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Objective:To study the clinical application of hanging moxibustion in intervention of deep venous thrombosis (DVT) of lower extremity after intertrochanteric fracture of femur, in order to provide theoretical basis for the clinical application of suspension moxibustion.Methods:By adopting a controlled clinical trial method, a total of 100 patients with femoral intertrochanteric fracture who came to Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province for orthopaedic surgery from January 2021 to September 2022 were selected by convenient sampling method and randomly divided into the control group and the observation group, 50 cases in each group. The control group was given routine nursing intervention, and the observation group was given the traditional Chinese medicine nursing intervention of hanging moxibustion on the basis of the control group. The changes of coagulation function indexes, hemorheology indexes, hemodynamics, the swelling degree score of the affected limb, and the Visual Analogue Scale (VAS) of the affected limb pain in the two groups of patients with intertrochanteric fracture before and 14 days after the intervention, and the incidence of lower extremity deep venous thrombosis (DVT) in the two groups after 1 d, 3 d, 7 d, and 14 d of intervention were observed and recorded.Results:After 14 days of intervention, D-dimer, fibrinogen and prothrombin time in the observation group were (380.64 ± 41.78) μg/L, (4.51 ± 0.49) g/L and (10.46 ± 1.04) s, respectively, which were better than those in the control group (464.91 ± 46.81) μg/L, (4.82 ± 0.56) g/L and (12.85 ± 1.12) s with statistical difference ( t=9.50, 2.95, 11.06, all P<0.05). After 14 days of intervention, the whole blood low tangential viscosity, whole blood high tangential viscosity and plasma viscosity in the observation group were (8.34 ± 0.42), (3.72 ± 0.28) and (1.21 ± 0.18) mPa/s, respectively, which were significantly lower than (8.90 ± 0.46), (4.13 ± 0.26) and (1.53 ± 0.22) mPa/s in the control group ( t=6.36, 7.59, 7.96, all P<0.05). After 14 days of intervention, the postoperative blood flow, maximum blood flow velocity and average blood flow velocity in the observation group were (1.89 ± 0.26) L/min, (31.57 ± 3.29) cm/s, (34.41 ± 3.62) cm/s, which were significantly higher than (1.45 ± 0.21) L/min, (24.18 ± 2.85) cm/s, (27.96 ± 3.15) cm/s in the control group ( t=9.31, 12.01, 9.50, all P<0.05). After 14 days of intervention, the total incidence of lower limb DVT in the observation group was 2.00%(1/50) , lower than 24.00%(12/50) in the control group, the difference between the two groups was significant ( χ2=10.70, P<0.05). Conclusions:Suspended moxibustion can significantly improve the coagulation function, hemorheology, hemodynamics, swelling and pain of the affected limb in patients with postoperative intertrochanteric fracture of the femur, and reduce the occurrence of DVT in the lower extremity. It is recommended to be widely used in clinical practice.
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Objective To investigate the changes of Caprini score, plasma D-D and FIB levels in patients with post-fracture DVT and its diagnostic significance.Methods Sixty patients with post-fracture DVT (DVT group) and 120 patients without DVT after fracture were selected (control group).The Caprini score, plasma D-D and FIB levels were compared between the two groups.The relationship between Caprini score and plasma D-D and FIB in the DVT group was analyzed.Results The Caprini score, D-D and FIB levels in the DVT group[7.26±1.88, (3.31±1.52) mg/L, (4.48±0.72) g/L] were significantly higher than those in the control group[3.39±0.80, (0.46±0.11) mg/L, (3.60±0.68) g/L], and the difference was statistically significant (P＜0.05).There was a significant positive correlation between Caprini score and D-D and FIB levels in patients with DVT (P＜0.05).There was a positive correlation between Caprini score and level of D-D and FIB (r=0.748、r=0.662, P＜0.05).The sensitivity of Caprini score combined with D-D and FIB levels in the diagnosis of DVT in fracture patients was 97.83％, specificity was 92.00％, missed diagnosis rate was 2.17％, misdiagnosis rate was 8.00, and area under ROC curve was 0.947 (P＜0.05).Conclusion Caprini score, D-D and FIB levels in patients with lower limb fracture have certain clinical value for the diagnosis of DVT.
