川芎嗪注射液联合利伐沙班对股骨颈骨折经髋关节置换术后下肢深静脉血栓形成的预防作用及对患者D-二聚体、IL-6、IL-10水平的影响
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摘要
目的探讨川芎嗪注射液联合利伐沙班对股骨颈骨折经髋关节置换术后下肢深静脉血栓形成(DVT)的预防作用及对患者D-二聚体、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平的影响。方法 2017年1月—2018年10月宜昌市第一人民医院收治120例股骨颈骨折并行髋关节置换术,随机分为利伐沙班组和川芎嗪注射液联合利伐沙班组,每组各60例。利伐沙班组中男性35例,女性25例;年龄46～76岁,平均66.7岁。川芎嗪注射液联合利伐沙班组中男性32例,女性28例,年龄44～74岁,平均66.1岁。术后,常规基础上,利伐沙班组给予利伐沙班治疗,川芎嗪注射液联合利伐沙班组给予川芎嗪注射液联合利伐沙班治疗。比较两组患者下肢DVT发生率、血浆D-二聚体水平、血清IL-6、IL-10等炎性因子水平及不良反应发生情况。结果术后2周,川芎嗪注射液联合利伐沙班组患者下肢DVT发生率低于利伐沙班组(6.7%vs. 20.0%,P<0.05)。术后2周,与利伐沙班组相比,川芎嗪注射液联合利伐沙班组患者血浆D-二聚体、血清IL-6水平降低,血清IL-10水平升高,组间比较差异有统计学意义(P均<0.05)。药物应用过程中,两组患者不良反应发生率组间比较差异无统计学意义(13.3%vs. 16.7%,P>0.05)。结论川芎嗪注射液联合利伐沙班能够有效预防股骨颈骨折患者经髋关节置换术后下肢DVT发生,明显降低术后血浆D-二聚体水平,改善相关炎性因子水平,且不增加不良反应发生率,临床上值得应用。
Objective To investigate the prevention effect of chuanxiongqin injection in combination with rivaroxaban in the prevention of deep venous thrombosis(DVT) of lower extremity after operation of hip replacement and its influences on levels of D-Dimer,interleukin 6(IL-6) and interleukin 10( IL-10). Methods Totally 120 patients who received hip replacement were collected as observational objects and randomly divided into the control group and the observation group with 60 cases in each group. In the obsevation group,there were 35 males and 25 females aged 66.7(46-76) years. In the control group,there were 32 males and 28 females aged 66.1(44-74) years.After operation,besides conventional treatments,the control group was given rivaroxaban,while the observation group was given chuanxiongqin injection in combination with rivaroxaban. Incidences of DVT of lower extremity,levels of plasma D-Dimer,serum inflammatory factors of IL-6,IL-10 and adverse reactions were compared between the two groups. Results Two weeks after operation,the incidence of DVT of lower extremity in the observation group was statistically lower than that in the control group(6.7% vs. 20.0%,P<0.05). Two weeks after operation,in comparison with the control group,the observation group had lower levels of plasma D-Dimer,serum IL-6 and higher level of serum IL-10 with all statistical differences(all P<0.05). During the application of drugs,the incidences of adverse reactions in the control group and the observation group were statistically same(13.3% vs. 16.7%,P>0.05). Conclusion Chuanxiongqin injection in combination with rivaroxaban can effectively prevent the incidence of DVT of lower extremity after hip replacement. And it can significantly reduce level of plasma D-Dimer and improve levels of related inflammatory factors without increasing incidence of adverse reactions.
Objective To investigate the prevention effect of chuanxiongqin injection in combination with rivaroxaban in the prevention of deep venous thrombosis(DVT) of lower extremity after operation of hip replacement and its influences on levels of D-Dimer,interleukin 6(IL-6) and interleukin 10( IL-10). Methods Totally 120 patients who received hip replacement were collected as observational objects and randomly divided into the control group and the observation group with 60 cases in each group. In the obsevation group,there were 35 males and 25 females aged 66.7(46-76) years. In the control group,there were 32 males and 28 females aged 66.1(44-74) years.After operation,besides conventional treatments,the control group was given rivaroxaban,while the observation group was given chuanxiongqin injection in combination with rivaroxaban. Incidences of DVT of lower extremity,levels of plasma D-Dimer,serum inflammatory factors of IL-6,IL-10 and adverse reactions were compared between the two groups. Results Two weeks after operation,the incidence of DVT of lower extremity in the observation group was statistically lower than that in the control group(6.7% vs. 20.0%,P<0.05). Two weeks after operation,in comparison with the control group,the observation group had lower levels of plasma D-Dimer,serum IL-6 and higher level of serum IL-10 with all statistical differences(all P<0.05). During the application of drugs,the incidences of adverse reactions in the control group and the observation group were statistically same(13.3% vs. 16.7%,P>0.05). Conclusion Chuanxiongqin injection in combination with rivaroxaban can effectively prevent the incidence of DVT of lower extremity after hip replacement. And it can significantly reduce level of plasma D-Dimer and improve levels of related inflammatory factors without increasing incidence of adverse reactions.
引文
[1] Hofstede SN,Gademan MGJ,Vlieland TPMV,et al.Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis:a systematic review[J].BMC Musculoskeletal Disorders,2016,17:212.
[2] Raslan AM,Fields JD,Bhardwaj A.Prophylaxis for venous thrombo-embolism in neurocritical care:a critical appraisal[J].Neurocriti Care,2010,12(2):297-309.
