活血灵干预骨科大手术后深静脉血栓形成的临床观察
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摘要
目的：观察活血灵片对骨科大手术后血液流变学、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)指标的变化。希望通过这些指标好转来表明活血灵片具有促进血液循环,改善血液高粘和高凝状态。降低骨科大手术术后深静脉血栓形成(DVT)的危险因素从而降低其发生率。
方法：将2008年11月—2010年2月期间东莞市中医院骨科病房90例行骨科大手术住院合格病例(包括人工股骨头置换术、人工全髋关节置换术、髋部周围骨折行内固定手术和人工膝关节置换术)按分层随机分成A、B、C三组,术后12小时开始分别给予活血灵片、活血灵片+低分子肝素、低分子肝素干预,疗程均为10天。通过观察三组患者术前、术后第1、14天血液流变学、PT和APTT指标的变化。并比较三组病例DVT的发生率。
结果：
1血液流变学指标
研究结果显示用药前三组患者血液流变学指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较血沉明显增高,有统计学差异(P<0.05)。其余血液流变学指标比较虽无统计学差异,但术后第1天大部分血液流变学指标均值比术前低。在术后第14天自身全血粘度、全血高切相对指数、全血低切相对指数、全血低切还原粘度、全血高切还原粘度均降低,有统计学差异(P<0.05)。治疗后B组患者血液流变学指标优于A、C组。而A组和C组患者大部分血液流变学指标无统计学差异(P>0.05),而血浆粘度指标比较C组、B组与A组有统计学差异(P<0.05)。
2出凝血组检指标
研究结果显示用药前三组患者PT和APTT指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较PT指标有统计学差异(P<0.05),APTT指标无统计学差异(P>0.05)。在术前和术后第14天自身比较PT和APTT指标均有统计学差异(P<0.05)。A组分别与B组和C组PT比较有统计学差异(P值均<0.05),APTT比较无统计学差异(P值均>0.05)。
3 DVT发生率
研究结果显示90例病例中,共有8例发生DVT,总发生率为8.89%。其中B组发生2例DVT,发生率6.67%。A组和C组均发生3例DVT,发生率均为10.00%。
结论：活血灵片和低分子肝素对大部分血液流变学指标均有明显改善,对于血浆粘度改善,活血灵片不如低分子肝素。同时活血灵片和低分子肝素都能明显延长PT和APTT,但低分子肝素效果优于活血灵片。故采用活血灵片干预骨科大手术后患者,能降低患者的血液流变学及延长出凝血组检指标,改善血液高粘和高凝状态。同时低分子肝素联合应用活血灵片效果更明显,故指导临床上可应用中西医结合方法预防骨科大手术后DVT。
Objective:Observating the variation of hemorheology and prothrombin time and activated partial thromboplatin time after major surgery orthopedics with the tablet of Huo Xue Ling. Hope for the tablet of Huo Xue Ling has the functions of promoting blood circulation and reducing high blood coagulation, and high-viscosity through the forthebetter of these indexes. Decreasing the risk factors of deep venous thrombosis after major surgery orthopedics, consequently decreasing the rate of deep venous thrombosis.
Method:90 patients with major surgery orthopedics(Including prosthetic replacement for femoral head, total hip arthroplasty, fixation around the line of hip fracture and total knee arthroplasty)were selected from Dongguan Hospital of TCM during November 2008 to February 2010, and were divided into three groups at stratified randomization. Three groups were given The tablet of Huo Xue Ling, Low molecular weight heparin and The tablet of Huo Xue Ling, Low molecular weight heparin, were using to 10 days. Compared the variation of hemorheology and prothrombin time and activated partial thromboplatin time when preoperatively, after the first and 14th day of the operation. Compared the deep venous thrombosis rate of them.
Results:
1. Hemorheology
The results showed that the hemorheology of these three groups had no significant difference(P>0.05)before treatment. The erythrocyte sedimentation rate of these three groups themselves had significant difference (P<0.05) between before treatment and the first day of the operation. Although the rest of hemorheology had no significant difference(P>0.05), However, The average of hemorheology after operation was lower than before treatment. The whole blood viscosity, The high-shear relative index of whole blood, The low-shear relative index of whole blood,The low-shear reduced viscosity of whole blood and The high-shear reduced viscosity of whole blood reduced when after the 14th day of the operation, showed significant difference (p<0.05). The hemorheology of group B was better than group A and C when after the 14th day of the operation. Most of hemorheology had no significant difference (P>0.05) between group A and group C. But the Plasma viscosity of group C and group B was better than group A showed significant difference(p<0.05).
