Effect Of Smokeless Moxibustion Combined With Acupoint Massage On Preventing Deep Vein Thrombosis After Orthopedic Hip Surgery In Elderly Patients With Deficiency Syndrome

ObjectiveTo explore the intervention effect of smokeless moxibustion combined with acupoint massage to prevent three key factors of postoperative thrombosis in elderly cases with hip joint deficiency syndrome in orthopaedic department.Laboratory diagnostic indicators such as blood coagulation function,hemodynamics,vascular endothelial growth factor(VEGF)and postoperative hip function improvement were analyzed for the interaction between the two interventions.MethodsThe expert group meeting improved the joint intervention plan based on literature,theories and preliminary studies.After the scheme was confirmed,132 eldly cases with hip fracture were selected in the Putuo Hospital affiliate to Shanghai University of Traditional Chinese Medicine Orthopaedics Department ? and ? from February 2018 to December 2018,and block randomly divided into four group:Routine Care Group(RCG),Smokeless Moxibustion Group(SMG),Acupoint Massage Group(AMG)nd Joint Intervention Group(JIG),each group has 33 cases.RCG received routine nursing method based on the guideline,while the SMG received smokeless moxibustion�Yongquan�point on the basis of RCG nursing,AMG received acupoint massage on the corresponding acupoints of zusanyin zusanyang meridians on the basis of RCG nursing,JIG received smokeless moxibustion and acupoint massage combined measures on the basis of RCG nursing.The blood coagulation function(D-Dimer,Fib)and haemodynamics of the four groups were compared on the first day and the seventh day after the operation.The VEGF was detected preoperatively and the 7th day postoperatively,and the recovery of hip joint function was assessed.The incidence of burns,massive bleeding and other adverse events and the number of cases of DVT were collected at discharge.ResultsA total of eight experts were invited to discuss and decide on the measures of acupoint massage.The overall authority coefficient of the experts was 0.875.Finally,the acupoint of "Yongquan" point the group was selected for intervention with the smokeless moxibustion method,and the acupoints of "zusanli","fu tu","xuehai","yanglingquan"etc were selected for intervention with the massage method.It is advisable for patients to feel "getting qi" for 2 minutes at each acupoint,and intervention twice a day,at 9:00 am and at 16:00 PM.Due to the elimination,shedding and suspended of the intervention objects,data analysis was finally carried out on 120 cases that met the protocol set,including 30 cases in the conventional care group,29 cases in the smokeless moxibustion group,31 cases in the acupoint massage group,and 30 cases in the combined intervention group.There was no significant difference between the four groups in general data(P>0.05).After the implementation of the intervention,no symptomatic deep vein thrombosis occurred in either group,one asymptomatic thrombosis occurred in RCG and one occurred in SMG and were to eliminate,and the asymptomatic thrombosis disappeared after treatment before discharge.In terms of coagulation function,there were statistically significant differences in DD between the four groups after intervention(P=0.002).There were statistically significant differences between the RCG,SMG,AMG and the JIG respectively(P=0.001,P=0.020,P=0.001)between the SMG and the JIG(P<0.05),and between the AMG and the combined intervention group(P<0.01).The interaction effect of smokeless moxibustion combined with acupoint massage on DD was statistically significant(P<0.05),and the effect of smokeless moxibustion alone was slightly stronger than that of acupoint massage alone.There was no interaction on Fib index,and the main effect of smokeless moxibustion on reducing Fib was better than acupoint massage.In terms of hemodynamics,there were statistically significant differences of popliteal vein and posterior tibial vein blood flow velocity between the AMG and JIG(P<0.05).The main effect of acupoint massage was better than that of smokeless moxibustion,and there was no interaction between the two intervention.In terms of vascular endothelial function,there were statistically differences between RCG and AMG,RCG and JIG,SMG and JIG respectively(P=0.011,P=0.001 P=0.043),tthe joint interaction to slow the growth of VEGF was statistically significant(P=0.033),and the separate effects of acupuncture point massage is slightly stronger than the smokeless moxibustion.In terms of hip j oint function recovery,there was a statistical difference between the RCG,AMG and JIG(P<0.05),and there was an interaction between the two intervention methods(P=0.040).The separate effect of acupoint massage was slightly stronger than the smokeless moxibustion.No burns,skin damage,massive bleeding and other adverse events occurred during the whole intervention process.Conclusion1.The acupoint selection,and intervention measures in this study are scientific to some extent2.Smokeless moxibustion combined with acupoint massage can improve the indicators of patients' coagulation function,and the combined use of the two intervention methods can synergistic promote the reduction of DDimer.The combination of the two methods has no interaction with Fib,and the main effect of smokeless moxibustion is better than acupoint massage.3.Both acupoint massage and smokeless moxibustion can promote the hemodynamics of patients.It is not considered that the combined use of the two intervention methods can play a synergistic role,and the main effect of acupoint massage on promoting the blood flow velocity is better than smokeless moxibustion.4.Smokeless moxibustion combined with acupoint massage can synergistic delay the increase of VEGF concentration,and the single effect of acupoint massage in delaying the increase of vascular endothelial growth factor concentration is better than smokeless moxibustion.5.Smokeless moxibustion combined with acupoint massage can synergistically promote the recovery of hip joint function,especially in the aspect of motion amplitude.Both kinds of intervention methods have an impact on the recovery of hip joint function,and the single effect of acupoint massage is superior to the single effect of smokeless moxibustion.6.Smokeless moxibustion combined with acupoint massage is safe,feasible and suitable for clinical nursing staff to promote intervention.