桃红四妙汤结合低分子肝素钙防治全膝关节置换术后深静脉血栓形成的临床观察

Clinical observation on the curative effect of TAOHONG SIMIAO DECOCTION combined with low molecular weight heparin calcium in the preventive treatment of deep vein thrombosis after total knee arthroplasty

目的:探讨桃红四妙汤配合低分子肝素钙防治全膝关节置换术后深静脉血栓形成的临床疗效及安全性。方法:将符合要求的40例患者随机分为治疗组和对照组,每组20例。治疗组采用桃红四妙汤加低分子肝素钙治疗,对照组仅采用低分子肝素钙治疗。术后测定2组患者的患肢肿胀情况、凝血指标、血小板计数、切口引流量、血肿瘀斑及深静脉血栓发生情况。结果:①患肢肿胀情况。大腿周径:不同时间点周径不全相同(F=25.320,P=0.000);2组间周径总体有差别(F=5.530,P=0.024),进一步比较显示术后第6天治疗组周径小于对照组(F=175.303,P=0.000);治疗方法与时间因素之间存在交互作用(F=14.214,P=0.000)。小腿周径:不同时间点周径不全相同(F=67.520,P=0.000);2组间周径总体有差别(F=5.348,P=0.026),进一步比较显示术后第2天、第6天、第10天治疗组周径小于对照组(F=13.960,P=0.001;F=42.183,P=0.000;F=7.678,P=0.009);治疗方法与时间因素之间存在交互作用(F=22.428,P=0.000)。②凝血指标。2组患者术后第2天凝血酶原时间及活化部分凝血活酶时间比较,差异无统计学意义(t=1.480,P=0.147;t=0.821,P=0.417);治疗组术后第14天与术后第2天凝血酶原时间及活化部分凝血活酶时间差值均大于对照组(t=2.117,P=0.041;t=2.104,P=0.042)。③血小板计数。不同时点血小板计数不全相同(F=67.155,P=0.000);2组间血小板计数未见不同(F=0.716,P=0.403);治疗方法与时间因素之间不存在交互效应(F=0.318,P=0.591)。④切口引流量。术后治疗组切口引流量小于对照组(t=1.520,P=0.137)。⑤血肿瘀斑发生情况。术后2组患者血肿、瘀斑发生情况比较,差异无统计学意义(P=0.244;χ2=2.667,P=0.102)。⑥深静脉血栓发生情况。治疗期间仅对照组2例发生深静脉血栓,2组患者深静脉血栓发生情况比较,差异无统计学意义(P=0.244)。结论:桃红四妙汤结合低分子肝素钙能明显延长凝血酶原时间及活化部分凝血活酶时间,明显减轻全膝关节置换术后患肢肿胀,减少术后出血,有效防治全膝关节置换术后深静脉血栓形成,并且具有较高的安全性。

Objective：To explore the clinical curative effect and safety of TAOHONG SIMIAO DECOCTION combined with low molecular weight heparin calcium（LMWHC）in the preventive treatment of deep vein thrombosis（DVT）after total knee arthroplasty（TKA）.Methods：Forty patients met the requirements were randomly divided into treatment group and control group,20 cases in each group.Patients in the treatment group were administrated with TAOHONG SIMIAO DECOCTION combined with LMWHC,while the others in the control group were administrated with LMWHC only.The swelling situations of the affected limbs,coagulation indexes,platelet count,incision drainage,hematoncus ecchymosis and DVT occurrences of the patients in the 2 groups were measured after TKA.Results：①The swelling situations of the affected limbs：On the aspect of thigh circumference：not all of the circumferences were same at the different time points（F=25.320,P=0.000）;there was difference in circumference between the 2 groups totally（F=5.530,P=0.024）,the circumference of treatment group was less than that of control group at the 6th day after TKA through the further comparison（F=175.303,P=0.000）;there was an interaction between treatment method and time factor（F=14.214,P=0.000）.On the aspect of calf circumference：not all of the circumferences were same at the different time points（F=67.520,P=0.000）;there was difference in circumference between the 2 groups totally（F=5.348,P=0.026）,the circumference of treatment group was less than that of control group at the 2nd,6th,10th day after TKA through the further comparison（F=13.960,P=0.001;F=42.183,P=0.000;F=7.678,P=0.009）;there was an interaction between-treatment method and time factor（F=22.428,P=0.000）.②Coagulation indexes：There was no statistical difference in prothrombin time（PT）and activated partial thromboplastin time（APTT）between the 2 groups at the 2nd day after TKA（t=1.480,P=0.147;t=0.821,P=0.417）;The difference in PT and APTT between the 14th postoperative day value and the 2nd postoperative day value of the treatment group were all larger than those of the control group（t=2.117,P=0.041;t=2.104,P=0.042）.③Platelet count：not all of the platelet counts were same at the different time points（F=67.155,P=0.000）;there was no difference in platelet count between the 2 groups（F=0.716,P=0.403）;there was not an interaction between treatment method and time factor（F=0.318,P=0.591）.④Incision drainage of treatment group was less than that of the control group after TKA（t=1.520,P=0.137）.⑤There was no statistical difference in incidence of hematoncus and ecchymosis between the 2 groups（P=0.244;χ~2=2.667,P=0.102）.⑥DVT occurrences：Only 2 cases with DVT were found in the control group during the treatment period;there was no statistical difference in incidence of DVT between the 2 groups（P=0.244）.Conclusion：The therapy of TAOHONG SIMIAO DECOCTION combined with LMWHC of higher safety can effectively prevent DVT through obviously extension of PT and APTT,obviously relieving of the affected limb swelling situations after TKA and reduction of postoperative bleeding.