2. Coagulation group seized Index
The results showed that the prothrombin time and activated partial thromboplatin time of these three groups had no significant difference(P>0.05)before treatment. The prothrombin time of these three groups themselves had significant difference(P<0.05)between before treatment and the first day of the operation. But comparing the activated partial thromboplatin time had no significant difference(P>0.05). The prothrombin time and activated partial thromboplatin time of these three groups themselves had significant difference(p<0.05)between before treatment and the 14th day of the operation. The prothrombin time of the group A had significant difference (p<0.05) among group B and group C when after the 14th day of the operation, But the activated partial thromboplatin time had no significant difference(P>0.05).
3. Deep venous thrombosis rate
The results showed that Ninety cases, a total of eight cases occurred DVT, with a total incidence of 8.89 percent, in which group B occurred two cases of DVT rate of 6.67 percent, group A and group C all occurred three cases of DVT rate of 10.00 percent.
Conclusion:
Most of hemorheology significantly reduced after using the tablet of Huo Xue Ling or Low molecular weight heparin, Huo Xue Ling was worse than Low molecular weight heparin to reducing in plasma viscosity. The prothrombin time and activated partial thromboplatin time were significantly extended after using the tablet of Huo Xue Ling or Low molecular weight heparin, but the Low molecular weight heparin was better than Huo Xue Ling. The Hemorheology of patients can be reduced and the Coagulation group seized Index of patients can be extended and the high blood coagulation, and high-viscosity of patients can be improved after major surgery orthopedics with the tablet of Huo Xue Ling. The effect is better when using the tablet of Huo Xue Ling and Low molecular weight heparin at the same time. So we can prevent the formation of DVT after major surgery orthopedics combining treatment of traditional Chinese medicine and western medicine in clinically.
方法：将2008年11月—2010年2月期间东莞市中医院骨科病房90例行骨科大手术住院合格病例(包括人工股骨头置换术、人工全髋关节置换术、髋部周围骨折行内固定手术和人工膝关节置换术)按分层随机分成A、B、C三组,术后12小时开始分别给予活血灵片、活血灵片+低分子肝素、低分子肝素干预,疗程均为10天。通过观察三组患者术前、术后第1、14天血液流变学、PT和APTT指标的变化。并比较三组病例DVT的发生率。
结果：
1血液流变学指标
研究结果显示用药前三组患者血液流变学指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较血沉明显增高,有统计学差异(P<0.05)。其余血液流变学指标比较虽无统计学差异,但术后第1天大部分血液流变学指标均值比术前低。在术后第14天自身全血粘度、全血高切相对指数、全血低切相对指数、全血低切还原粘度、全血高切还原粘度均降低,有统计学差异(P<0.05)。治疗后B组患者血液流变学指标优于A、C组。而A组和C组患者大部分血液流变学指标无统计学差异(P>0.05),而血浆粘度指标比较C组、B组与A组有统计学差异(P<0.05)。
2出凝血组检指标
研究结果显示用药前三组患者PT和APTT指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较PT指标有统计学差异(P<0.05),APTT指标无统计学差异(P>0.05)。在术前和术后第14天自身比较PT和APTT指标均有统计学差异(P<0.05)。A组分别与B组和C组PT比较有统计学差异(P值均<0.05),APTT比较无统计学差异(P值均>0.05)。
3 DVT发生率
研究结果显示90例病例中,共有8例发生DVT,总发生率为8.89%。其中B组发生2例DVT,发生率6.67%。A组和C组均发生3例DVT,发生率均为10.00%。
结论：活血灵片和低分子肝素对大部分血液流变学指标均有明显改善,对于血浆粘度改善,活血灵片不如低分子肝素。同时活血灵片和低分子肝素都能明显延长PT和APTT,但低分子肝素效果优于活血灵片。故采用活血灵片干预骨科大手术后患者,能降低患者的血液流变学及延长出凝血组检指标,改善血液高粘和高凝状态。同时低分子肝素联合应用活血灵片效果更明显,故指导临床上可应用中西医结合方法预防骨科大手术后DVT。
Objective:Observating the variation of hemorheology and prothrombin time and activated partial thromboplatin time after major surgery orthopedics with the tablet of Huo Xue Ling. Hope for the tablet of Huo Xue Ling has the functions of promoting blood circulation and reducing high blood coagulation, and high-viscosity through the forthebetter of these indexes. Decreasing the risk factors of deep venous thrombosis after major surgery orthopedics, consequently decreasing the rate of deep venous thrombosis.
