Intinial Observation Of The Distribution And Evolution Of Qi/Blood Deficiency Syndrome After Knee Arthroplasty

1 BackgroundWith the rapid economic development, and constantly improve the health system, and the aging population continues to increase, degenerative changes in the knee has become a major problem for human health, quality of life severely affected in the elderly. Knee to early arthritis and pain, joint deformity with late dysfunction, early conservative treatment, post-surgical treatment required, total knee arthroplasty is an effective measure of severe osteoarthritis treatment, According to statistics, China in 2012 about 200,000 patients undergoing knee replacement surgery.Chinese medicine, organs gradually decline in the elderly, weak blood, difficult to tolerate major surgical trauma. In addition, the surgery itself can cause blood deficiency, perioperative need bed rest, fasting, etc., long injury lay gas, water valley is the source of qi and blood, in addition, postoperative bleeding, severe soft tissue damage, mostly there will be blood deficiency, the gas with the blood off performance. Western medicine for postoperative recuperation, in addition to conventional symptomatic treatment, there is no good treatment, and Chinese medicine to improve the deficiency, or anemia status have a greater advantage, can help patients recover as quickly as possible to prevent the occurrence of various complicationsHowever, after the intervention of Chinese medicine for the lack of theoretical basis and research support. In recent years, scholars have focused on the study of postoperative syndrome type distribution, less involved syndrome syndromes evolution. For the "injury after injury of blood gas" theory has not proved plus research and, at present, specifically for postoperative qi deficiency, blood deficiency syndrome research has not been found, most only in passing. In this study, total knee arthroplasty as a precondition for knee replacement surgery appears qi deficiency, blood deficiency syndrome in the case studies, preliminary observation knee replacement surgery qi deficiency, blood deficiency syndrome or distribution, evolution trend, and associated with postoperative laboratory indicators of relevance, provide a theoretical basis for Chinese medicine for knee replacement surgery intervention.2 ObjectiveObservation knee replacement surgery qi deficiency, blood deficiency syndrome, blood deficiency syndrome and other syndromes distribution and evolution, and to explore the evolution and postoperative syndromes HB, RBC, HCT, ALB change correlation for osteoarthritis of the knee joint replacement TCM intervention to provide a theoretical basis.3 Materials and Methods3.1 Type of StudyThis test is a small sample of clinical observation.3.2 StudyMet the inclusion and exclusion criteria for patients with osteoarthritis of the knee, the system ineffective conservative treatment, the need knee replacement surgery treatment.3.3 Case SourceObserved cases are from the China Academy of Traditional Chinese Medicine Second Department of Bone and Joint Wangjing Hospital inpatients. The test were observed in 40 patients after TKA, excluding 7 cases,33 cases, including 6 males and 27 females, male/female=2:9; minimum age is 52 years old, the maximum age of 84 years, mean age 67 years old. Wherein the row left knee replacement surgery in 15 cases,18 cases of right knee.3.4 Preoperative evaluationPreoperative patient comprehensive examination to exclude hemodynamic disorders, abnormal blood clotting mechanism, disorders of the body vital organs and systems, aggressive treatment of the underlying disease.3.5 Observe after qi deficiency, blood deficiency syndromeRespectively, after 24 hours,48 hours,72 hours,5 days,7 days,14 days, to collect relevant patient qi deficiency, blood deficiency syndrome or related symptoms, according to the diagnostic criteria for determination qi deficiency syndrome, or blood deficiency syndrome. In addition, according to qi deficiency, blood deficiency syndrome symptom ratings quantization table given none, mild, moderate and severe, respectively,0 points,1 point,2 points and 3 points.3.6 Observe after HB, RBC, HCT’sRespectively, after 24 hours,72 hours,7 days,14 