[3] 孙少君,王晓明.Wells评分联合D-二聚体预测下肢深静脉血栓的价值[J].实用医学杂志,2016,32(1):98-101.
[4] 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.
[5] 刘秀,陈跃鑫,曾嵘,等.利伐沙班与华法林治疗下肢深静脉血栓的临床效果对比[J].中华普通外科杂志,2017,32(6):512-515.
[6] 李勤.川芎嗪注射液的药理作用和临床应用[J].医学综述,2009,15(9):1402-1405.
[7] 赵希铭,张国秋,张广源.低分子量肝素预防老年人工全髋关节置换术后下肢深静脉血栓形成的疗效及对血浆D-二聚体含量的影响[J].中国老年学杂志,2017,37(1):152-153.
[8] 程艳秋.预防下肢深静脉血栓护理流程联合利伐沙班在髋关节置换手术患者中的应用效果[J].河北医学,2016,22(4):618-620.
[9] Chahal GS,Saithna A,Brewster M,et al.A comparison of complications requiring return to theatre in hip and knee arthroplasty patients taking enoxaparin versus rivaroxaban for thromboprophylaxis[J].Orthop Traumatol Rehabil,2013,15(2):125-129.
[10] 杨凯,蔡庆丰,范建荣.川芎嗪注射液联合常规疗法对大面积脑栓塞患者支架植入术后血小板血流变学及疗效的影响[J].中国药师,2016,19(11):2078-2080.
[11] 黎先萍,李娟.血清D-二聚体、同型半胱氨酸及Wells评分对剖宫产术后并发下肢深静脉血栓的临床预判价值[J].现代预防医学,2017,44(22):188-191.
[12] 袁国伟,王步云,巫水周,等.低分子肝素对老年髋部骨折患者术前下肢深静脉血栓及D-二聚体水平的影响[J].中国老年学杂志,2014,9(13):3617-3619.
[13] 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与相关性分析[J].临床军医杂志,2016,44(11):1175-1177.
[14] 丁萌,张青云,景阳,等.C-反应蛋白、白介素-6和D-二聚体在下肢深静脉血栓形成患者干预前后血清中的表达及意义[J].中国实验诊断学,2017,21(1):63-65.
[15] 黄荣,李梦帆,黄毅.深静脉血栓患者血清炎症因子水平与血管损伤程度的关系[J].山东医药,2016,56(44):58-60.
[16] 刘晓毅,杨林,祁光裕,等.白介素、C-反应蛋白和纤维蛋白原在下肢深静脉血栓炎症反应中的作用[J].中国普外基础与临床杂志,2010,17(7):660-663.
[2] Raslan AM,Fields JD,Bhardwaj A.Prophylaxis for venous thrombo-embolism in neurocritical care:a critical appraisal[J].Neurocriti Care,2010,12(2):297-309.
[3] 孙少君,王晓明.Wells评分联合D-二聚体预测下肢深静脉血栓的价值[J].实用医学杂志,2016,32(1):98-101.
[4] 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.
[5] 刘秀,陈跃鑫,曾嵘,等.利伐沙班与华法林治疗下肢深静脉血栓的临床效果对比[J].中华普通外科杂志,2017,32(6):512-515.
[6] 李勤.川芎嗪注射液的药理作用和临床应用[J].医学综述,2009,15(9):1402-1405.
[7] 赵希铭,张国秋,张广源.低分子量肝素预防老年人工全髋关节置换术后下肢深静脉血栓形成的疗效及对血浆D-二聚体含量的影响[J].中国老年学杂志,2017,37(1):152-153.
[8] 程艳秋.预防下肢深静脉血栓护理流程联合利伐沙班在髋关节置换手术患者中的应用效果[J].河北医学,2016,22(4):618-620.
[9] Chahal GS,Saithna A,Brewster M,et al.A comparison of complications requiring return to theatre in hip and knee arthroplasty patients taking enoxaparin versus rivaroxaban for thromboprophylaxis[J].Orthop Traumatol Rehabil,2013,15(2):125-129.
[10] 杨凯,蔡庆丰,范建荣.川芎嗪注射液联合常规疗法对大面积脑栓塞患者支架植入术后血小板血流变学及疗效的影响[J].中国药师,2016,19(11):2078-2080.
[11] 黎先萍,李娟.血清D-二聚体、同型半胱氨酸及Wells评分对剖宫产术后并发下肢深静脉血栓的临床预判价值[J].现代预防医学,2017,44(22):188-191.
[12] 袁国伟,王步云,巫水周,等.低分子肝素对老年髋部骨折患者术前下肢深静脉血栓及D-二聚体水平的影响[J].中国老年学杂志,2014,9(13):3617-3619.
[13] 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与相关性分析[J].临床军医杂志,2016,44(11):1175-1177.
[14] 丁萌,张青云,景阳,等.C-反应蛋白、白介素-6和D-二聚体在下肢深静脉血栓形成患者干预前后血清中的表达及意义[J].中国实验诊断学,2017,21(1):63-65.
[15] 黄荣,李梦帆,黄毅.深静脉血栓患者血清炎症因子水平与血管损伤程度的关系[J].山东医药,2016,56(44):58-60.
[16] 刘晓毅,杨林,祁光裕,等.白介素、C-反应蛋白和纤维蛋白原在下肢深静脉血栓炎症反应中的作用[J].中国普外基础与临床杂志,2010,17(7):660-663.