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目的观察穴位按摩预防妇科腹腔镜术后不同风险级别深静脉血栓(deep venous thrombosis,DVT)发生的效果。方法利用Autar深静脉风险评估量表对2014年6—12月行妇科腹腔镜手术患者术前1天及术后24h进行评估,选出中、高危患者作为研究对象,中度风险组72例,高度风险组34例。将中、高风险患者按随机区组分为对照组和试验组。对照组给予常规护理加间歇性肢体气压治疗;试验组给予常规护理加穴位按摩(上巨虚、足三里、梁丘、阴市、伏兔)。检测患者术前、术后第1天、术后第5天红细胞聚集指数和腘窝静脉血流速度及统计术后血栓发生率。结果本研究中共有4例发生下肢DVT,中、高危患者各有2例,中危患者中对照组下肢DVT发生率为5.6%(2/36),试验组为0.0%(0/36);高危患者依次为11.8%(2/17)及0.0%(0/17)。中、高危患者中试验组患者血栓发生率均明显低于对照组(P<0.05)。中、高危患者术后第1天与术前比较,红细胞聚集指数明显升高,血流速度显著降低(P<0.05)。术后第5天红细胞聚集指数较术后第1天降低,腘静脉血流速度则升高(P<0.05)。与对照组比较,试验组术后第5天红细胞聚集指数明显降低、腘静脉血流速度升高(P<0.05)。结论对于Autar评估中、高危患者,在给予常规护理的同时辅助穴位按摩有利于预防术后DVT的发生。
Objective To observe the effect of acupoint massage in preventing the occurrence of deep venous thrombosis (DVT) at different risk levels after gynecological laparoscopy. Methods According to the Autar Deep Venous Risk Assessment Scale, patients undergoing gynecological laparoscopic surgery from January to December 2014 were evaluated one day before operation and 24h after operation. Middle and high risk patients were selected as the study subjects, 72 patients in moderate risk group, High risk group of 34 cases. Middle and high-risk patients were divided into control group and experimental group according to randomization group. The control group was given routine nursing and intermittent limb barotraphy. The experimental group was given routine nursing and acupoint massage (Shangju xu, Zusanli, Liangqiu, Yin and V rabbit). Preoperative, postoperative day 1, postoperative 5th day erythrocyte aggregation index and popliteal vein blood flow velocity and statistical postoperative thrombosis rate were detected. Results In this study, there were 4 cases of DVT in the lower extremities, 2 in each of middle and high risk groups, and 5.6% (2/36) in the control group. The incidence of DVT in the control group was 0.0% (0/36) in the experimental group. The high-risk patients were 11.8% (2/17) and 0.0% (0/17) in turn. The incidence of thrombosis in test group was significantly lower than that in control group (P <0.05). Middle and high-risk patients on the first postoperative day compared with preoperative, erythrocyte aggregation index was significantly increased, blood flow velocity was significantly reduced (P <0.05). On the 5th postoperative day, the erythrocyte aggregation index was lower than that on the first postoperative day, and the velocity of the vein blood flow increased (P <0.05). Compared with the control group, the index of erythrocyte aggregation in the experimental group decreased significantly on the fifth day after operation, and the velocity of the popliteal vein blood flow increased (P <0.05). Conclusion For the Autar evaluation, high-risk patients, while giving routine care assisted acupoint massage is conducive to the prevention of postoperative DVT.