TDP照射联合四黄散外敷对桡动脉穿刺术后前臂血肿治疗研究

吕萍 陈永祥 柴宁

【摘要】目的 探讨经桡动脉行冠脉介入术后并发前臂血肿的中药敷贴治疗方法。方法 选择我院2013年11月至2015年11月经桡动脉行冠脉介入术并发前臂血肿患者90例为研究对象，将其随机分为对照组和观察组，以冰敷组、硫酸镁湿敷组为对照，四黄散外敷配合TDP神灯照射为观察组，各30例，比较干预后患者前臂肿胀程度、出血时间、疼痛及骨筋膜室综合症等术后并发症发生情况。结果 观察组的临床总有效率明显高于冰敷组和硫酸镁湿敷组（96.7% vs 73.3%；96.7% vs 80.0%），组间比较显示，差异有统计学意义（P<0.05）。观察组改善患者前臂血肿情况明显，血肿消散患者比例达到86.7%，与冰敷组与硫酸镁湿敷组相比均有显著性差异（P<0.05），没有骨筋膜室综合症发生，患者尺动脉SpO2均大于95%。护理干预3 d后，观察组患者前臂肿胀程度与干预前相比有显著性差异（P<0.05）；护理干预6 d后，各组患者前臂肿胀程度与干预前相比均有显著性差异（P<0.05）。结论 四黄散外敷配合TDP照射能够有效防治患者前臂血肿恶化，对骨筋膜室综合症的发生有积极的预防作用，该方法可明顯减轻患者痛苦，有利于患者预后康复；迅速消肿，止痛效果满意，无毒副作用，安全可靠，值得临床推广应用。

【关键词】桡动脉；前臂血肿；四黄散；TDP照射

【中图分类号】R541.4 【文献标识码】B 【文章编号】ISSN.2095-6681.2017.36..04

【Abstract】Objective To explore the chinese medicine sticking nursing methods of transradial coronary intervention concurrent forearm hematoma.Metheods In our hospital from november 2013 to november 2015 ，transradial coronary intervention concurrent forearm hematoma in 90 cases，acccording to the different nvrsing program，divided into the control group （ice compress group and magnesium sulfate wet compress group） and observation group （sihuang powder combined with TDP irradiation），effect of prevention and treatment effect observation of the bone compartment syndrome， degree of swelling，bleeding time，and degree of pain.Results The clinical total effective rate of the observation group was significantly higher than that of the ice compress group and magnesium sulfate wet compress group （96.7% vs 73.3%， 96.7% vs 80.0%，P<0.05）.The observation group was significantly improved with forearm hematoma and the dissipation of hematoma patients with the ratio is 86.7%.Compared with the ice compress group and magnesium sulfate wet compress group， there was no significant difference between the two groups （P<0.05），There were no patients with compartment syndrome， and the ulnar artery SpO2 was greater than 95%. 3 days after nursing intervention， There was significant difference between the before intervention and after for the forearm swelling （P<0.05）；6 days after nursing intervention， there were significant differences in the degree of forearm swelling in each group before and after intervention （P<0.05）.Conclusion Based on the chinese medicine sticking combined with TDP irradiation nursing can effectively prevent the deterioration of the forearm hematoma，prevent osteofascial compartment syndrome occurred，to alleviate the suffering of patients，rehabilitation of favorable prognosis.The method was relieving pain repidly and non-side effects and is worthy of clinical promotion.

【Key words】Radial vein；froearm hematoma；Sihuang powder；TDP irradiation

桡动脉穿刺是目前冠心病患者介入（trans-radial intervention，TRI）诊疗最常用的血管径路，其主要优点在于并发症少、术后可立即拔除鞘管、无体位限制、住院时间短、不影响抗凝药物连续使用等，因此临床经桡动脉路径行介入手术的应用越来越普及[1，2，3]。桡动脉血管相对细小，在受到刺激后容易出现血管痉挛，并且桡动脉血管走行多变异、曲折、多分枝，其解剖学特点决定了经桡动脉介入时可能会出现一些特有并发症，如前臂血肿等[4]，轻者可导致患者剧痛，前臂长期功能受损，血肿持续恶化可诱导骨筋膜室综合症等重大并发症发生，传统护理通常采用弹性绷带加压包扎、止血阀双重加压、外用药物护理等方法，但容易引起手背部肿胀、静脉回流障碍、皮肤硬结瘀斑等症状，同时增加患者经济负担[5，6]。基于此，课题组采用中药敷贴配合TDP照射对发生前臂血肿患者进行积极有效的护理干预，在前期临床研究中取得了满意效果，现报道如下。……