丹参多酚酸盐联合低分子肝素钙治疗ICU气滞血瘀型下肢深静脉血栓患者的临床疗效观察
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摘要
【目的】观察丹参多酚酸盐联合低分子肝素钙治疗重症医学科(ICU)气滞血瘀型下肢深静脉血栓(股肿)患者的临床疗效及安全性。【方法】将80例气滞血瘀型下肢深静脉血栓患者随机分为对照组和治疗组,每组各40例。对照组单用低分子肝素钙治疗,治疗组给予丹参多酚酸盐联合低分子肝素钙治疗,疗程14 d。观察2组患者治疗前后下肢股静脉阻塞情况、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分情况及凝血功能指标(D-二聚体、纤维蛋白原和凝血酶原时间)的变化情况,并评价2组疗效和安全性。【结果】(1)经14 d治疗后,治疗组的治愈率和总有效率分别为75.0%和95.0%,对照组分别为47.5%和92.5%;治疗组的总体疗效和治愈率均明显优于对照组(P<0.05)。(2)治疗后,2组患者下肢股静脉的阻塞情况、D-二聚体、凝血酶原时间、纤维蛋白原及APACHE-Ⅱ评分均较治疗前明显改善(P <0.05),且治疗组对各项指标的改善作用均优于对照组(P <0.05)。(3)并发症发生情况:治疗组在治疗过程中发生2例肺栓塞,1例急性心力衰竭;对照组在治疗过程中发生3例肺部感染;2组患者的并发症发生率比较,差异无统计学意义(P>0.05)。(4)治疗过程中均无不良事件及不良反应情况发生。【结论】丹参多酚酸盐联合低分子肝素钙治疗ICU气滞血瘀型下肢深静脉血栓患者具有较好的临床疗效。
Objective To observe the clinical efficacy and safety of salvianolate combined with low molecular heparin calcium in treating deep venous thrombosis(LVD)of the lower limbs(knows as swollen thigh in the field of traditional Chinese medicine)with the syndrome of Qi stagnation and blood stasis in intensive care unit(ICU).Methods Eighty lower limb LVD patients with the syndrome of Qi stagnation and blood stasis were randomized into treatment group and control group,40 cases in each group.The patients of the control group were given oral use of low molecular heparin calcium,and patients of the treatment group were given oral use of salvianolate combined with low molecular heparin calcium.The treatment of the two groups lasted for 14 days.Before and after treatment,the obstruction of femoral vein,Acute Physiology and Chronic Health Evaluation(APACHEⅡ)scores,and coagulation function indexes of D-dimer,fibrinogen and prothrombin time in the two groups were observed.After treatment,the clinical efficacy and safety of two groups were compared.Results(1)After treatment for 14 days,the cure rate and the total effective rate in the treatment group were 75.0%and 95.0%,and in the control group were 47.5%and 92.5%,respectively.The cure rate and the total effective rate in the treatment group were superior to those in the control group(P<0.05).(2)The obstruction of the femoral vein,D-dimer content,prothrombin time,fibrinogen level and APACHEⅡscores in the two groups after treatment were significantly improved as compared with those before treatmen(tP<0.05),and the improvement in the treatment group was superior to that in the control group(P<0.05).(3)During the treatment,the treatment group had 2 cases of pulmonary embolism and one case of acute heart failure;the control group had 3 cases of pulmonary infection.The differences of the incidence of complications between the two groups were insignificant(P>0.05).(4)No adverse event or adverse reaction occurred in the two groups during the treatment.Conclusion Salvianolate combined with low molecular heparin calcium exerts certain clinical efficacy in treating ICU lower limb LVD patients with the syndrome of Qi stagnation and blood stasis.
Objective To observe the clinical efficacy and safety of salvianolate combined with low molecular heparin calcium in treating deep venous thrombosis(LVD)of the lower limbs(knows as swollen thigh in the field of traditional Chinese medicine)with the syndrome of Qi stagnation and blood stasis in intensive care unit(ICU).Methods Eighty lower limb LVD patients with the syndrome of Qi stagnation and blood stasis were randomized into treatment group and control group,40 cases in each group.The patients of the control group were given oral use of low molecular heparin calcium,and patients of the treatment group were given oral use of salvianolate combined with low molecular heparin calcium.The treatment of the two groups lasted for 14 days.Before and after treatment,the obstruction of femoral vein,Acute Physiology and Chronic Health Evaluation(APACHEⅡ)scores,and coagulation function indexes of D-dimer,fibrinogen and prothrombin time in the two groups were observed.After treatment,the clinical efficacy and safety of two groups were compared.Results(1)After treatment for 14 days,the cure rate and the total effective rate in the treatment group were 75.0%and 95.0%,and in the control group were 47.5%and 92.5%,respectively.The cure rate and the total effective rate in the treatment group were superior to those in the control group(P<0.05).(2)The obstruction of the femoral vein,D-dimer content,prothrombin time,fibrinogen level and APACHEⅡscores in the two groups after treatment were significantly improved as compared with those before treatmen(tP<0.05),and the improvement in the treatment group was superior to that in the control group(P<0.05).(3)During the treatment,the treatment group had 2 cases of pulmonary embolism and one case of acute heart failure;the control group had 3 cases of pulmonary infection.The differences of the incidence of complications between the two groups were insignificant(P>0.05).(4)No adverse event or adverse reaction occurred in the two groups during the treatment.Conclusion Salvianolate combined with low molecular heparin calcium exerts certain clinical efficacy in treating ICU lower limb LVD patients with the syndrome of Qi stagnation and blood stasis.