days, morning fasting venous blood, blood testing.3.7 Postoperative albuminRespectively, after 24 hours,72 hours,7 days,14 days, morning fasting venous blood, routine biochemical tests.3.8 Data ProcessingInstitute obtained data applications SPSS 20.0 statistical package for analysis and processing. Count data application χ2 test, measurement data by t test. Related applications Pearson correlation test, Logistic regression analysis.4 Results4.1 Syndrome DistributionQi deficiency appear alone in 10 cases,30%; 3 cases of blood deficiency alone, 9%; blood deficiency syndrome occurred in 17 cases (52%), non-qi deficiency or deficiency syndromes in 3 cases,9%.4.2 Syndromes integral changes over timeAfter the first 24 hours,48 hours,72 hours,5 days,7 days,14 days of Qi Deficiency Syndrome (containing blood deficiency syndrome) median symptom score was 7 points,5 points,4 points,2 points,2 points,0 points, decreases with time, symptom scores from high to low.After the first 24 hours,48 hours,72 hours,5 days,7 days,14 days Deficiency Syndrome (containing blood deficiency syndrome) median symptom score was 2 points,3 points,4 points,4 points,3 points,0 points, change over time, the first high to low.After the first 24 hours,48 hours,72 hours, with a median value of 5 days,7 days,14 days and blood deficiency syndrome symptom scores were 10 points,8 points,8 points,6 points,5 points,0 points, change over time and reduced symptom scores from high to low.The number of cases over time the situation occurred4.3 SyndromesThe number of cases after the first 24 hours,48 hours,72 hours,5 days,7 days, 14 days of Qi Deficiency Syndrome (containing blood deficiency syndrome) appeared were 24 cases,19 cases,18 cases,10 cases,6 cases,3 cases, changes over time, the number of cases less and less.The number of cases after the first 24 hours,48 hours,72 hours,5 days,7 days, 14 days Deficiency Syndrome (containing blood deficiency syndrome) appeared were 11 cases,13 cases,17 cases,15 cases,12 cases,3 cases, changes over time, the number of cases first high to low.The number of cases after the first 24 hours,48 hours,72 hours,5 days,7 days, 14 days, blood deficiency syndrome emerged were 8 cases,10 cases,11 cases,7 cases, 4 cases,2 cases, change over time, the number of cases less and less.4.4 HB, RBC, HCT changes overtimeBefore surgery,24 hours,72 hours,7 days,14 days total distribution of hemoglobin values at the first time, after the rise. The median value (g/L) were135,102,95,95,104,101.Before surgery,24 hours,72 hours,7 days,14 days total distribution of red blood cells at the first value over time, after the rise. The median value (* 109/L) were4.47,3.40,3.01,3.09,3.40.Before surgery,24 hours,72 hours,7 days,14 days total distribution hematocrit value over time under the first, after the rise. The median value (%), respectively 39.8,31.1,27.4,28.2,31.0.4.5 Albumin changes overtimeBefore surgery,24 hours,72 hours,7 days,14 days median albumin (g/L) were 42.6,31.2,28.9,32.3,35.1, will be distributed at the first time, after the rise.5 Conclusion5.1 postoperative containing qi deficiency, blood deficiency syndrome mainly less alone Blood deficiency, or simply have other permit conditions.5.2 postoperative qi deficiency occurs earlier and acute symptoms and rapid recovery; after fade of blood deficiency, blood deficiency syndrome and to give priority; after the main order of blood deficiency, blood deficiency syndrome appear relatively late, symptoms first slowly increase, then recovery, slow recovery.5.3 Hb, RBC, Hct, ALB first time varying from low to high, and then slowly to normal trough for the first 3-7 days, and the variation of blood deficiency points similar, there may be a correlation between the two.6 Scarcity6.1 small sample size:small sample observation, due to differences in different hospitals, different surgeons manner using prosthetic materials, difficult to achieve multi-center, large sample observation.6.2 Too many subjective factors:the ratings for a variety of symptoms, there are differences tell patients, there are differences for the viewer to grasp the signs.6.3 in patients with large differences:The main Research ages 50 to 85 years, different underlying diseases, severity, larger differences.