Method:90 patients with major surgery orthopedics(Including prosthetic replacement for femoral head, total hip arthroplasty, fixation around the line of hip fracture and total knee arthroplasty)were selected from Dongguan Hospital of TCM during November 2008 to February 2010, and were divided into three groups at stratified randomization. Three groups were given The tablet of Huo Xue Ling, Low molecular weight heparin and The tablet of Huo Xue Ling, Low molecular weight heparin, were using to 10 days. Compared the variation of hemorheology and prothrombin time and activated partial thromboplatin time when preoperatively, after the first and 14th day of the operation. Compared the deep venous thrombosis rate of them.
Results:
1. Hemorheology
The results showed that the hemorheology of these three groups had no significant difference(P>0.05)before treatment. The erythrocyte sedimentation rate of these three groups themselves had significant difference (P<0.05) between before treatment and the first day of the operation. Although the rest of hemorheology had no significant difference(P>0.05), However, The average of hemorheology after operation was lower than before treatment. The whole blood viscosity, The high-shear relative index of whole blood, The low-shear relative index of whole blood,The low-shear reduced viscosity of whole blood and The high-shear reduced viscosity of whole blood reduced when after the 14th day of the operation, showed significant difference (p<0.05). The hemorheology of group B was better than group A and C when after the 14th day of the operation. Most of hemorheology had no significant difference (P>0.05) between group A and group C. But the Plasma viscosity of group C and group B was better than group A showed significant difference(p<0.05).
2. Coagulation group seized Index
The results showed that the prothrombin time and activated partial thromboplatin time of these three groups had no significant difference(P>0.05)before treatment. The prothrombin time of these three groups themselves had significant difference(P<0.05)between before treatment and the first day of the operation. But comparing the activated partial thromboplatin time had no significant difference(P>0.05). The prothrombin time and activated partial thromboplatin time of these three groups themselves had significant difference(p<0.05)between before treatment and the 14th day of the operation. The prothrombin time of the group A had significant difference (p<0.05) among group B and group C when after the 14th day of the operation, But the activated partial thromboplatin time had no significant difference(P>0.05).
3. Deep venous thrombosis rate
The results showed that Ninety cases, a total of eight cases occurred DVT, with a total incidence of 8.89 percent, in which group B occurred two cases of DVT rate of 6.67 percent, group A and group C all occurred three cases of DVT rate of 10.00 percent.
Conclusion:
Most of hemorheology significantly reduced after using the tablet of Huo Xue Ling or Low molecular weight heparin, Huo Xue Ling was worse than Low molecular weight heparin to reducing in plasma viscosity. The prothrombin time and activated partial thromboplatin time were significantly extended after using the tablet of Huo Xue Ling or Low molecular weight heparin, but the Low molecular weight heparin was better than Huo Xue Ling. The Hemorheology of patients can be reduced and the Coagulation group seized Index of patients can be extended and the high blood coagulation, and high-viscosity of patients can be improved after major surgery orthopedics with the tablet of Huo Xue Ling. The effect is better when using the tablet of Huo Xue Ling and Low molecular weight heparin at the same time. So we can prevent the formation of DVT after major surgery orthopedics combining treatment of traditional Chinese medicine and western medicine in clinically.
引文
[1]Hirsh J, Bates SM. Prognosis in.acute pulmonary embolism[J]. Lancet 1999,353:1375-1376.
[2]Prandoni P, Lensing AWA, Prins M. Long-term outcomes after deep venous thrombosis of the lower extremities[J]. Vasc Med 1998,3:57-60.
[3]Fedullo PF, Auger WR, Channick RN,et al. Chronic thromboembolic pulmonaryhypertension[J]. Clin Chest Med 2001,22:561-81.
[4]中华医学会骨科学分会.预防骨科大手术深静脉血栓形成指南(草案)[J].中华矫形外科杂志,2009,17(2)：118-119.
[5]吕厚山,徐斌.人工髋关节置换术后下肢深静脉血栓形成[J].中华骨科杂志,1999,19(3)：155-156.
[6]曲洪雪.骨科深静脉血栓形成危险因素及发病机制的研究进展[J].中国矫形外科杂志.2009,17,(2)：110-112.
[7]张学颖.汤坤标主任医师论痰瘀股肿证治[J].陕西中医,1997,18(5)：213-215.
[8]李曰庆主编.中医外科学[M].北京：中国中医药出版社,2002,8：302.
[9]刘明伟,黄海滨,廖小波等.活血化瘀方防治髋部骨折术后深静脉血栓86例[J].山东中医杂志,2002,21(12)：722-723.
[10]王亚斌,高峰.血府逐瘀汤预防髋部术后下肢深静脉血栓形成[J].山西临床医学,2001,10(10)：776.
[11]白广德.中西医结合治疗下肢深静脉血栓形成疗效观察[J].广西中医药,2001,24(6)：33-34.
