The effect of traditional Chinese medicine fumigation and washing combined with Western medical care on resting pain in elderly males with lower extremity arterial occlusion

2.1 General data

This study included 200 elderly male patients suffering from resting pain attributed to LEAO treated at our hospital between January 2021 and January 2023. Participants were randomly assigned to two groups, each with 100 participants: the experimental group and the control group. Table 1 shows both groups’ general information is shown in Table 1, with comparable data (p > 0.05).

Inclusion criteria: (1) Meet the Vascular Surgery Society’s diagnostic criteria for LEAO [8]; (2) Age ≥60 years and undergoing interventional surgery; (3) Communicate normally and be willing to cooperate in all examinations; (4) Informed consent form signed.

Exclusion criteria: (1) Severe cardiovascular and pulmonary diseases; (2) Chronic diseases or other major organ diseases; (3) Cognitive impairments or communication barriers; (4) Non-interventional surgery patients.

2.2 Methods

Patients were routinely treated with antiplatelets (enteric-coated aspirin + clopidogrel) and lipid-lowering medications (atorvastatin calcium tablets) for approximately one week before surgery.

All patients underwent percutaneous transluminal angioplasty followed by daily vital signs monitoring. We administered intravenous anticoagulation, assessed coagulation function and replenished fluids. As part of the lifestyle recommendations, smoking cessation, alcohol avoidance and regular routines were suggested.

Patients with diabetes were given Humulin R subcutaneous injections 30 minutes before each meal and at bedtime. Doses were adjusted in 2–4U units based on glucose monitoring. During fasting periods before and after surgery, insulin injections were replaced with intravenous infusions of 5% glucose or 0.9% NaCl solution containing regular insulin until normal dietary intake resumed, allowing return to baseline insulin regimens. Patients with hypertension were prescribed amlodipine tablets, starting at 2.5 mg/day and not exceeding 10 mg/day. Patients with hyperlipidemia started on atorvastatin calcium at 10 mg/day, with dosages from 10–60 mg/day adjusted after 2–4 weeks of monitoring.

Postoperative nursing: The control group received conventional Western medical nursing: (1) Health education: Provision of information about pathology, treatment plans and prognosis of the disease to patients and their families by forms. To increase patients’ confidence in treatment, nurses informed them in advance about intraoperative and postoperative adverse reactions. (2) Psychological care: Patients were communicated with face-to-face to combat anxiety, depression and other negative emotions. Offering targeted guidance and instructing patients to perform deep breath or relax muscles. (3) Pain intervention: One day after admission, the lower limbs were kept warm. To relieve pain sensations like cold-induced leg cramps, soft protectors and blankets were used. During leg pain, legs were naturally hung down to increase blood circulation and relieve pain. Acute pain episodes were relieved by sitting up in bed and leaning on a table. For surgical pain, morphine was used to provide pharmacological pain relief to prevent cardiovascular events triggered by pain. (4) Nutritional supplementation was recommended based on the patient’s preferences and dietary habits, with a light diet, which contained high-quality proteins and vitamins, and avoiding spicy and greasy foods to prevent postoperative complications (itchy wounds, pain, incision infection, etc.). During the night, patients were given aromatherapy oils with sedative and sleep-inducing properties. (5) Walking program: At first, patients were encouraged to walk daily, for ≥30 minutes per session, 3–5 times per week, according to the principle of not feeling fatigued. Two weeks later, regular progressive walking training began. Brisk walking several times a day, for 30 minutes of intermittent walking, increasing by 5 minutes each time, until pain limits further walking. Training was aimed at 6–8 kilometers per day. Training was stopped immediately if discomfort occurred. Three months of progressive walking training are conducted for each patient, with claudication distances and total kilometers recorded each day. ABI, body mass index (BMI) and lipid profile indicators were administered at two months’ follow-up.

The experimental group performed TCM fumigation therapy based on the control group. Si Miao Yong An Tang, composed of honeysuckle, Scrophularia, Chinese angelica and roasted licorice. For patients with heavy damp-heat syndrome may benefit from adding Phellodendron, Moutan Peony bark, achyranthes and sophora flavescens. Lycopodium clavatum is added for blood stasis syndrome. The method was as follows: one dose daily, with the prescription boiled in 3000 mL of water. Using steam for fumigation, the decoction was poured into a basin where a stool atop the liquid surface rested on patient’s feet. A 20-minute session was provided on a daily basis when the decoction temperature dropped to approximately 40 °C, patients submerged their feet for a 20-minute session once per day. In a six-week period, five times per week were carried out. Post-discharge follow-up: Patients were communicated with weekly to monitor medication compliance and dietary habits. A biweekly telephone consultation focused on assessment of the lower extremities status. Further, monthly hospital visits were mandated for comprehensive evaluations of coagulation and vascular health in the lower limbs, which helped refine nursing care.

2.3 Observation indicators

(1) Clinical outcomes: The recovery duration and length of hospital stay after surgery were compared between the groups. (2) Functional and circulatory assessments: Comparing Fugl-Meyer scores and Ankle-brachial index (ABI) values for both cohorts before and after nursing care. Lower limb motor function was assessed using the Fugl-Meyer scale [9], with a maximum score of 34 suggesting superior limb function. Lower limb circulation was determined by ABI [10], with a normal resting range of 0.9–1.3; scores below 0.8 indicate moderate impairment, below 0.5 indicate severe compromise, and values above 1.3 indicate extensive peripheral vascular disease. (3) Quality of life assessment: Short Form Health Survey (SF-36) [11] assesses physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. High scores indicate better quality of life for each dimension out of 100 points. (4) Nursing satisfaction: Nursing satisfaction survey scale [12] was used, scoring 25 points out of 100 for nursing quality, attitude, professionalism and procedures, with <60 points dissatisfied, 60–80 points satisfied, and >80 points very satisfied. (5) Complications: Monitoring hematoma, infection, myocardial infarction and other complications during and following surgery.

2.4 Statistical methods

Statistical analysis was conducted using SPSS 22.0 statistical software (IBM, Armonk, NY, USA). Quantitative data were described as (x̄ ± s), compared by t-test; Count data were described in percentage (%), compared by χ² tests, with p < 0.05 indicating statistically significant differences.

3.1 Clinical indicators

Both patient groups achieved 100% procedural success. The experimental group had significantly shorter postoperative recovery times and hospital stays than the control group (p < 0.05) (Table 2). A patient in the experimental group and 5 patients in the control group did not recover. They received ongoing inpatient care and nursing interventions.

3.2 Fugl-Meyer scores and ABI

Both Fugl-Meyer scores and ABI increased after intervention in the experimental group compared to the control group (p < 0.05) (Table 3).

3.3 Quality of life assessment

Quality of life dimension scores in the experimental group were significantly higher than the control group (p < 0.05) (Table 4).

3.4 Nursing satisfaction

The experimental group’s nursing satisfaction rate was significantly higher than the control group (p < 0.05) (Table 5).

3.5 Intraoperative and postoperative complications

The incidence rate of complications in the experimental group was significantly lower than the control group (p < 0.05) (Table 6).