Efficacy of Sanqi Powder Combined with Finger Exercises in Treating Upper Limb Hematoma after Coronary Intervention

Authors: Dai Shuangyuan, Kuang Zhongshao, Xiao Yinjuan
Affiliation: Department of Cardiovascular Medicine, Third Affiliated Hospital of Nanhua University, Hengyang 421900, China
Corresponding Author: Dai Shuangyuan, female, bachelor's degree, deputy chief nurse, head nurse

Abstract

Objective: To investigate the clinical effect of external application of Sanqi powder combined with six-step finger exercise on upper limb hematoma after coronary intervention. Methods: A total of 100 patients with upper limb hematoma after coronary intervention were divided into control group and observation group according to admission time. The control group received 50% magnesium sulfate wet compress combined with hirudoid external application, while the observation group received Sanqi powder external application combined with six-step finger exercise intervention. Hematoma regression time, arm circumference, pain score (VAS), comfort degree (GCQ), and complication rate were compared between the two groups. Results: The observation group showed significantly better outcomes than the control group in hematoma regression time, arm circumference, pain score (VAS), comfort degree (GCQ), and complications (all P<0.05). Conclusion: For patients with upper limb hematoma after coronary intervention, Sanqi powder external application combined with six-step finger exercise intervention can accelerate hematoma absorption, relieve pain, improve comfort, and reduce the risk of complications.

Keywords: Sanqi powder; six-step finger exercise; coronary intervention; upper limb hematoma; nursing intervention

Introduction

Coronary heart disease is a common cardiovascular disease threatening human health. In 2022, the number of patients with coronary heart disease in China reached approximately 11.39 million, with elderly patients aged 60 and above accounting for nearly 30% [1]. As China's population aging and urbanization accelerate, the incidence of coronary heart disease is showing a yearly increasing trend [2]. Coronary artery intervention, including coronary angiography (CAG) and percutaneous coronary intervention (PCI), is currently the most effective method for early diagnosis and treatment [3]. In recent years, transradial coronary intervention (TRI) has been recommended as the preferred diagnostic and therapeutic approach for coronary heart disease patients due to its higher safety and comfort [4].

The most common complication of this approach is forearm hematoma [5], which is often associated with factors such as operator inexperience, patient-specific factors, excessive anticoagulant medication, inadequate nurse observation, and improper compression at the puncture site [6]. Studies have reported that the incidence of hematoma after transradial puncture ranges from 0% to 12% [7]. If large hematomas are not treated promptly, they can cause severe pain, local tissue ischemia and necrosis, thrombosis, and even skin breakdown. In severe cases, compartment syndrome may develop [8], reducing patient compliance and increasing suffering, hospitalization time, and costs. Therefore, early detection and treatment with strengthened nursing intervention for limb hematoma are crucial.

Currently, conventional nursing typically employs 50% magnesium sulfate wet compress combined with hirudoid external application, but hematoma resolution is slow, and the effect on established hematomas is limited. In recent years, traditional Chinese medicine has demonstrated unique advantages in postoperative rehabilitation. Sanqi (Panax notoginseng), a precious traditional Chinese medicinal herb, possesses bidirectional regulatory characteristics of hemostasis without stasis and stasis resolution without harming healthy qi. Its active component, Panax notoginseng saponins (PNS), can significantly reduce blood viscosity and promote tissue edema absorption [9]. Based on evidence-based nursing concepts, this study is the first to explore the combined application of Sanqi powder and rehabilitation exercises, attempting to treat patients with limb hematoma and pain after transradial coronary intervention using Sanqi powder external application combined with six-step finger exercise, achieving satisfactory results.

Methods

Study Design and Participants

We selected 100 patients who developed upper limb hematoma after transradial coronary intervention at our hospital from January 2022 to December 2024 as study subjects. Inclusion criteria were: (1) upper limb hematoma occurring within 24 hours after transradial coronary intervention with diameter ≥ 2 cm; (2) normal preoperative platelet count (100-300×10⁹/L) and normal coagulation parameters (PT, APTT, TT, FIB) within hospital laboratory reference ranges; (3) clear consciousness, normal communication ability, and signed informed consent; (4) affected limb muscle strength ≥ grade 4 (Lovett scale). Exclusion criteria included: (1) severe dysfunction of heart, liver, kidney, or lung (e.g., NYHA class IV heart failure, chronic kidney disease stage 5); (2) preoperative limb trauma, deformity, or limited mobility; (3) history of mental illness (e.g., depression, schizophrenia); (4) postoperative hemodynamic instability (systolic blood pressure <90 mmHg or requiring vasoactive drugs); (5) postoperative use of high-dose anticoagulation (heparin >50 IU/kg/h).

