| ObjectiveTo investigate the influence of acupuncture treatment on hemorrhage management during perioperative period by the elderly patients undergoing total knee arthroplasty (TKA) at the first time. To evaluate the clinical efficacy and safety of acupuncture treatment on hemorrhage management during perioperative period undergoing total knee arthroplasty (TKA) at the first time by objective standard. To provide practical and effective method for clinical practice by the new method and the standardization scheme embodied with the characteristics of traditional Chinese Medicine, to explore its clinical value and promotion significance.MethodsElderly patients with osteoarthritis of the knee treated with the first time unilateral total knee arthroplasty were collected from January 2015 to October 2015 in the Department of orthopedics, Guangdong Provincial TCM Hospital as for the aim of research. A randomized, controlled clinical trial was used. Cases meeting the research requirements were divided into acupuncture group and control group. There were 35 cases in each group and 70 cases in total. The two groups on the basis of the same previous treatment were used the methods of acupuncture treatment and non-acupuncture treatment respectively. To observe the effect of acupuncture on hemorrhage management during the perioperative period of total knee arthroplasty through clinical comparison. This study was based on the day before surgery, the day of surgical operation, after 1 day of surgery, after 3 days of surgery and after 7 days of surgery. Regular blood test including:blood hemoglobin, hematocrit; Postoperative blood induced flow volume, blood transfusion volume, calculation of blood loss at each stage including:actual total loss of blood, dominant and recessive loss of blood; Blood coagulation function including: blood coagulation regular three items, D2-polymer on the day before surgery, the surgical operation day and after 1,3,7 days of surgery. Local symptom including:affected limb pain score and swelling score on the day before surgery, after 3 days of surgery and after 7 days of surgery; Joint function including:investigation of knee joint function (HSS score sheet) on the day before surgery, after 3 days of surgery and after 7 days of surgery; Safety includes:limb skin, acral feeling, blood circulation etc; Adverse event records; Economic benefits include:length of stay for observation. There were using SPSS19.0 statistical software for statistical analysis of the results.ResultsIn 70 cases, by statistical analysis, two groups of hematocrit (HCT), after 10 hours, P< 0.05, with statistical significance, said 10 hours after operation in two groups of HCT had obvious difference. The 1,3,7 days after the operation, P< 0.01, with statistical significance, HCT the first 1,3,7 days of the two groups after operation were significantly different. Hemoglobin (Hb), preoperative, postoperative within 10 hours and first days after operation in Hb were not statistically significant (P> 0.05), no significant difference between the two groups. Compared with Hb third days after Hb, P< 0.05, with statistical significance the two group, said after third days of Hb and Hb were significantly different. Compared seventh days after operation, P< 0.01, with statistical significance, Hb said the seventh days of the two groups after operation were significantly different. Hours after the blood loss were compared between the two groups of surgery, postoperative 10 hours to the 1 day and postoperative days 1 to the 3 days between blood loss was statistically significant (P< 0.01), two groups of blood loss were significantly different, and in postoperative 3 days to 7 days of blood loss was not statistically significant (P> 0.05). Two groups of blood loss, there was no significant difference. In different period of time, the total blood loss difference, two groups of 1 day total blood loss,3 days of total loss of output and 1 week of total blood loss were statistically significant (P< 0.01), the two groups at different times of the total blood volume of significant differences (P<0.05). Total dominant bleeding volume and total drainage volume difference (P> 0.05). There were no statistical significance, the said between the acupuncture group and the control group the total explicit loss of blood volume and total drainage volume had no significant difference. Hidden blood loss of the two groups of 3 days of hidden blood loss and 1 weeks of hidden blood loss was statistically significant (P < 0.01), the two groups of blood loss were significantly different. Prothrombin time (PT), prothrombin activity (AT), fibrinogen (FIB), activated partial thromboplastin time (APPT) and D2-polymer (D-dimer) compared to the difference, P> 0.05, there was not statistical significant, there was no significant difference between the acupuncture group and the control group. After 1 weeks and 2 weeks after surgery, the HSS scores were compared between the two groups of pain, function, activity, muscle strength was statistically significant (P< 0.01). There were significant differences in HSS scores between the two groups. Pain VAS score difference comparison, two groups of VAS score, in addition to preoperative VAS score was not statistically significant (P> 0.05), no significant difference, VAS score was statistically significant (P< 0.01) 3 days after operation and 7 days after operation, There were significant differences in the pain VAS scores between the two groups at the time of the session. The difference on the circumference of the patellar 10cm,1 weeks before surgery, third days after operation (P> 0.05) were not statistically significant, there is no significant difference between acupuncture group and control group in this period of time the supra-patellar 10cm leg case, and on the seventh postoperative day between acupuncture group and control group on 10cm of patellar circumference (P< 0.05) there was statistical significance, said at the time the supra-patellar 10cm is a significant difference in leg circumference. The difference between the mid-calf circumference and the calf circumference one week before operation (P> 0.05) were not statistically significant. There are no obvious difference of the middle leg circumference between the acupuncture group and the control group of this period of time. And the third day and the seventh day after surgery, The middle leg circumference between the acupuncture group and control group, P< 0.01, there was statistical significance, representing there are significant difference in the middle leg circumference during the period of time. There was no severe bleeding and other discomfort during the experiment in the two groups.ConclusionThrough clinical verification, the acupuncture treatment can obvious treatment can significantly reduce the total knee arthroplasty in patients with total blood loss and the hidden blood loss. And postoperative 1 week and 2 weeks of knee joint function that acupuncture and moxibustion can make pain significantly reduced, while functional, activity, muscle strength can significantly improve. Acupuncture treatment on postoperative complications has improved significantly, in addition to significantly reduce pain, lower limb swelling also improved significantly, the speed of calf detumescence faster than the speed of thigh detumescence relatively. On the economic benefits, acupuncture can shorten the time of hospitalization, speeds up the hospital rotation, let more patients benefit. |
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