[12]金志忠.活血化瘀法沿革及临床应用举隅[J].内蒙古中医药,2007,2：31-32.
[13]周强,刘国光,周明等.创伤后血液流变学的改变及活血化瘀疗法对其影响[J].中华临床医学杂志,2006,7(5)：63-64.
[14]王连深,佘海云等.活血化瘀疗法的临床应用初探[J].中国民间疗法,2006,14(10)：5-7.
[15]张强.中医辨证治疗下肢深静脉血栓形成52例[J].陕西中医,2006,27(11)：1371-1372.
[16]陈光,郭洛宏,段浩.辨证治疗下肢深部静脉血栓形成30例[J].时珍国医国药,2000,11(5)：456.
[17]王菊凤,许文捷,袁岚.瘀血汤治疗下肢深静脉血栓形成后综合征[J].中国中医药信息杂志,2001,8(10)：53.
[18]韩冰.直接患肢深静脉溶栓并中药治疗下肢深静脉血栓形成的临床观察[J].中 国中西医结合杂志,1999,19(4)：199.
[19]赵兆琳,李厚铨.奚九一治疗下肢深静脉血栓形成的经验[J].中医杂志,2000,41(6)：338.
[20]王银中,秦珊珊.侯玉芬教授辨证治疗下肢深静脉血栓形成经验[J].2007,25(11)：2229-2230.
[21]曹德亭.黄芪延胡汤治疗深静脉血栓形成30例[J].辽宁中医杂志,1996,23(7)：330.
[22]李允敬,张淑云.脉痹汤治疗深静脉血栓形成49例[J].中国中医药科技,1997,4(4)：251.
[23]马立人.崔公让教授治疗周围血管疾病经验撷要[J].国医论坛,2004,19(5)：12-13.
[24]郭小青,霍凤.化痰通络法治疗下肢深静脉血栓形成后遗症36例疗效观察[J].北京中医,2003,22(4)：33.
[25]李逸群,陈志维.中医活血祛淤防治人工髋关节置换术后深静脉栓塞[J].中国中医骨伤科杂志,1999,7(5)：23—24.
[26]闵文,沈计荣.活血Ⅰ号方预防人工髋、膝关节置换术后DVT发生的临床观察[J].中国中医骨伤科杂志,2007,15(12)：25-27.
[27]阮洪江,张世华.复元活血汤配合低分子肝素钠预防人工髋关节置换术后下肢深静脉血栓形成[J].中国骨伤,2005,18(12)：719-721.
[28]滕居赞,朱江龙,陈跃平等.髋关节置换术后中药预防深静脉血栓形成的临床观察[J].中国中医骨伤科杂志,2007,15(9)：57-58.
[29]方涛.中西药预防人工髋关节术后并发深静脉血栓形成效果比较分析[J].中医正骨,2009,21(2)：11-14.
[30]肖伟宏.丹红注射液联合低分子肝素钙围手术期预防下肢深静脉血栓形成的临床观察[J].当代医学,2009,15(7)：13.
[31]刘军,万豫尧.益气活血法预防老年患者髋部术后下肢深静脉血栓形成[J].中国骨伤,2006,19(6)：344-347.
[32]饶耀剑,张俊.中药黄芪对全髋术后血液流变学影响[J].中医正骨,2007,19(10)：756.
[33]李章华,廖文,王志林等主编.人工髋膝关节外科[M].北京：军事医学科学出版社,2008,4：106.
[34]顾海伦,王欢,段景柱.人工全髋关节置换术后下肢深静脉血栓形成的多因素分析[J].中国骨伤,2007,20(9)：611-613.
[35]顾海伦,段景柱,王欢.髋臼骨折术后下肢深静脉血栓形成的多因素分析[J].中国骨与关节损伤杂志,2007,22(6)：462-464.
[36]关振鹏,吕厚山,陈彦章等.影响人工关节置换术后下肢深静脉血栓形成的临床风险因素分析[J].中华外科杂志,2005,43(20)：1317-1320.
[37]石荣光,李冬梅,王琳等.创伤骨折后下肢深静脉血栓形成危险因素分析及预防对策[J].中国医师进修杂志,2007,30(6)：66-67.
[38]沈洲,徐福祥,樊盛军等.低分子肝素对于人工全髋关节置换术后下肢深静脉血栓形成的预防[J].中国现代医药杂志,2007,9(2)：74-76.
[39]陈灏珠主编.实用内科学(第11版)[M].人民卫生出版社,2008,8：1616-1617.
[40]张跃,刘效敏,张玉冬.深静脉血栓形成患者血清TNF-α、IL-6、IL-10水平变化及意义[J].放射免疫学杂志,2006,20(1)：13-15.