A non-randomized concurrent control design was adopted, with patients grouped by admission time: the first 50 admitted patients were assigned to the control group, and the subsequent 50 to the observation group. The control group included 26 males and 24 females, aged 37-79 years (mean 56.20±7.39 years). The observation group included 25 males and 25 females, aged 34-76 years (mean 55.14±6.89 years). Baseline data including gender and age showed no significant statistical differences between groups (P>0.05). This study protocol was approved by our hospital's Medical Ethics Committee.

Intervention Methods

A research team was established, led by one deputy chief nurse (≥15 years of experience, including >5 years in cardiovascular medicine), comprising five supervising nurses (>5 years in cardiovascular medicine) and five nurses (>3 years in cardiovascular medicine). All team members underwent training covering Sanqi powder external application standard procedures, six-step finger exercise instruction, and data collection protocols (unified VAS scoring script, circumference measurement positioning methods). Assessment included theoretical examination (closed book, ≥90 points required) and practical evaluation (scored by team leader, ≥95 points required). Team members who passed three consecutive practical assessments and signed operation commitment letters were qualified to participate. To ensure rigor, operations and data collection were performed by two designated team members (one for execution, one for recording).

Control Group: After transradial coronary intervention, patients returned to the ward and responsible nurses observed the operative limb according to routine. Upon discovering hematoma, the research team was immediately notified to mark the hematoma area (with marker pen) and measure circumference at the hematoma site and the same location on the contralateral limb to determine hematoma extent. Magnesium sulfate wet compress was applied: according to swelling range and avoiding the puncture site, 50% magnesium sulfate injection (10ml:5g, Tianjin Pharmaceutical Peace Co., Ltd.) was used to soak 4 layers of sterile gauze (5×5 cm) until saturated (without dripping), covering the hematoma area (extending ≥2 cm beyond edges) while avoiding the puncture site; outer layer covered with plastic wrap (extending 1 cm beyond gauze edges) for fixation; after 30 minutes, the compress was removed, skin cleaned and dried; 1.5-2 hours later, hirudoid was applied to an area 2-3 cm larger than the hematoma, 3-4 times daily until hematoma resolution.

Observation Group: Received Sanqi powder external application combined with six-step finger exercise intervention. After elastic bandage removal at 24 hours, appropriate amount of Sanqi powder was mixed with warm water into paste according to hematoma size. Two layers of sterile gauze were fully soaked in the Sanqi paste and applied to the affected area, covering 2-3 cm beyond hematoma range while avoiding the needle site, then wrapped with plastic wrap. Applied once daily until complete hematoma resolution. Simultaneously combined with six-step finger exercise: started when postoperative condition stabilized (generally 30 minutes post-operation), performed once per hour during non-sleep periods until elastic bandage removal; after bandage removal, performed once every 2 hours. Exercise movements were gentle to avoid elastic bandage loosening and bleeding. Condition was closely monitored; exercise was suspended if vital signs were unstable, limb numbness occurred, or pain was intolerable, and resumed after relief; exercise was stopped if wound bleeding, local blisters, or radial artery spasm occurred.

The six-step finger exercise comprises six active hand movements summarized as "grasp, touch, count, press, extend, flick." "Grasp": extend five fingers with palm up, then make a fist. "Touch": thumb touches index, middle, ring, and little fingers sequentially. "Count": extend five fingers, then bend thumb, index, middle, ring, and little fingers sequentially for counting exercise. "Press": extend five fingers, use thumb to press index, middle, ring, and little fingers sequentially. "Extend": keep five fingers together with palm up, then forcefully extend all five fingers. "Flick": use thumb to press fingertips of index, middle, ring, and little fingers sequentially, then flick them open. Each movement was repeated for 10-15 cycles.

