血府逐瘀汤联合低分子肝素钙预防全髋关节置换术后深静脉血栓
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摘要
目的观察应用血府逐瘀汤口服联合低分子肝素钙皮下注射预防全髋关节置换术后深静脉血栓的临床效果。方法筛选行单侧全髋关节置换术患者76例,随机分为2组,每组38例。对照组术后给予常规低分子肝素钙皮下注射,试验组除常规给予低分子肝素钙皮下注射外,另加血府逐瘀汤口服,用药时间为2周。比较2组患者术前、术后1、6、13dwells评分,D-二聚体、纤维蛋白原(Fg),活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)及下肢彩超,并记录2组的有效率和不良反应。结果对照组出现深静脉血栓3例,皮下出血2例,消化道出血1例,无肺动脉栓塞、呼吸衰竭发生;试验组出现深静脉血栓1例,皮下出血1例,无肺动脉栓塞、呼吸衰竭发生。2组间术后并发症比较(P>0.05)差异无统计学意义。试验组APTT、PT与术前比较,术后6、13 d均延迟,组间差别有统计意义(P<0.05);试验组D-二聚体、Fg与术前比较,术后6 d增高,与术后6 d相比,术后13 d下降,差异均有统计学意义(P<0.05);试验组wells评分≥3分例数与术前比较,术后6 d增加,与术后6 d相比,术后13 d下降,差异均具有统计学意义(P<0.05)。术后下肢B超确诊试验组发生1例股静脉血栓,1例皮下血肿,对照组发生2例股静脉血栓、1例腘静脉血栓,2例皮下血肿,各组间差异比较无统计学意义(P>0.05)。结论血府逐瘀汤联合低分子肝素钙预防全髋关节置换术后深静脉血栓的临床疗效确定,且可减少单纯使用低分子肝素钙的不良反应。
Objective To observe the application of Xuefu Zhuyu decoction combined low-molecularweight heparin calcium to prevent therapeutic clinical effect of deep vein thrombosis after total hip replacement. Methods Seventy-six patients who underwent unilateral THA were randomly divided into 2 groups, 38 cases in experimental group, and 38 cases in control group. The control group postoperatively was treated with low-molecular heparin calcium subcutaneous injections, on the basis of the control group, the experimental group was treated wit Xuefu Zhuyu decoction for two weeks. Compared the two groups of patients with preoperative and postoperative 1, 6, 13 Wells score, D-dimer, fibrinogen(Fg), activated partial prothrombin time(APTT), prothrombin time(PT) and lower limbs ultrasound, and record in the two groups of efficient and adverse reactions. Results The control group in deep vein thrombosis(3 cases), 2 cases of subcutaneous hemorrhage, 1 case of gastrointestinal bleeding, pulmonary embolism and respiratory failure occurred; The experimental group in deep vein thrombosis(1 case), subcutaneous bleeding in 1 case, pulmonary embolism and respiratory failure occurred. Compared the postoperative complications between the 2 groups(P > 0.05), there was no obvious diff erence. In the experimental group,in postoperative 6 d, 13 d,the APTT and PT were significantly prolonged, the diff erence had statistical significance between groups(P < 0.05); In postoperative 6 d,the D-D and Fg in the experimental group was significantly increased. Compared with the result in postoperative 6 days, the result on 13 d was significantly decreased. The diff erence was statistically significant(P < 0.05). The number of Wells score is greater than three points of experimental group in postoperative 6 d was increased,. Compared with the result in postoperative 6 days,the result on13 d was significantly decreased. The diff erence was statistically significant(P < 0.05). After the operation, in experimental group, 1 case of femoral vein thrombosis, 1 case of subcutaneous hematoma was diagnosed by the lower limb ultrasound, the control group occurred in 2 cases of femoral vein thrombosis, 1 case of popliteal vein thrombosis, 2 cases of subcutaneous hematoma, there was no obvious diff erence between the groups(P > 0.05). Conclusion The clinical curative effect of Xuefu Zhuyu decoction combined low-molecular-weight heparin calcium to prevent therapeutic clinical effect of deep vein thrombosis after total hip replacement is distinct, and it can reduce the adverse reactions of employing low-molecularweight heparin calcium alone.