[41]Salvati EA, Della Valle AG,Westrich GH, et al. The John Charnley Award:heritable thrombophilia and development of thromboembolic disease after total hip arthroplasty[J].Clin Orthop Relat Res.2005,441:40-55.
[42]Senaran H, Acaroglu E, Ozdemir HM, et al. Enoxaparin and heparin comparison of deep vein thrombosis prophylaxis in total hip replacement patients[J]. Arch Orthop Trauma Surg 2006,126(1):1-5.
[43]Berend KR, Lombardi AV Jr. Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty:the role of aspirin[J]. Am J Orthop 2006,35(1):24-29.
[44]邱贵兴,戴尅戎,杨庆铭等.预防骨科大手术后深静脉血栓形成的专家建议[J].中国临床医生,2006,34(1)：27-33.
[45]阎冰,张春雨.彩色多普勒超声早期监测人工关节术后深静脉血栓的价值[J].中华超声影像学杂志,2000,9(6)：365-367.
[46]仲跻风,王炼.彩色多普勒超声诊断下肢深静脉血栓的价值[J].中国超声诊断杂志,2005,6(5)：375-377.
[47]Verhaeghe R. Extended prophylaxis of venous thromboembolism in major orthopaedic surgery[J]. Aeta Orthop Belg 2005,71 (3):255-259.
[48]徐建华.血液流变学临床应用[J].中华临床与卫生,2004,2(3)：118.
[49]姜永广,刘晓静,刘文良.低分子肝素对老年髋部骨折患者血流变的影响[J].中国误诊学杂志,2008,8,(16)：3858-3859.
[50]杨进刚.美国医师学会静脉血栓栓塞性疾病诊疗指南解读[J].心血管病学进展,2007,28(2)：193-194.
[51]O Donnell M, Linkins LA, Kearon C, et al. Reduction of out-of-hospital symptomatic venous thromboembolism by extended thrombo-prophylaxis with low-molecular-weight heparin following elective hip arthroplasty:a systematic review[J].Arch Intern Med,2003,163:1362-1366.
[52]Hull RD, Pineo GF, Francis C, et al.Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients:a double-blind, randomized comparison. North American Fragmin Trial Investigators [J].Arch Intern Med,2000,160:2208-2215.
[53]Harenberg J. Fixed-dose versus adjusted-dose low molecular weight heparin the intitial treatment of patients with deep venous thrombosis[J]. Curr Opin Pulm Med,2002,8 (5):383.
[54]Alban S. From heparins to factor Xa inhibitors and beyong[J]. European Journal of Clinical Investigation,2005,35(Suppl 1):12-20.
[55]李腾.浅析活血化瘀法在临床中的应用[J].实用医技杂志,2007,14(36)：5022-5024.
[56]黄兆胜主编.中药学(M).北京：人民卫生出版社,2002,1：309.
[57]梅汉尧,周永顶,索鹏等.丹参预防人工全髋关节置换术后下肢深静脉血栓形成的研究[J].中国中医骨伤科杂志,2006,14(3)：14-17.
[58]吴尧忠,倪正,许慧琪等.丹参活血化瘀作用及机理探讨[J].南京中医药大学学报,1995,11(6)：35-36.
[59]JIANG Kai-Yu,RUAN Chang-Geng, GU Zhen-Lun. Effects of tanshinone Ⅱ-A sulfonate on adhesion molecule expression of endothelial cells and platelets in vitro [J]. Chinese Pharmacological Bulletin,1998,19(1):47-50.
[60]姜开余,阮长耿,顾振纶.丹参素对CDllb、P-selectin、ICAM-1、VCAM-1、E-se]ectin表达的影响[J].中国药理学通报,2000,16(6)：682-684.
[61]姜开余,阮长耿,顾振纶.WH505体内抗血栓作用及其机制研究[J].苏州医学院学报,2000,20(3)：203-205.
[62]姜开余,阮长耿,顾振纶.WH505对实验性血栓形成的影响及其作用机制[J].中成药,2000,22(11)：782-785.
[63]汪钟,张宏,龙敏慧等.丹参有效成份764—3对血小板聚集和花生四烯酸代谢产物的影响[J].中国医学科学院学报,1994,16(2)：140-143.
[64]张国平,孙梅,杨洁红等.川芎嗪对缺氧人脐静脉内皮细胞抗凝和纤溶功能的影响[J].中草药,2008,39(1)：71-73.
[65]陈志勇,翁进,李副刚等.764—3对人血小板功能及血管内皮细胞抗凝作用的影响[J].中国动脉硬化杂志,1994,2(4)：137-139.