Outcome Measures

Data collection was performed simultaneously by one team leader and one team member. (1) Hematoma regression time: time from intervention start to complete hematoma absorption; (2) Arm circumference: measured and recorded using a soft tape at the most swollen part of the affected limb and the same location on the contralateral limb (cm), assessed before intervention and on days 1-6; (3) Pain score (VAS): assessed using Visual Analogue Scale (VAS, 0-10 points) [10] before intervention and on days 1-6; (4) Comfort score (GCQ): assessed using General Comfort Questionnaire (GCQ) containing four dimensions (physiological, psychological, sociocultural, environmental), with total score range 28-112 points; generally, 28-56 indicates poor comfort, 57-84 moderate comfort, and 85-112 good comfort; (5) Complication rate: including local skin allergy, tension blisters, compartment syndrome, etc.

Statistical Analysis

Data were analyzed using SPSS 26.0 statistical software. Measurement data were expressed as mean ± standard deviation. After Shapiro-Wilk test, normally distributed data were compared between groups using independent samples t-test; non-normally distributed data were expressed as median (quartiles) [M(Q1,Q2)] and compared using Mann-Whitney U test. Count data were expressed as number (percentage) [n(%)] and compared using χ² test. P<0.05 was considered statistically significant.

Results

Hematoma Regression Time

The observation group showed significantly shorter complete hematoma regression time than the control group (P<0.05). See Table 1 [TABLE:1].

Table 1 Comparison of Hematoma Regression Time Between Groups
| Group | Regression Time (d) | P-value |
|-------|---------------------|---------|
| Observation | 5.1±1.0 | <0.001 |
| Control | 7.8±1.5 | |

Arm Circumference

Before intervention, no significant difference existed in operative limb arm circumference between groups (P>0.05). After intervention, the observation group showed significantly reduced arm circumference and obvious swelling reduction compared with the control group (P<0.05). See Table 2 [TABLE:2].

Table 2 Comparison of Operative Limb Arm Circumference (cm, mean±SD)
| Day | Observation Group | Control Group |
|-----|-------------------|---------------|
| 1 | 32.92±2.04 | 33.14±2.40 |
| 2 | 32.91±2.03 | 33.06±2.40 |
| 3 | 31.90±2.09 | 32.37±2.46 |
| 4 | 30.99±2.08 | 31.87±2.55 |
| 6 | 30.26±2.16 | 31.47±2.49 |
| | 29.88±2.07 | 30.80±2.70 |
| | 29.88±2.07 | 29.80±2.60 |

Pain Scores

Before intervention, no significant difference existed in pain scores between groups (P>0.05). After intervention, pain decreased in both groups, with significantly lower pain scores in the observation group compared with the control group (P<0.05). See Table 3 [TABLE:3].

Table 3 Comparison of Pain Scores (points, mean±SD)
| Day | Observation Group | Control Group |
|-----|-------------------|---------------|
| 1 | 7.58±0.70 | 7.46±0.68 |
| 2 | 7.42±0.61 | 7.32±0.79 |
| 3 | 4.14±0.88 | 6.00±0.93 |
| 4 | 2.66±0.89 | 4.28±0.97 |
| 6 | 0.78±0.76 | 2.74±0.92 |
| | 0.28±0.54 | 1.34±0.87 |

Comfort Scores

Before intervention, no significant difference existed in comfort scores between groups (P>0.05). After intervention, comfort scores increased in both groups, with significantly higher comfort scores in the observation group compared with the control group (P<0.05). See Table 4 [TABLE:4].

Table 4 Comparison of Comfort Scores (points, mean±SD)
| Day | Observation Group | Control Group |
|-----|-------------------|---------------|
| 1 | 65.78±4.76 | 66.20±5.33 |
| 2 | 67.82±5.12 | 67.74±5.11 |
| 3 | 76.96±5.08 | 71.62±4.96 |
| 4 | 83.72±5.84 | 76.24±5.25 |
| 6 | 89.08±6.19 | 80.66±5.84 |
| | 93.92±7.52 | 84.90±6.47 |

Complication Rate

The observation group showed significantly lower complication rate than the control group (P<0.05). In the observation group, only 2 cases of mild skin redness occurred and resolved spontaneously without special treatment. The control group had 3 cases of local blisters and 4 cases of allergic reactions, with no serious complications such as compartment syndrome. See Table 5 [TABLE:5].