Objective To observe the application of Xuefu Zhuyu decoction combined low-molecularweight heparin calcium to prevent therapeutic clinical effect of deep vein thrombosis after total hip replacement. Methods Seventy-six patients who underwent unilateral THA were randomly divided into 2 groups, 38 cases in experimental group, and 38 cases in control group. The control group postoperatively was treated with low-molecular heparin calcium subcutaneous injections, on the basis of the control group, the experimental group was treated wit Xuefu Zhuyu decoction for two weeks. Compared the two groups of patients with preoperative and postoperative 1, 6, 13 Wells score, D-dimer, fibrinogen(Fg), activated partial prothrombin time(APTT), prothrombin time(PT) and lower limbs ultrasound, and record in the two groups of efficient and adverse reactions. Results The control group in deep vein thrombosis(3 cases), 2 cases of subcutaneous hemorrhage, 1 case of gastrointestinal bleeding, pulmonary embolism and respiratory failure occurred; The experimental group in deep vein thrombosis(1 case), subcutaneous bleeding in 1 case, pulmonary embolism and respiratory failure occurred. Compared the postoperative complications between the 2 groups(P > 0.05), there was no obvious diff erence. In the experimental group,in postoperative 6 d, 13 d,the APTT and PT were significantly prolonged, the diff erence had statistical significance between groups(P < 0.05); In postoperative 6 d,the D-D and Fg in the experimental group was significantly increased. Compared with the result in postoperative 6 days, the result on 13 d was significantly decreased. The diff erence was statistically significant(P < 0.05). The number of Wells score is greater than three points of experimental group in postoperative 6 d was increased,. Compared with the result in postoperative 6 days,the result on13 d was significantly decreased. The diff erence was statistically significant(P < 0.05). After the operation, in experimental group, 1 case of femoral vein thrombosis, 1 case of subcutaneous hematoma was diagnosed by the lower limb ultrasound, the control group occurred in 2 cases of femoral vein thrombosis, 1 case of popliteal vein thrombosis, 2 cases of subcutaneous hematoma, there was no obvious diff erence between the groups(P > 0.05). Conclusion The clinical curative effect of Xuefu Zhuyu decoction combined low-molecular-weight heparin calcium to prevent therapeutic clinical effect of deep vein thrombosis after total hip replacement is distinct, and it can reduce the adverse reactions of employing low-molecularweight heparin calcium alone.
引文
[1]岑光荣.抗凝药物对全髋关节置换术后隐性失血的隐性[J].中医正骨,2013,25(11):23-24.
[2]Wells P S,Anderson D R,Bormanis J,et al.Value of assessment of pre-test probability of deep vein thrombosis in clinical management[J].Lancet,1997,350(9094):1795-1798.
[3]赵慧茹.血浆D-二聚体和纤维蛋白原对全膝关节置换术后急性下肢深静脉血栓形成的诊断价值[J].医学研究杂志,2013,42(11):87-88.
[4]董嘉尧.临床评分表及血清学标记物对深静脉血栓诊断和治疗的临床意义[D].广州:南方医科大学,2016.
[5]李文龙.活血通络膏联合低分子肝素钙预防全髋关节置换术后深静脉血栓形成的临床观察[J].中国中医急症,2017,26(2):339-340.
[6]刘剑刚,董国菊.血府逐瘀口服液对冠心病心绞痛患者血小板活化分子表达的影响[J].长春中医药大学学报,2007,23(1):29-31.
[7]孙文军,唐启盛.从血府逐瘀汤看王清任治疗焦虑症的思想[J].吉林中医药,2011,1(31):1-3.
[8]易详明.血府逐瘀汤治疗四肢骨折临床研究[J].亚太传统医药,2015,11(8):111-112.
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[11]张建方,金国强.补阳还五汤加减预防髋关节置换术后深静脉血栓形成的临床研究[J].中医正骨,2013,25(2):19-21.