[66]Li F G. Detection of plasma α-granulr membrane prolein(GMP) 140 using radiolabeled monoclonal an-tibodies in thromotic diseases[J]. Haemostasis,1993,23:121.
[67]陈志勇,翁进,李副刚等.764—3对人血小板功能及血管内皮细胞抗凝作用的影响[J].中国动脉硬化杂志,1994,2(4)：137-139.
[68]白建平,汪钟.内皮细胞促凝与抗凝作用机理的研究进展[J].中国药理学通报,1993,9(1)：1-3.
[69]黄兆胜主编.中药学(M).北京：人民卫生出版社,2002,1：303.
[70]刘国仗,陈盂勤,周此凡等.我国高血压病研究的主要成果[J].中华心血管病杂志,1999,27(4)：403.
[71]柳海平,李玉吉,王承祥等.川芎嗪对全髋关节置换术后深静脉血栓形成的预防作用[J].中华实用中西医杂志,2007,20(20)：1755-1756.
[72]相凇华,吴启南,王立新等.中药归尾的质量研究[J].分析测试学报,2001,20(6) ：55-57.
[73]欧仕益,包惠燕,蓝志东等.中药材[M],2001,24：220.
[74]陈灵敏,周海星.骨折患者手术前凝血功能检测临床意义[J].实验与检验医学,2009,27(1)：86.
[75]王月梅,吕占清,陆彩云.凝血常规检测在脑血管疾病抗血栓和溶血栓治疗中的应用及评价[J].吉林医学,2008,29(15)：1268-1269.
[2]Prandoni P, Lensing AWA, Prins M. Long-term outcomes after deep venous thrombosis of the lower extremities[J]. Vasc Med 1998,3:57-60.
[3]Fedullo PF, Auger WR, Channick RN,et al. Chronic thromboembolic pulmonaryhypertension[J]. Clin Chest Med 2001,22:561-81.
[4]中华医学会骨科学分会.预防骨科大手术深静脉血栓形成指南(草案)[J].中华矫形外科杂志,2009,17(2)：118-119.
[5]吕厚山,徐斌.人工髋关节置换术后下肢深静脉血栓形成[J].中华骨科杂志,1999,19(3)：155-156.
[6]曲洪雪.骨科深静脉血栓形成危险因素及发病机制的研究进展[J].中国矫形外科杂志.2009,17,(2)：110-112.
[7]张学颖.汤坤标主任医师论痰瘀股肿证治[J].陕西中医,1997,18(5)：213-215.
[8]李曰庆主编.中医外科学[M].北京：中国中医药出版社,2002,8：302.
[9]刘明伟,黄海滨,廖小波等.活血化瘀方防治髋部骨折术后深静脉血栓86例[J].山东中医杂志,2002,21(12)：722-723.
[10]王亚斌,高峰.血府逐瘀汤预防髋部术后下肢深静脉血栓形成[J].山西临床医学,2001,10(10)：776.
[11]白广德.中西医结合治疗下肢深静脉血栓形成疗效观察[J].广西中医药,2001,24(6)：33-34.
[12]金志忠.活血化瘀法沿革及临床应用举隅[J].内蒙古中医药,2007,2：31-32.
[13]周强,刘国光,周明等.创伤后血液流变学的改变及活血化瘀疗法对其影响[J].中华临床医学杂志,2006,7(5)：63-64.
[14]王连深,佘海云等.活血化瘀疗法的临床应用初探[J].中国民间疗法,2006,14(10)：5-7.
[15]张强.中医辨证治疗下肢深静脉血栓形成52例[J].陕西中医,2006,27(11)：1371-1372.
[16]陈光,郭洛宏,段浩.辨证治疗下肢深部静脉血栓形成30例[J].时珍国医国药,2000,11(5)：456.
[17]王菊凤,许文捷,袁岚.瘀血汤治疗下肢深静脉血栓形成后综合征[J].中国中医药信息杂志,2001,8(10)：53.
[18]韩冰.直接患肢深静脉溶栓并中药治疗下肢深静脉血栓形成的临床观察[J].中 国中西医结合杂志,1999,19(4)：199.
[19]赵兆琳,李厚铨.奚九一治疗下肢深静脉血栓形成的经验[J].中医杂志,2000,41(6)：338.
[20]王银中,秦珊珊.侯玉芬教授辨证治疗下肢深静脉血栓形成经验[J].2007,25(11)：2229-2230.
[21]曹德亭.黄芪延胡汤治疗深静脉血栓形成30例[J].辽宁中医杂志,1996,23(7)：330.
