四妙通脉汤预防术后深静脉血栓的临床研究

Clinical Study of Simiao Tongmai Decoction in Preventing Postoperative Deep Venous Thrombosis

目的:临床观察四妙通脉汤预防术后深静脉血栓形成的疗效和安全性。方法:从骨科病房收集骨科大手术患者80例,按入院顺序分为A、B两组。A组为中药四妙通脉汤治疗组,B组为西药低分子肝素钠对照组,中药组术后6h服用四妙通脉汤,每日1剂,连服10d;西药组术后当日开始应用低分子肝素钠5000IU,每12h1次,皮下注射,术后7d停用。①分别于术前、术后第2、4、7天测量患者伤肢肿胀程度。②分别于术前、术后第7d行下肢彩超,观察下肢深静脉血流情况及血栓形成情况。③分别于术前、术后第2、4天检测血常规(PLT),APTT、PT。(4)A、B两组术后第1、2天切口引流量和敷料渗血情况及切口愈合情况比较。结果:①术后四妙通脉汤与低分子肝素钠均能改善下肢(大腿、小腿)肿胀情况。②四妙通脉汤和低分子肝素钠预防术后下肢深静脉血栓形成方面具有同等作用,术后肺栓塞(PE)的发生率两组比较差异无统计学意义(P>0.05)。③A组和B组在治疗前后APTT、PT、PLT比较差异有统计学意义(P<0.01),均能明显改善患者凝血情况,延长凝血时间;对血小板的计数影响两组比较差异有统计学意义(P<0.05),两者在血小板的计数影响上,低分子肝素钠较四妙通脉汤显著。④四妙通脉汤组出血并发症更少,更安全。结论:四妙通脉汤能有效预防骨科大手术后下肢深静脉血栓的形成,并具有较高的安全性。

Objective：To observe the efficacy and safety of Simiao Tongmai Decoction in preventing postoperative deep venous thrombosis（DVT）.Methods：Eighty cases of orthopedic surgery patients were collected,who had open surgeries on fractures of pelvis,acetabulum,hip and knee,or had total hip-knee arthroplasty.According to the order of admission,they were divided into group A,treated with Simiao Tongmai Decoction one dose daily for ten days,and group B,treated with 5000 IU subcutaneous injection of low molecular weight heparin twice a day for seven days.The following indicators were observed：the limb swelling degree in preoperative and postoperative patients on the 2nd,4th and 7th days;deep vein blood flow situation and thrombosis cases of the lower limbs before and 7 days after the operation via color Doppler examination;the levels of blood platelet,APTT and PT before the operation,2 and 4 days after the operation;the incision drainage,dressings oozing case and incision healing on the 1st and 2nd day after the operation.Results：① Both Simiao Tongmai Decoction and low-molecular-weight heparin can improve lower limb（thigh,calf） swelling situation.② Both have the same role in preventing DVT after operation.There was no significant difference in the incidence of pulmonary embolism（P〈0.05）.③Compared with before the treatment,significant differences were found in the levels of APTT,PT,and PLT in both groups after the treatment（P0.05）.④ Simiao Tongmai Decoction has few bleeding complications,which was much safer.Conclusion：Simiao Tongmai Decoction can effectively prevent DVT after orthopedic surgery operation,with high security.