[12]刘姣,季晓军,金英杰,等.产后早期足三里、三阴交穴位注射促产妇乳汁分泌疗效观察[J].浙江中西医结合杂志,2014,24(8):697-699.
[13]万爱雪,林恩胡,郭秀媚.血府逐瘀汤加减联合穴位艾灸预防股骨颈骨折术后下肢深静脉血栓80例观察[J].新中医,2015,47(9):240-242.
[14]曾武,刘晋闽.血府逐瘀汤加减治疗cotton骨折术后的疗效观察[J].广西中医药大学学报,2014,17(4):32-34.
[15]郭昌军.创伤骨折并发下肢深静脉血栓的危险因素探讨[J].北方药学,2013,10(8):99-100.
[16]张佳宇,任明彪,陈先久.血府逐瘀汤治疗肋骨骨折的临床研究[J].中医临床研究,2012,4(12):13-14.
[17]陈超.血府逐瘀汤预防全髋关节置换术后下肢静脉血栓疗效观察[J].新中医,2014,46(8):98-100.
[18]尹爱武,黄赛金.血府逐瘀汤化学成分研究[J].中药材,2011,34(10):1553-1554.
[19]张力.血府逐瘀汤加味煮散治疗深静脉血栓形成临床研究[J].辽宁中医药大学学报,2016,18(1):11-12.
[2]Wells P S,Anderson D R,Bormanis J,et al.Value of assessment of pre-test probability of deep vein thrombosis in clinical management[J].Lancet,1997,350(9094):1795-1798.
[3]赵慧茹.血浆D-二聚体和纤维蛋白原对全膝关节置换术后急性下肢深静脉血栓形成的诊断价值[J].医学研究杂志,2013,42(11):87-88.
[4]董嘉尧.临床评分表及血清学标记物对深静脉血栓诊断和治疗的临床意义[D].广州:南方医科大学,2016.
[5]李文龙.活血通络膏联合低分子肝素钙预防全髋关节置换术后深静脉血栓形成的临床观察[J].中国中医急症,2017,26(2):339-340.
[6]刘剑刚,董国菊.血府逐瘀口服液对冠心病心绞痛患者血小板活化分子表达的影响[J].长春中医药大学学报,2007,23(1):29-31.
[7]孙文军,唐启盛.从血府逐瘀汤看王清任治疗焦虑症的思想[J].吉林中医药,2011,1(31):1-3.
[8]易详明.血府逐瘀汤治疗四肢骨折临床研究[J].亚太传统医药,2015,11(8):111-112.
[9]顿宝生,周永学.方剂学[M].北京:中国中医药出版社,2012.
[10]钟赣生,中药学[M].3版.北京:中国中医药出版社,2012.
[11]张建方,金国强.补阳还五汤加减预防髋关节置换术后深静脉血栓形成的临床研究[J].中医正骨,2013,25(2):19-21.
[12]刘姣,季晓军,金英杰,等.产后早期足三里、三阴交穴位注射促产妇乳汁分泌疗效观察[J].浙江中西医结合杂志,2014,24(8):697-699.
[13]万爱雪,林恩胡,郭秀媚.血府逐瘀汤加减联合穴位艾灸预防股骨颈骨折术后下肢深静脉血栓80例观察[J].新中医,2015,47(9):240-242.
[14]曾武,刘晋闽.血府逐瘀汤加减治疗cotton骨折术后的疗效观察[J].广西中医药大学学报,2014,17(4):32-34.
[15]郭昌军.创伤骨折并发下肢深静脉血栓的危险因素探讨[J].北方药学,2013,10(8):99-100.
[16]张佳宇,任明彪,陈先久.血府逐瘀汤治疗肋骨骨折的临床研究[J].中医临床研究,2012,4(12):13-14.
[17]陈超.血府逐瘀汤预防全髋关节置换术后下肢静脉血栓疗效观察[J].新中医,2014,46(8):98-100.
[18]尹爱武,黄赛金.血府逐瘀汤化学成分研究[J].中药材,2011,34(10):1553-1554.
[19]张力.血府逐瘀汤加味煮散治疗深静脉血栓形成临床研究[J].辽宁中医药大学学报,2016,18(1):11-12.