祛瘀生新汤联合利伐沙班预防全膝关节置换术后下肢深静脉血栓的疗效及对血液流变学的影响
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摘要
目的:探讨祛瘀生新汤联合利伐沙班预防全膝关节置换术后下肢深静脉血栓的疗效及其对患者血液流变学的影响。方法:92例全膝关节置换术患者作为研究对象,采用抽签法将上述患者分为观察组及对照组,每组46例。所有患者均接受全膝关节置换术治疗,术后均进行戒酒、戒烟、控制血脂等常规治疗。对照组同时给予利伐沙班,每次1片,每日1次。观察组在对照组基础上另给予祛瘀生新汤治疗,每日1剂。术后14 d,观察两组患者下肢深静脉血栓的发生率。术后1 d及术后14 d,分别检测两组患者血液流变学指标(血浆黏度、红细胞压积、血小板黏附率及全血高切黏度),凝血指标[D-二聚体(D-D)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)及凝血酶时间(TT)],炎性因子[C反应蛋白(CRP)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)],大腿周径差及小腿周径差。结果:术后14 d,观察组下肢深静脉血栓发生率为4.3%,明显低于对照组的15.2%(P<0.05)。术后14 d,观察组血浆黏度、红细胞压积、血小板黏附率及全血高切黏度水平分别为(1.32±0.16)mPa/s、(36.34±3.53)%、(25.34±2.76)%及(2.91±0.28)mPa/s,均明显低于对照组(P<0.05)。术后14 d,观察组D-D、FIB、APTT及TT等凝血指标,CRP、IL-8及TNF-α等炎性因子水平、大腿周径差及小腿周径差均明显低于对照组(P<0.05)。结论:祛瘀生新汤联合利伐沙班可较好的防止全膝关节置换术后出现下肢深静脉血栓,能够有效改善患者血液高凝状态,值得进行深入研究。
Objective: To study the clinical efficacy of Quyu Shengxin Decoction and rivaroxaban in the prevention of deep venous thrombosis of lower extremities after total knee arthroplasty. Methods: Ninety-two patients with total knee arthroplasty were randomly divided into observation group and control group,46 cases in each group. The patients were treated by regular treatment,such as quit drinking,quit smoking and control blood lipid,while control group was further treated by rivaroxaban( 1 time/day,1 tablet/time). The observation group was treated by Quyu Shengxin Decoction on the basis of control group( 1 dose/day). The effects were observed in the 2 groups 14 days after the surgery. The levels of hemorheology index( plasma viscosity,erythrocyte deposited,platelet adhesion rate and whole blood high shear viscosity),coagulation index( D-D,FIB,APTT and TT),inflammatory factors( CRP,IL-8 and TNF-α),thigh diameter and shank diameter in the two groups were detected 14 days after the surgery. Results: The deep venous thrombosis rate in the observation group was 4. 3%,significantly lower than 15. 2% in the control group( P < 0. 05). 14 days after the surgery,the levels of plasma viscosity,erythrocyte deposited,platelet adhesion rate and whole blood high shear viscosity were( 1. 32 ± 0. 16) mPa/s,( 36. 34 ± 3. 53) %,( 25. 34 ± 2. 76) % and( 2. 91 ± 0. 28) mPa/s in observation group,significantly lower than those of the control group( P < 0. 05),while the levels of D-D,FIB,APTT,TT,CRP,IL-8 and TNF-α,thigh diameter and shank diameter were significantly lower than those of the control group( P < 0. 05).Conclusions: The method of Quyu Shengxin Decoction and rivaroxaban in the prevention of deep venous thrombosis of lower extremities after total knee arthroplasty has a good clinical efficacy and could significantly promote the hypercoagulable state.
Objective: To study the clinical efficacy of Quyu Shengxin Decoction and rivaroxaban in the prevention of deep venous thrombosis of lower extremities after total knee arthroplasty. Methods: Ninety-two patients with total knee arthroplasty were randomly divided into observation group and control group,46 cases in each group. The patients were treated by regular treatment,such as quit drinking,quit smoking and control blood lipid,while control group was further treated by rivaroxaban( 1 time/day,1 tablet/time). The observation group was treated by Quyu Shengxin Decoction on the basis of control group( 1 dose/day). The effects were observed in the 2 groups 14 days after the surgery. The levels of hemorheology index( plasma viscosity,erythrocyte deposited,platelet adhesion rate and whole blood high shear viscosity),coagulation index( D-D,FIB,APTT and TT),inflammatory factors( CRP,IL-8 and TNF-α),thigh diameter and shank diameter in the two groups were detected 14 days after the surgery. Results: The deep venous thrombosis rate in the observation group was 4. 3%,significantly lower than 15. 2% in the control group( P < 0. 05). 14 days after the surgery,the levels of plasma viscosity,erythrocyte deposited,platelet adhesion rate and whole blood high shear viscosity were( 1. 32 ± 0. 16) mPa/s,( 36. 34 ± 3. 53) %,( 25. 34 ± 2. 76) % and( 2. 91 ± 0. 28) mPa/s in observation group,significantly lower than those of the control group( P < 0. 05),while the levels of D-D,FIB,APTT,TT,CRP,IL-8 and TNF-α,thigh diameter and shank diameter were significantly lower than those of the control group( P < 0. 05).Conclusions: The method of Quyu Shengxin Decoction and rivaroxaban in the prevention of deep venous thrombosis of lower extremities after total knee arthroplasty has a good clinical efficacy and could significantly promote the hypercoagulable state.