[22]李允敬,张淑云.脉痹汤治疗深静脉血栓形成49例[J].中国中医药科技,1997,4(4)：251.
[23]马立人.崔公让教授治疗周围血管疾病经验撷要[J].国医论坛,2004,19(5)：12-13.
[24]郭小青,霍凤.化痰通络法治疗下肢深静脉血栓形成后遗症36例疗效观察[J].北京中医,2003,22(4)：33.
[25]李逸群,陈志维.中医活血祛淤防治人工髋关节置换术后深静脉栓塞[J].中国中医骨伤科杂志,1999,7(5)：23—24.
[26]闵文,沈计荣.活血Ⅰ号方预防人工髋、膝关节置换术后DVT发生的临床观察[J].中国中医骨伤科杂志,2007,15(12)：25-27.
[27]阮洪江,张世华.复元活血汤配合低分子肝素钠预防人工髋关节置换术后下肢深静脉血栓形成[J].中国骨伤,2005,18(12)：719-721.
[28]滕居赞,朱江龙,陈跃平等.髋关节置换术后中药预防深静脉血栓形成的临床观察[J].中国中医骨伤科杂志,2007,15(9)：57-58.
[29]方涛.中西药预防人工髋关节术后并发深静脉血栓形成效果比较分析[J].中医正骨,2009,21(2)：11-14.
[30]肖伟宏.丹红注射液联合低分子肝素钙围手术期预防下肢深静脉血栓形成的临床观察[J].当代医学,2009,15(7)：13.
[31]刘军,万豫尧.益气活血法预防老年患者髋部术后下肢深静脉血栓形成[J].中国骨伤,2006,19(6)：344-347.
[32]饶耀剑,张俊.中药黄芪对全髋术后血液流变学影响[J].中医正骨,2007,19(10)：756.
[33]李章华,廖文,王志林等主编.人工髋膝关节外科[M].北京：军事医学科学出版社,2008,4：106.
[34]顾海伦,王欢,段景柱.人工全髋关节置换术后下肢深静脉血栓形成的多因素分析[J].中国骨伤,2007,20(9)：611-613.
[35]顾海伦,段景柱,王欢.髋臼骨折术后下肢深静脉血栓形成的多因素分析[J].中国骨与关节损伤杂志,2007,22(6)：462-464.
[36]关振鹏,吕厚山,陈彦章等.影响人工关节置换术后下肢深静脉血栓形成的临床风险因素分析[J].中华外科杂志,2005,43(20)：1317-1320.
[37]石荣光,李冬梅,王琳等.创伤骨折后下肢深静脉血栓形成危险因素分析及预防对策[J].中国医师进修杂志,2007,30(6)：66-67.
[38]沈洲,徐福祥,樊盛军等.低分子肝素对于人工全髋关节置换术后下肢深静脉血栓形成的预防[J].中国现代医药杂志,2007,9(2)：74-76.
[39]陈灏珠主编.实用内科学(第11版)[M].人民卫生出版社,2008,8：1616-1617.
[40]张跃,刘效敏,张玉冬.深静脉血栓形成患者血清TNF-α、IL-6、IL-10水平变化及意义[J].放射免疫学杂志,2006,20(1)：13-15.
[41]Salvati EA, Della Valle AG,Westrich GH, et al. The John Charnley Award:heritable thrombophilia and development of thromboembolic disease after total hip arthroplasty[J].Clin Orthop Relat Res.2005,441:40-55.
[42]Senaran H, Acaroglu E, Ozdemir HM, et al. Enoxaparin and heparin comparison of deep vein thrombosis prophylaxis in total hip replacement patients[J]. Arch Orthop Trauma Surg 2006,126(1):1-5.
[43]Berend KR, Lombardi AV Jr. Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty:the role of aspirin[J]. Am J Orthop 2006,35(1):24-29.
[44]邱贵兴,戴尅戎,杨庆铭等.预防骨科大手术后深静脉血栓形成的专家建议[J].中国临床医生,2006,34(1)：27-33.
[45]阎冰,张春雨.彩色多普勒超声早期监测人工关节术后深静脉血栓的价值[J].中华超声影像学杂志,2000,9(6)：365-367.
[46]仲跻风,王炼.彩色多普勒超声诊断下肢深静脉血栓的价值[J].中国超声诊断杂志,2005,6(5)：375-377.
[47]Verhaeghe R. Extended prophylaxis of venous thromboembolism in major orthopaedic surgery[J]. Aeta Orthop Belg 2005,71 (3):255-259.
[48]徐建华.血液流变学临床应用[J].中华临床与卫生,2004,2(3)：118.