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Objective: To analyze and evaluate the diagnostic value of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for pulmonary thromboembolism (PTE). Methods: The clinical data of 140 clinically suspected PTE patients admitted to Department of Respiratory and Critical Care Medicine, Ruijin Hospital between January 2012 and December 2016 were retrospectively analyzed. Based on the results of computed tomographic pulmonary angiography (CTPA), all included patients were divided into CTPA negative group (non-PTE group) and CTPA positive group (PTE group). The univariate and multivariate analyses were used to compare and evaluate the diagnostic and predictive efficacy of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for PTE. Results: There was no significant difference in gender, age, smoking, underlying diseases (malignancy, hypertension, coronary heart disease, dyslipidemia, and chronic obstructive pulmonary disease) and surgical history within 30 days between the two groups (All P>0.05). Univariate analysis revealed significant differences in D-dimer (P=0.003), pulmonary artery pressure (P=0.000), and partial pressure of carbon dioxide (P=0.000) between the groups. Multivariate analysis suggested that deep venous thrombosis of the lower extremities, pulmonary hypertension, and elevated D-dimer levels were significantly associated with the incidence of PTE. Further ROC curve analysis suggested that the area under the curve (AUC) of deep venous thrombosis, pulmonary hypertension and D-dimer increase was 0.624, 0.673 and 0.624, respectively. The AUC of combined three factors was 0.837. The sensitivity, specificity, positive predictive value and negative predictive value of the combined diagnosis reached 86.8%, 88.4%, 87.5%, and 84.6%, respectively. Conclusion: D-dimer combined with echocardiography and vascular ultrasound of lower extremity might have diagnostic and predictive value for PTE.
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Objective To explore effects of the nursing care combined with low molecular weight heparin on the lower extremity deep venous thrombosis after cesarean section incidence. Methods 192 patients who underwent cesarean section from October 2015 to October 2016 in Yongkang maternal and child health hospital, excluding the relevant taboos, according to the different nursing methods, were divided into the control group (n=96) and the study group (n=96). Two groups of patients after 24 h of cesarean section were treated with low molecular weight heparin calcium 5000 IU subcutaneous injection, once a day, continuous treatment for 5 days; the control group was given routine cesarean section nursing after the operation; the study group was given targeted nursing (psychological guidance, preoperative guidance, postoperative care, dietary guidance, exercise guidance, and environmental care). Results The incidence of deep venous thrombosis of patients (2.08%) in the study group was significantly lower than (9.38%) in the control group with statistical significance (P<0.05); the plasma D dimer in the study group was significantly lower than the control group with statistical significance (P<0.05); nursing satisfaction rate of patients in the study group was (95.83%) higher than (81.25%) of the control group with statistical significance (P<0.05). Conclusion The combination of targeted care plus low molecular weight heparin could improve the satisfaction of nursing and the quality of life, reduce the incidence of postoperative deep vein thrombosis. It is worthy of clinical application.
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Objective To explore effects of the nursing care combined with low molecular weight heparin on the lower extremity deep venous thrombosis after cesarean section incidence. Methods 192 patients who underwent cesarean section from October 2015 to October 2016 in Yongkang maternal and child health hospital, excluding the relevant taboos, according to the different nursing methods, were divided into the control group (n=96) and the study group (n=96). Two groups of patients after 24 h of cesarean section were treated with low molecular weight heparin calcium 5000 IU subcutaneous injection, once a day, continuous treatment for 5 days; the control group was given routine cesarean section nursing after the operation; the study group was given targeted nursing (psychological guidance, preoperative guidance, postoperative care, dietary guidance, exercise guidance, and environmental care). Results The incidence of deep venous thrombosis of patients (2.08%) in the study group was significantly lower than (9.38%) in the control group with statistical significance (P<0.05); the plasma D dimer in the study group was significantly lower than the control group with statistical significance (P<0.05); nursing satisfaction rate of patients in the study group was (95.83%) higher than (81.25%) of the control group with statistical significance (P<0.05). Conclusion The combination of targeted care plus low molecular weight heparin could improve the satisfaction of nursing and the quality of life, reduce the incidence of postoperative deep vein thrombosis. It is worthy of clinical application.