引文
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[6]陈俊南,唐赢,易刚,等.利伐沙班和依诺肝素预防人工膝关节置换术后下肢深静脉血栓的临床研究[J].中国临床药理学杂志,2016,32(2):108-110.
[7]王静华,刘武岩,谢博多,等.推拿配合持续冰敷对全膝关节置换术后康复及预防下肢深静脉血栓形成的效果[J].世界中医药,2017,12(6):1432-1435.
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[12]白斗,蒋岚杉,武少辉,等.脉络疏通颗粒联合利伐沙班治疗下肢深静脉血栓患者的疗效及对血液流变学、炎性因子的影响[J].疑难病杂志,2017,16(2):164-167.
[13]李春亮,李钊伟.低分子肝素联合中药离子导入预防老年膝关节置换术后下肢深静脉血栓的疗效[J].中国老年学杂志,2015,35(13):3671-3673.
[14]王彬,刘明,郝清智,等.中药调节Th1/Th2免疫平衡在下肢深静脉血栓形成治疗中的作用[J].中国中西医结合外科杂志,2013,19(4):355-358.
[15]张琪,张曦.人工关节置换术后下肢深静脉血栓的预防与治疗[J].长春中医药大学学报,2015,31(1):180-183.
[16]常征,王小平.中西医结合治疗下肢深静脉血栓形成后综合征[J].中医学报,2014,29(5):743-745.
[17]陆南山.中医治疗下肢深静脉血栓形成进展[J].中医临床研究,2017,9(10):146-148.
[18]曹桑,陈应隆.清热利湿活血法联合尿激酶、肝素钙及肠溶阿司匹林治疗下肢深静脉血栓的临床观察[J].中国中医急症,2014,23(11):2108-2110.
[19]全雨峰.自拟祛瘀生新汤对冠心病心绞痛患者血清NO及血管新生相关因子的影响[J].四川中医,2016,34(12):65-68.
[20]张炜,蒋海燕.祛瘀生新方对慢性间歇性缺氧所致氧化应激及炎症反应作用研究[J].北京中医药,2017,36(4):291-294.
[21]易春智,陈锦伦,李肇宏,等.利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响[J].中医正骨,2016,28(1):17-19.
[22]黄健斌,曾采采,丁悦,等.利伐沙班与低分子肝素预防髋关节置换术后深静脉血栓形成的疗效对比[J].中国新药与临床杂志,2011,30(4):255-259.
[23]刘会娟,耿树岩,王海涛.中西药预防下肢深静脉血栓形成血液流变学对比[J].中国矫形外科杂志,2015,23(9):856-585.
[24]白文斌,王凯,韩生寿,等.苦碟子加利伐沙班预防TKA术后下肢深静脉血栓形成及对血液流变学和炎性因子的影响[J].实用骨科杂志,2016,22(1):25-27.
[25]赵炜.推拿对膝关节置换术后患者康复以及D-二聚体水平的影响观察[J].云南中医中药杂志,2015,36(7):47-48.
[26]李晓鸥,吴雪峰,李艳,等.血浆纤维蛋白原和D-二聚体检测在肿瘤患者深静脉血栓形成中的应用价值[J].中国实验诊断学,2015,19(2):277-279.
[27]丁萌,张青云,景阳,等.炎性反应因子及凝血因子在下肢深静脉血栓形成中作用和相关性分析[J].临床军医杂志,2016,44(11):1175-1177.
[2]邱雪庆.活血祛瘀汤预防髋关节置换术后并发症的临床疗效观察[J].中华中医药学刊,2015,33(11):2812-2813.
[3]Ola Rolfson,Eric Bohm,Patricia Franklin,et al.Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II.Recommendations for selection,administration,and analysis[J].Acta Orthop,2016,87(Suppl 1):9-23.