[49]姜永广,刘晓静,刘文良.低分子肝素对老年髋部骨折患者血流变的影响[J].中国误诊学杂志,2008,8,(16)：3858-3859.
[50]杨进刚.美国医师学会静脉血栓栓塞性疾病诊疗指南解读[J].心血管病学进展,2007,28(2)：193-194.
[51]O Donnell M, Linkins LA, Kearon C, et al. Reduction of out-of-hospital symptomatic venous thromboembolism by extended thrombo-prophylaxis with low-molecular-weight heparin following elective hip arthroplasty:a systematic review[J].Arch Intern Med,2003,163:1362-1366.
[52]Hull RD, Pineo GF, Francis C, et al.Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients:a double-blind, randomized comparison. North American Fragmin Trial Investigators [J].Arch Intern Med,2000,160:2208-2215.
[53]Harenberg J. Fixed-dose versus adjusted-dose low molecular weight heparin the intitial treatment of patients with deep venous thrombosis[J]. Curr Opin Pulm Med,2002,8 (5):383.
[54]Alban S. From heparins to factor Xa inhibitors and beyong[J]. European Journal of Clinical Investigation,2005,35(Suppl 1):12-20.
[55]李腾.浅析活血化瘀法在临床中的应用[J].实用医技杂志,2007,14(36)：5022-5024.
[56]黄兆胜主编.中药学(M).北京：人民卫生出版社,2002,1：309.
[57]梅汉尧,周永顶,索鹏等.丹参预防人工全髋关节置换术后下肢深静脉血栓形成的研究[J].中国中医骨伤科杂志,2006,14(3)：14-17.
[58]吴尧忠,倪正,许慧琪等.丹参活血化瘀作用及机理探讨[J].南京中医药大学学报,1995,11(6)：35-36.
[59]JIANG Kai-Yu,RUAN Chang-Geng, GU Zhen-Lun. Effects of tanshinone Ⅱ-A sulfonate on adhesion molecule expression of endothelial cells and platelets in vitro [J]. Chinese Pharmacological Bulletin,1998,19(1):47-50.
[60]姜开余,阮长耿,顾振纶.丹参素对CDllb、P-selectin、ICAM-1、VCAM-1、E-se]ectin表达的影响[J].中国药理学通报,2000,16(6)：682-684.
[61]姜开余,阮长耿,顾振纶.WH505体内抗血栓作用及其机制研究[J].苏州医学院学报,2000,20(3)：203-205.
[62]姜开余,阮长耿,顾振纶.WH505对实验性血栓形成的影响及其作用机制[J].中成药,2000,22(11)：782-785.
[63]汪钟,张宏,龙敏慧等.丹参有效成份764—3对血小板聚集和花生四烯酸代谢产物的影响[J].中国医学科学院学报,1994,16(2)：140-143.
[64]张国平,孙梅,杨洁红等.川芎嗪对缺氧人脐静脉内皮细胞抗凝和纤溶功能的影响[J].中草药,2008,39(1)：71-73.
[65]陈志勇,翁进,李副刚等.764—3对人血小板功能及血管内皮细胞抗凝作用的影响[J].中国动脉硬化杂志,1994,2(4)：137-139.
[66]Li F G. Detection of plasma α-granulr membrane prolein(GMP) 140 using radiolabeled monoclonal an-tibodies in thromotic diseases[J]. Haemostasis,1993,23:121.
[67]陈志勇,翁进,李副刚等.764—3对人血小板功能及血管内皮细胞抗凝作用的影响[J].中国动脉硬化杂志,1994,2(4)：137-139.
[68]白建平,汪钟.内皮细胞促凝与抗凝作用机理的研究进展[J].中国药理学通报,1993,9(1)：1-3.
[69]黄兆胜主编.中药学(M).北京：人民卫生出版社,2002,1：303.
[70]刘国仗,陈盂勤,周此凡等.我国高血压病研究的主要成果[J].中华心血管病杂志,1999,27(4)：403.
[71]柳海平,李玉吉,王承祥等.川芎嗪对全髋关节置换术后深静脉血栓形成的预防作用[J].中华实用中西医杂志,2007,20(20)：1755-1756.
[72]相凇华,吴启南,王立新等.中药归尾的质量研究[J].分析测试学报,2001,20(6) ：55-57.
[73]欧仕益,包惠燕,蓝志东等.中药材[M],2001,24：220.
[74]陈灵敏,周海星.骨折患者手术前凝血功能检测临床意义[J].实验与检验医学,2009,27(1)：86.
[75]王月梅,吕占清,陆彩云.凝血常规检测在脑血管疾病抗血栓和溶血栓治疗中的应用及评价[J].吉林医学,2008,29(15)：1268-1269.