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

Comparison and ananlysis on the effects of TCM and western medicine on preventing deep venous thrombosis post-operation of artificial hip joint

目的:探讨中药脉络宁预防全髋关节术后并发深静脉血栓的疗效及用药安全性。方法:选择行全髋关节置换术的符合研究标准的168例患者,随机分为中药治疗组80例和西药治疗组88例。两组在采用相同的基本预防措施和机械预防措施的基础上,分别采用中药脉络宁针剂和西药分子肝素钠针剂对手术后可能发生的深静脉血栓(DVT)进行预防。比较两组术后DVT发生率,术前及术后7 d和14 d后活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、国际标准化比值(INR),血小板计数(PLT)等凝血指标及术中出血量、术后伤口引流量等安全性指标变化的差异。结果:中药组发生DVT23例,发生率28.75%;西药组发生20例,发生率22.73%。经统计学检验,差异无统计学意义。两组间术前APTT比较,差异无统计学意义(P>0.05),术后7 d、14 d比较,差异均有统计学意义(P<0.05)。两组间PT术前及术后7 d比较,差异无统计学意义(P>0.05),术后14 d比较,差异有统计学意义(P<0.001)。两组间INR术前、术后7 d、术后14 d比较,差异均无统计意义(P>0.05)。两组间PLT术前及术后7 d、14 d比较,差异均有统计学意义(P<0.01)。术中出血量、术后伤口引流量等安全性指标比较,无显著性差异。结论:单独应用中药脉络宁防治髋关节置换术后DVT可获得与西药低分子肝素钠近似的疗效。但从药物安全性角度分析,虽然两组术后凝血指标存在统计学差异,但由于两组凝血指标的实际数值均在正常范围之内,并不一定具有临床意义,因此尚不能肯定脉络宁较低分子肝素钠在预防髋关节置换术后DVT时有着更高的安全性。

Objective：To approach the curative effect and Medication safe of MAILUONING （MLN, a TCM composition） on preventing deep venous thrombos is （DVT） post-replacement of totaI hip. Methods： 168 cases of patients for replacement of total hip and consistented with the standard for the study were choosed and randomly divided into two groups, group A （TCM group, 80 cases）and group B （western medicine group. 88 cases）. On the base of the same elementary precaution and Machine precaution added to two groups, ampule of MLN and LMH （Low Molecular Heparin） were respectively used to prevent DVT. In two groups, incidence rates of DVT post-operation, blood clotting indexes such as activated partial thromboplastin time（APTT） ,plasma prothrombin time（ PT）, INR and PLT pre-and 7 days and 14 days post-operation and changes of safe targets including counts of blood loss in operations and rainage counts post -operation,were observed and contrasted. Results：In group A, there had 23 cases of DVT, the incidence rate was 28.75%. The numbers above in group B were respectively 20 and 22. 73%. There had no statistically significant on difference by statistical test. On APTF, there had no statistically significant on difference in two groups pre-operation （P 70.05） ,but had on both 7 days and 14 days post-operation（P 〈0.05 -0. 001 ）. On PT,there had no in two groups on pre-and 7 days post-operation （ P 〉 0. 05 ）, but had on I4 days post-operation （ P 〈 0. 001 ）. On INR, there had no in two groups on pre-and 7 days and I4 days post-operation （ P 〉 0.05 ）. but on PLT, there had in two groups on pre-and 7 days and 14 days post-operation（ P 〈0. 0 1 ）. and there had no significant difference by statistical test on safe targets. Conclusion ： On preventing DYT post-replacement of total hip, MLN singly used could obtain similar curative effect with LMH. On the angle of drug safe, there had statistical difference on blood clotting targets post - operation in two groups, but they were in normal, clinical sence was impossible, the merit of MLN super to LMH on preventing DVT could not be sure.