引文
[1]李晓强,张福先,王深明.深静脉血栓形成的诊断和治疗指南(第3版)[J].中国血管外科杂志(电子版),2017(4):250.
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[3]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:155.
[4]赵宁,张加乐,江婷,等.ICU患者外周静脉置入中心静脉导管相关上肢深静脉血栓形成的危险因素[J].中华危重病急救医学,2017,29(2):167.
[5]马春燕,曹杰,张楠,等.神经危重症患者下肢深静脉血栓形成的相关危险因素及预后分析[J].中风与神经疾病杂志,2015,22(6):544.
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[7]傅振会,任波,赵群都.低分子肝素钙预防ICU患者静脉血栓栓塞症的临床观察[J].中国药房,2016,27(20):2838.
[8]刘晋仙,李玮涛,张在忠,等.低分子肝素药理学机制及适应证研究进展[J].药学研究,2015,34(7):420.
[9]贾斌,张勇,高迪,等.中医治疗下肢深静脉血栓形成用药特点的聚类分析[J].中国中医急症,2013,22(5):717.
[10]刘玉波,孙岩,康庆伟.丹参多酚酸盐联合低分子肝素预防术后深静脉血栓Meta分析[J].中国中西医结合外科杂志,2018,24(1):35.
[11]郝彦超,苏建.丹参多酚酸对脑梗死患者血液流变学和神经功能的影响[J].中国实用神经疾病杂志,2014,17(16):67.
[12]刘微.丹参多酚酸盐对冠心病稳定型心绞痛患者血液流变学影响的临床研究[J].中国实用医药,2016,28(1):106.
[13]庞洲,查赣,许尔凤.丹参多酚酸盐对老年不稳定型心绞痛患者血液流变学及内皮功能的影响[J].实用药物与临床,2014,17(1):38.
[14]刘磊,温志超,罗心平,等.丹参多酚酸盐抑制急性冠脉综合症血小板膜糖蛋白表达的临床研究[J].中成药,2012,34(12):2290.
[15]Ma C,Yao Y,Yue Q X,et al.Differential proteomic analysis of platelets suggested possible signal cascades network in platelets treated with salvianolic acid B[J].PLoS One,2011,6(2):e14692.
[2]Heit J A,Spencer F A,White R H.The epidemiology of venous thromboembolism[J].J Thromb Thrombolys,2016,41(1):3.
[3]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:155.
[4]赵宁,张加乐,江婷,等.ICU患者外周静脉置入中心静脉导管相关上肢深静脉血栓形成的危险因素[J].中华危重病急救医学,2017,29(2):167.
[5]马春燕,曹杰,张楠,等.神经危重症患者下肢深静脉血栓形成的相关危险因素及预后分析[J].中风与神经疾病杂志,2015,22(6):544.
[6]Cook D,McDonald E,Smith O,et al.Co-enrollment of critically ill patients into multiple studies:patterns,predictors and consequences[J].Crit Care,2013,17(1):R1.
[7]傅振会,任波,赵群都.低分子肝素钙预防ICU患者静脉血栓栓塞症的临床观察[J].中国药房,2016,27(20):2838.
[8]刘晋仙,李玮涛,张在忠,等.低分子肝素药理学机制及适应证研究进展[J].药学研究,2015,34(7):420.
[9]贾斌,张勇,高迪,等.中医治疗下肢深静脉血栓形成用药特点的聚类分析[J].中国中医急症,2013,22(5):717.
[10]刘玉波,孙岩,康庆伟.丹参多酚酸盐联合低分子肝素预防术后深静脉血栓Meta分析[J].中国中西医结合外科杂志,2018,24(1):35.
[11]郝彦超,苏建.丹参多酚酸对脑梗死患者血液流变学和神经功能的影响[J].中国实用神经疾病杂志,2014,17(16):67.
[12]刘微.丹参多酚酸盐对冠心病稳定型心绞痛患者血液流变学影响的临床研究[J].中国实用医药,2016,28(1):106.
[13]庞洲,查赣,许尔凤.丹参多酚酸盐对老年不稳定型心绞痛患者血液流变学及内皮功能的影响[J].实用药物与临床,2014,17(1):38.
[14]刘磊,温志超,罗心平,等.丹参多酚酸盐抑制急性冠脉综合症血小板膜糖蛋白表达的临床研究[J].中成药,2012,34(12):2290.
[15]Ma C,Yao Y,Yue Q X,et al.Differential proteomic analysis of platelets suggested possible signal cascades network in platelets treated with salvianolic acid B[J].PLoS One,2011,6(2):e14692.