加味骨一方预防脊柱骨折并截瘫患者深静脉血栓的研究

Clinical Study on Modified Guyi Decoction in the Prevention and Treatment of DVT for the Patients with Spinal Fracture and Paraplegia

目的探讨加味骨一方在预防脊柱骨折并截瘫患者下肢深静脉血栓形成疗效的确切性及其安全性。方法将60例脊柱骨折并截瘫患者随机分成治疗组与对照组,分别给予加味骨一方及低分子肝素钠治疗。手术前后观察两组病例的临床症状、体征、彩色多普勒超声的改变,同时观测患者血小板计数(PLT)、血流变学、凝血酶原时间(PT)、部分凝血活酶时间(APTT)四项指标变化。结果 60例患者中,共有5例发生DVT,总发生率8.30%,其中治疗组发生3例DVT,发生率为10.00%,对照组发生2例DVT,发生率为6.66%,两组发生率比较无统计学差异(P>0.05)。患者血液流变学指标、APTT和PT指标变化治疗组与对照组分别与术前比较均有统计学差异(P<0.01或P<0.05),术后14d治疗组血液流变学指标、APTT和PT指标变化与对照组比较有统计学差异(P<0.01或P<0.05)。血小板计数变化两组患者手术前后自身比较无显著性差异(P>0.05),术后14d治疗组与对照组比较无显著性差异(P>0.05)。对照组有7例于用药10d后身上出现散在出血点,而治疗组仅1例出现这种现象,两组发生率比较有统计学差异(P<0.05)。结论加味骨一方具有明显的抗凝功能,能通过改善血液流变性、降低血粘度达到防治脊柱骨折截瘫术后下肢深静脉血栓形成的作用,而且比低分子肝素钠具有更好的安全性。

Objective To explore the effect and safety of modified guyi decoction in the prevention and treatment of DVT for the patients with spinal fracture and paraplegia.Methods 60 cases of spinal fracture and paraplegia were randomly divided into treatment group and control group,the patients were respectively treated with the modified guyi decoction and low molecular weight heparin.Before and after surgery the clinical symptoms,signs,color Doppler ultrasound changes of the patients in the two groups were observed,at the same time the changes of four indexes such as platelet count（PLT）,blood rheology,prothrombin time（PT）,partial thromboplastin time（APTT） were also observed.Results In the 60 patients,there were 5 cases with DVT,the total incidence rate was 8.30%,of which 3 cases in treatment group,the incidence rate was 10.00%,2 cases in control group,the incidence rate was 6.66%,the incidence rate had no significant difference in the two groups（P0.05）.There were comparatively significant differences in the changes with blood rheology,APTT and PT in both the treatment group and control group before and after treatment（P0.01 or P0.05）,and there also were comparatively significant differences between the two groups for 14 d after operation（P0.01 or P0.05）.There were no comparatively significant differences in the changes with PLT in both the treatment group and control group before and after treatment（P 0.05）,there also were no comparatively significant differences between the two groups for 14 d after operation（P0.05）.In the control group there were 7 cases who had scattered bleeding points,while only 1 case in the treatment group,the incidence rate had comparatively significant differences（P0.05）.Conclusion Modified guyi decoction has obvious anticoagulant function and can prevent lower limb DVT after the surgery of spinal fracture and paraplegia through improving blood rheology and reducing blood viscosity,so it has better security than low molecular weight heparin.