桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成随机平行对照研究
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摘要
[目的]观察桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成效果。[方法]使用随机平行对照方法,将30例住院患者按病志号抽签方法简单随机分两组;术前均牵引治疗,肿胀消退软组织条件好转行切开复位内固定术;多腔室空气压力治疗仪对患肢足、小腿中上段、大腿多室交替使用,避开骨折踝关节周围,2h/d。对照组15例LMWH,脐周皮下注射5000U/12h,直至术后第10天。治疗组15例桃红四物汤(桃仁、红花各10g,熟地黄、白芍、当归、川芎各15g),1剂/d,水煎300m L,早晚口服;西药治疗同对照组。连续治疗10d为1疗程。观测临床症状、动态监测凝血酶原(PT)、活化部分凝血活酶时间(APTT)、血小板计数、不良反应。治疗1疗程,判定疗效。[结果]PT、APTT、血小板检测结果两组均有改善(P<0.05),两组间无明显差异(P>0.05)。静脉血栓总发病率治疗组低于对照组(P<0.05)。[结论]桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成,疗效满意,无严重不良反应,值得推广。
[Objective]To explore the clinical prevention and curative effects and usage safety of Taohong Siwu Decoction combined with low molecular weight heparin calcium for DVT caused by pilon fracture.[Methods]The randomized parallel trial of retrospective analysis of case notes were performed,through reviewing 30 patients' clinical records that diagnosed as pilon fractures during the period of 2012 to 2014.30 patients were divided into 2 groups according to the random drawing lots.Both groups would be treated with traction treatment,the operation started when the swollen symptoms disappeared.Besides,we also applied the intermittent pneumatic compression treatment for the fractured leg and try to avoid the fracture bone area during the period inside the hospital.The intermittent pneumatic compression treatment lasts 2h/day.The routine low molecular weight heparin calcium treatment for 15 patients is the control group with subcutaneous injection 5000U/12 h until 10 days after operation.Taohong Siwu Decoction combined with low molecular weight heparin calcium treatment for 15 patients as the treatment group.The coagulation indicators,DVT incidence and the safety indicators were observed at day 7 and day 10 for both groups.[Results]Both groups have improvement for the PT/APTT/Platelet detection(P<0.05,P<0.01),however there were no statistical differences for both groups of the PT and APTT detection(P>0.05).The total vein thrombosis incidence in group A is 6.25% while group B is around 21.43%(P<0.05).[Conclusion]The prevention and curative effects of Taohong Siwu Decoction combined with low molecular weight heparin calcium is much better for DVT caused by pilon fracture when compared with the rountine low molecular weight heparin calcium treated only.And the combined treatment has no severe side effects and should be applied to the clinical treatment.
[Objective]To explore the clinical prevention and curative effects and usage safety of Taohong Siwu Decoction combined with low molecular weight heparin calcium for DVT caused by pilon fracture.[Methods]The randomized parallel trial of retrospective analysis of case notes were performed,through reviewing 30 patients' clinical records that diagnosed as pilon fractures during the period of 2012 to 2014.30 patients were divided into 2 groups according to the random drawing lots.Both groups would be treated with traction treatment,the operation started when the swollen symptoms disappeared.Besides,we also applied the intermittent pneumatic compression treatment for the fractured leg and try to avoid the fracture bone area during the period inside the hospital.The intermittent pneumatic compression treatment lasts 2h/day.The routine low molecular weight heparin calcium treatment for 15 patients is the control group with subcutaneous injection 5000U/12 h until 10 days after operation.Taohong Siwu Decoction combined with low molecular weight heparin calcium treatment for 15 patients as the treatment group.The coagulation indicators,DVT incidence and the safety indicators were observed at day 7 and day 10 for both groups.[Results]Both groups have improvement for the PT/APTT/Platelet detection(P<0.05,P<0.01),however there were no statistical differences for both groups of the PT and APTT detection(P>0.05).The total vein thrombosis incidence in group A is 6.25% while group B is around 21.43%(P<0.05).[Conclusion]The prevention and curative effects of Taohong Siwu Decoction combined with low molecular weight heparin calcium is much better for DVT caused by pilon fracture when compared with the rountine low molecular weight heparin calcium treated only.And the combined treatment has no severe side effects and should be applied to the clinical treatment.
引文
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[4]Testroote M,Stigter W,De Visser D C,et al.Low molecular weight heparin for prevention of venous thromboembolism in patients with lower leg immobilization[J].Cochrane Database of Systematic Reviews,2014(4):1-9.
[5]Sergio Siragusa,Benilde Cosmi,Franco Piovella,et al.Low-molecularweight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism:Results of a metaanalysis[J].The American Journal of Medicine,1996,100(3):269-277.
[6]Scurr JH,Coleridge-Smith PD,Hasty JH.Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis[J].Surgery,1987,102(5):816-820.
[7]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2012-02-05].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[8]池明宇.中西医结合血栓病学[M].北京:人民卫生出版社,2004:443-444.
[9]单德成.《医宗金鉴》对伤科学的贡献[J].江苏中医,1988(01).
[10]中华医学会骨科学分会.预防骨科大手术后深静脉血栓形成的专家建议[J].中华骨科杂志,2005,25:636-640.
[2]Merli,G.J.Deep vein thrombosis and pulmonary embolism prophylaxis in orthopedic surgery[J].Med Clin North Am,1993,77:397-411.
[3]陆芸,马宝通,郭若霖,等.骨科创伤患者深静脉血栓危险因素的研究[J].中华骨科杂志,2007,27(9):693-698.
[4]Testroote M,Stigter W,De Visser D C,et al.Low molecular weight heparin for prevention of venous thromboembolism in patients with lower leg immobilization[J].Cochrane Database of Systematic Reviews,2014(4):1-9.
[5]Sergio Siragusa,Benilde Cosmi,Franco Piovella,et al.Low-molecularweight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism:Results of a metaanalysis[J].The American Journal of Medicine,1996,100(3):269-277.
[6]Scurr JH,Coleridge-Smith PD,Hasty JH.Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis[J].Surgery,1987,102(5):816-820.
[7]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2012-02-05].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[8]池明宇.中西医结合血栓病学[M].北京:人民卫生出版社,2004:443-444.
[9]单德成.《医宗金鉴》对伤科学的贡献[J].江苏中医,1988(01).
[10]中华医学会骨科学分会.预防骨科大手术后深静脉血栓形成的专家建议[J].中华骨科杂志,2005,25:636-640.