柴黄活血汤防治髋关节置换术后下肢深静脉血栓形成疗效观察

Effect of Using Chaihuang Huoxue Decoction in the Prevention and Treatment of Deep Venous Thrombosis of Lower Extremity after Hip Arthroplasty

目的:观察中药柴黄活血汤防治髋关节置换术(HR)后下肢深静脉血栓形成(DVT)的临床疗效。方法:将110例HR患者按照随机数字表法分为2组,每组55例,对照组术后给予低分子肝素皮下注射;观察组在对照组用药基础上给予中药柴黄活血汤口服,两组均连续用药14天,比较两组术后1天、7天、14天凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板内皮细胞粘附因子-1(PECAM-1)、血管细胞粘附分子-1(VCAM-1)、P-选择素;比较术后1d、7d大腿周径和小腿周径;比较两组术后7d DVT发生率和术后14d血栓溶解有效率;并比较两组出血事件发生率。结果:术后7d、1d观察组PT、APTT长于对照组(P<0.01),FIB、D-D、PECAM-1、VCAM-1、P-选择素低于对照组(P<0.01);术后7d,观察组大腿周径、小腿周径均低于对照组(P<0.01),DVT发生率低于对照组(P<0.05),术后第14d,观察组血栓溶解有效率高于对照组(P<0.05),术后4周观察组出血事件发生率低于对照组(P<0.05),差异均有统计学意义。结论:柴黄活血汤可改善HR术后患者的机体凝血功能,促进纤维蛋白溶解,缓解患肢肿胀,对DVT发挥良好的预防和治疗作用,安全性好。

Objective:To investigate the clinical effect of using Chaihuang Huoxue Decoction in the prevention and treatment of deep venous thrombosis(DVT)of lower limbs after hip replacement(HR).Methods:110 HR patients were divided into two groups according to the random number table method,with 55 cases in each group.The controlled group were given subcutaneous injection of low molecular weight heparin after operation.The observation group were given Chaihuang Huoxue Decoction orally on the basis of medication of the controlled group.The two groups were given medicine for 14 days continuously.The prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen time(FIB),D-dimer(D-D),platelet endothelial cell adhesion factor-1(PECAM-1),vascular cell adhesion molecule-1(VCAM-1),P-selectin were compared between the two groups in 1,7 and 14 days after operation.Thigh circumference and calf circumference in 1 and 7 days after operation were compared,DVT incidence in 7 days after operation and thrombolysis efficiency in 14 days after operation were compared between the two groups.The incidence of bleeding events was compared between the two groups.Results:PT and APTT of the observation group were longer than those of the controlled group(P<0.01),FIB,D-D,PECAM-1,VCAM-1 and P-selectin were lower than those of the controlled group(P<0.01).Thigh circumference and calf circumference of the observation group were lower than those of the controlled group(P<0.01),DVT incidence was lower than that of the controlled group(P<0.05),and thrombolysis efficiency of the observation group was higher than that of the controlled group(P<0.05),on the 14th day after operation.The incidence of bleeding events of the observation group was lower than that of the controlled group in 4 weeks after operation(P<0.05),and the difference was statistically significant.Conclusion:Chaihuang Huoxue Decoction can improve the coagulation function,promote fibrinolysis,alleviate swelling of affected limbs,it plays a good role in prevention and treatment of DVT,and it has good safety.