[4]曾庆.银杏达莫注射液预防膝关节置换术后深静脉血栓形成[J].长春中医药大学学报,2016,32(5):1019-1021.
[5]赵建刚,李海金,李英.苦碟子预防恶性肿瘤化疗后并发下肢深静脉血栓的临床研究[J].中华中医药学刊,2015,33(10):2455-2457.
[6]陈俊南,唐赢,易刚,等.利伐沙班和依诺肝素预防人工膝关节置换术后下肢深静脉血栓的临床研究[J].中国临床药理学杂志,2016,32(2):108-110.
[7]王静华,刘武岩,谢博多,等.推拿配合持续冰敷对全膝关节置换术后康复及预防下肢深静脉血栓形成的效果[J].世界中医药,2017,12(6):1432-1435.
[8]Lin WY,Lee CC,Hsu CW,et al.Patients with knee osteoarthritis undergoing total knee arthroplasty have a lower risk of subsequent severe cardiovascular events:propensity score and instrumental variable analysis[J].PLo S One,2015,10:e127454.
[9]刘旭,姚尧,戎朕,等.全膝关节置换术后下肢深静脉血栓发生的时间分布[J].中国矫形外科杂志,2015,23(11):991-995.
[10]Przemysaw Tomasz Paradowski,Rafa Keska,Dariusz Witoński.Validation of the Polish version of the Knee injury and Osteoarthritis Outcome Score(KOOS)in patients with osteoarthritis undergoing total knee replacement[J].BMJ Open,2015,5(7):e006947.
[11]俞斌,季英,禹宝庆.下肢深静脉血栓的诊断及治疗进展[J].中国骨与关节损伤杂志,2017,32(1):109-111.
[12]白斗,蒋岚杉,武少辉,等.脉络疏通颗粒联合利伐沙班治疗下肢深静脉血栓患者的疗效及对血液流变学、炎性因子的影响[J].疑难病杂志,2017,16(2):164-167.
[13]李春亮,李钊伟.低分子肝素联合中药离子导入预防老年膝关节置换术后下肢深静脉血栓的疗效[J].中国老年学杂志,2015,35(13):3671-3673.
[14]王彬,刘明,郝清智,等.中药调节Th1/Th2免疫平衡在下肢深静脉血栓形成治疗中的作用[J].中国中西医结合外科杂志,2013,19(4):355-358.
[15]张琪,张曦.人工关节置换术后下肢深静脉血栓的预防与治疗[J].长春中医药大学学报,2015,31(1):180-183.
[16]常征,王小平.中西医结合治疗下肢深静脉血栓形成后综合征[J].中医学报,2014,29(5):743-745.
[17]陆南山.中医治疗下肢深静脉血栓形成进展[J].中医临床研究,2017,9(10):146-148.
[18]曹桑,陈应隆.清热利湿活血法联合尿激酶、肝素钙及肠溶阿司匹林治疗下肢深静脉血栓的临床观察[J].中国中医急症,2014,23(11):2108-2110.
[19]全雨峰.自拟祛瘀生新汤对冠心病心绞痛患者血清NO及血管新生相关因子的影响[J].四川中医,2016,34(12):65-68.
[20]张炜,蒋海燕.祛瘀生新方对慢性间歇性缺氧所致氧化应激及炎症反应作用研究[J].北京中医药,2017,36(4):291-294.
[21]易春智,陈锦伦,李肇宏,等.利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响[J].中医正骨,2016,28(1):17-19.
[22]黄健斌,曾采采,丁悦,等.利伐沙班与低分子肝素预防髋关节置换术后深静脉血栓形成的疗效对比[J].中国新药与临床杂志,2011,30(4):255-259.
[23]刘会娟,耿树岩,王海涛.中西药预防下肢深静脉血栓形成血液流变学对比[J].中国矫形外科杂志,2015,23(9):856-585.
[24]白文斌,王凯,韩生寿,等.苦碟子加利伐沙班预防TKA术后下肢深静脉血栓形成及对血液流变学和炎性因子的影响[J].实用骨科杂志,2016,22(1):25-27.
[25]赵炜.推拿对膝关节置换术后患者康复以及D-二聚体水平的影响观察[J].云南中医中药杂志,2015,36(7):47-48.
[26]李晓鸥,吴雪峰,李艳,等.血浆纤维蛋白原和D-二聚体检测在肿瘤患者深静脉血栓形成中的应用价值[J].中国实验诊断学,2015,19(2):277-279.
[27]丁萌,张青云,景阳,等.炎性反应因子及凝血因子在下肢深静脉血栓形成中作用和相关性分析[J].临床军医杂志,2016,44(11):1175-1177.