消肿止痛汤预防骨科大手术深静脉血栓临床疗效与药物经济学分析

The clinical study and medical economic analysis on the treatment with XiaoZhongZhiTong decoction for preventing deep venous thrombosis after major orthopedic operation

目的探讨预防骨科大手术后深静脉血栓形成有良好的临床效果及成效比的措施，为卫生资源的合理使用提供理论依据。方法选择行骨科大手术患者53例，随机分为消肿止痛汤治疗组和低分子肝素对照组进行术后防治，比较两组的预防效果以及药物安全性，采用成本-效果分析的方法，评估两组治疗成本。结果治疗组4例发生DVT，发生率为14．81％，不良反应2例；对照组5例发生DVT，发生率为19．23％，不良反应8例。两组DVT发生率以及药物安全性比较，差异有统计学意义（P〈0．05）。以术后DVT发生率为效果指标进行成本-效果分析（CEA），治疗组的CEA为1370．6，对照组为2268．5，治疗组的CEA较对照组低；进行敏感度分析，治疗组治疗成本提高10％后，CEA仍比对照组低。结论二种方案均能较有效的预防深静脉血栓形成，与低分子肝素相比，消肿止痛汤预防DVT具有效果确切、不良反应少、花费成本小、收益大等特点；消肿止痛汤比低分子肝素有更佳的成本-效果比，能以更少治疗成本获得更大的效益。

Objective To discuss the medicine with good clinical effect and effectiveness proportion to prevent deep venous thrombosis after major orthopedic operation and to provide the theory basis for the reasonable use of health resources. Method All 53 patients who planned to underwent major orthopedic operations were randomly divided into two groups, treated group（ 27 eases were given administration with XiaoZhongZhiTong decoction ）and controlled group（ 26 cases were given administration with low molecular heparin ）. Clinical preventive effects and drag safeties were compared in the two groups. Furthermore, cost-effectiveness analysis was used to calculate the curative costs of both groups. Results Analysised from preventive effect of the two groups, there were 4 cases of DVT and the incidence rate was 14.81% in treated group, and the numbers above were respectively 5 cases and 19.23% in controlled group. The treated group appeared 2 cases of subcutaneous blood stasis, while the controlled group had 3 cases of postoperative hematoma on puncture documented, 5 cases of unequal size area of subcutaneous blood stasis. The curative effect and drag safeties of the two groups were obviously different compared by X^2-test （ P〈 0.05 ）. The incidence of DVT is carried on the cost-effectiveness analysis（ CEA ）on both group, the CEA of the treated group is 1370.6, which is lower than that of the controlled group（ 2268.5 ）. Both groups are carried on the sensitivity analysis. The cost of the treated group increases by 10% and the ratio of CEA is still lower than that of controlled group. Conclusion Both the two kinds of medicine could effectively prevent deep venous thrombosis after major orthopedic operation. Compared with low molecular heparin, XiaoZhongZhiTong decoction produces certain clinical effect and fewer negative effects. Application of XiaoZhongZhiTong decoction has the better ratio of CEA, so it costs less to gain greater efficiency.