Table 5 Comparison of Complication Rates [n(%)]
| Complication | Observation Group | Control Group |
|--------------|-------------------|---------------|
| Tension blisters | 0 (0.0) | 3 (6.0) |
| Allergic reactions | 2 (4.0) | 4 (8.0) |
| Total complications | 2 (4.0) | 7 (14.0) |

Discussion

Transradial access for percutaneous coronary intervention is gradually becoming the preferred approach due to advantages including easy nursing care, minimal trauma, and rapid recovery, representing one of the recognized effective treatments for coronary heart disease [11]. However, due to the thin radial artery wall, small diameter, and susceptibility to spasm, transradial coronary intervention (TRI) can easily damage the radial artery [12]. Additionally, patients require long-term oral anticoagulants, which prolong coagulation time. Under these conditions, vascular injury, inaccurate puncture site compression, insufficient compression time, inadequate compression pressure, or postoperative antiplatelet drug use may dissolve newly formed blood clots on the arterial wall, increasing the risk of local hematoma and upper limb swelling [13]. When subcutaneous hematoma forms, the puncture site exhibits local swelling, pain symptoms, and varying degrees of ecchymosis [14], which can lead to local tissue ischemia, necrosis, thrombosis, and even upper limb dysfunction. Therefore, strengthened early nursing intervention for operative limb subcutaneous hematoma is essential.

Magnesium sulfate wet compress combined with hirudoid external application is currently the common method for treating limb swelling after coronary intervention. The hyperosmotic property of magnesium sulfate promotes gradual hematoma resolution, while magnesium ions dilate blood vessels, improve microcirculation, and exert anti-inflammatory effects to achieve swelling and pain relief [15]. Hirudoid ointment's main component is mucopolysaccharide polysulfate, which studies show can quickly penetrate skin and improve local circulation to accelerate edema and hematoma resolution without interfering with normal blood system function [16]. However, magnesium sulfate external application causes local skin dehydration and wrinkling, requires frequent gauze changes, and drug crystals can irritate and damage skin, affecting patient compliance [17]. Moreover, the onset time is long and symptom relief is slow, hindering postoperative recovery and necessitating more efficient treatment methods.

Traditional Chinese medicine holds that subcutaneous hematoma at puncture sites results from impaired local blood vessel circulation causing blood to overflow outside vessels and form subcutaneous stasis. Therefore, treatment follows principles of clearing heat and detoxifying, activating blood and resolving stasis, and unblocking collaterals to relieve pain [15]. Sanqi possesses dual hemostatic and blood-activating effects, effectively improving vascular endothelial function, inhibiting platelet aggregation, reducing blood viscosity, and improving local blood circulation to reduce swelling. It also has analgesic effects, as its ginsenoside Rg1 component can inhibit TRPV1-mediated skin keratinocyte responses, thereby relieving pain [18-19]. The six-step finger exercise uses "grasp, touch, count, press, extend, flick" movements to mobilize joints on the operative side, accelerating local blood circulation and metabolism, reducing nerve stimulation by inflammation, eliminating edema, and promoting early repair of damaged nerves and vessels. This effectively improves operative limb pain and swelling symptoms, reduces local vascular complications, and enhances postoperative comfort [20-21]. Therefore, Sanqi powder external application combined with six-step finger exercise can fully exert both pharmacological effects and early rehabilitation benefits, effectively reducing swelling and pain, resolving blood stasis, and shortening symptom improvement and pain disappearance time.

This study applied Sanqi powder external application combined with six-step finger exercise in clinical nursing care for patients with upper limb hematoma after coronary intervention. Results showed that on post-intervention days 2-6, the observation group exhibited significantly reduced operative limb arm circumference and obvious swelling reduction compared with the control group, with significantly superior hematoma regression time, pain scores (VAS), and comfort scores (GCQ) (all P<0.05). These findings demonstrate that Sanqi powder external application combined with six-step finger exercise can effectively relieve limb swelling after coronary intervention, reduce pain severity, and improve treatment efficacy.

