东,陈捷,等.多模式镇痛在全膝关节置换术中的临床疗效及对应激反应的影响[J].四川医学,2015,36(3):371-373.
[14] DREWS T,FRANCK M,RADTKE F M,et al. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient:a prospective observational study[J]. Eur J Anaesthesiol,2015,32(3):147-151.
[15] COHN D M,HERMANIDES J,DEVRIES J H,et al.Stress-induced hyperglycaemia and venous thromboembolism following total hip or total knee arthroplasty:analysis from the RECORD trials[J]. Thromb Haemost,2012,107(2):225-231.
[16]刘立云,邢庆胜,张晓东,等.补中益气汤预防下肢骨折患者围手术期深静脉血栓形成的临床研究[J].中国中医急症,2015,24(10):1798-1800.
[17]罗仕荣.温泻法对慢性肝性脑病虚寒夹实证的临床研究[D].沈阳:辽宁中医药大学,2007.