In summary, intervention with Sanqi powder external application combined with six-step finger exercise in patients with upper limb hematoma after coronary intervention can effectively promote hematoma absorption, relieve pain symptoms, improve patient comfort, and reduce complication risk. However, due to limited sample size, future large-sample studies are needed to provide scientific evidence for improving intervention efficacy in patients with upper limb hematoma after coronary intervention.

References

[1] 刘明波,何新叶,杨晓红,等.《中国心血管健康与疾病报告 2023》概要（心血管疾病流行及介入诊疗状况）[J].中国介入心脏病学杂志,2024,32(10):541-550.
[2] 王彬.心脑血管类疾病治疗药物对老年慢性病的影响[J].中国医药工业杂志,2023,54(10):1528-1529.
[3] 高磊,刘昱圻,薛桥,田进文,王禹.高龄急性冠状动脉综合征经桡动脉冠状动脉介入治疗的疗效和安全性观察[J].中华医学杂志,2014,94(26):2025-2029.
[4] Neumann, Franz-Josef et al. "2018 ESC/EACTS Guidelines on myocardial revascularization." European heart journal vol. 40,2 (2019): 87-165.
[5] da Silva, Roberto L et al. "Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin: PATENS Trial." JACC. Cardiovascular interventions vol. 15,10 (2022): 1040-1049.
[6] 蔡丽梅.经桡动脉冠状动脉介入术后术肢肿胀的原因分析与对策[J].国际医药卫生导报,2018,24(10):1592-1594.
[7] 余天浩,李瑜辉.经桡动脉途径行冠状动脉造影和腔内成形术及其并发症处理[J].新医学,2012,43(04):231-234.
[8] 龙杰,劳小清,黄彩云.经皮冠状动脉介入治疗术后术肢血肿护理研究进展[J].中国药物经济学,2021,16(03):125-128.
[9] 赵振霞,耿莲,安丽康,等.三七粉及三七伤药片质量评价方法研究[J].中国现代中药,2025,27(04):742-749.
[10] 倪博然,赵进喜,黄为钧,等.基于视觉模拟评分法探究中医临床疗效评价新方法[J].中华中医药杂志,2021,36(1):288-292.
[11] KHAN MR, KAYANI WT, WAQAS A, et al. Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta-analysis and meta-regression[J]. Clin Cardiol, 2019, 42(11):1071-1078.
[12] 邓芸,陈宝峰,唐良秋,肖雨雄,陈锦峰,张子妍.超声引导在经桡动脉冠脉介入术后前臂血肿治疗中的应用[J].医学影像学杂志,2021,31(03):506-509.
[13] 任冬梅,鲍克娜,朱芳.中药芒硝冷敷对经桡动脉行冠状动脉造影术后血肿的应用效果观察[J].心脑血管病防治,2016,16(05):391-392.
[14] 黄新香,黄海奎,何龙先,吴春花,李香荣.云南白药气雾剂治疗冠心病介入术后术肢血肿的护理[J].世界最新医学信息文摘,2018,18(55):244-245.
[15] 姜旭,王亚楠,雷敏,等.从气不摄血辨治华法林致皮下血肿一例[J].环球中医药,2021,14(9):1688-1690.
[16] 芮玉兰,陈国琴.喜辽妥联合硫酸镁治疗前列地尔所致静脉炎的疗效分析[J].实用临床护理学电子杂志,2020,5(52):133.
[17] 黄宝如,霍燕嫦,龙洁莹,等.止痛消炎软膏联合喜辽妥治疗经桡动脉PCI术后皮下血肿的疗效观察[J].实用临床护理学电子杂志,2020,5(22):190-191.
[18] 周莹,李建军,黄巧娟.三七总皂苷对脂多糖诱导的THP-1源巨噬细胞炎症损伤的保护作用[J].中国临床药理学杂志,2018,34(22):2631-2635.
[19] 聂娟,唐标.基于系统药理学分析三七总皂苷干预脑血管疾病的作用机制[J].湖南中医药大学学报,2018,38(9):1032-1037.
[20] 梁菲,何妍臻.六步手指操改善经桡动脉介入术后患者肢体症状的效果评价[J].护理学杂志,2018,33(23):33-35.
[21] 刘珊珊,马玉娇,石凯婷.握力锻炼及手指操对经桡动脉行PCI术后患肢肿胀及血运的影响[J].护士进修杂志,2021,36(15):1424-1427+1432.