活血利水法预防下肢骨折术后深静脉血栓形成的疗效研究

Clinical Observation of Blood-activating and Diuresis-promoting Therapy for Preventing Deep Vein Thrombosis in Lower Limb Fracture Patients After Surgery

【目的】观察活血利水法预防下肢骨折术后深静脉血栓形成(DVT)的临床疗效。【方法】根据一般情况及骨折分类将200例下肢骨折术后病例按照分层随机化法分为试验组、对照组各100例。根据《中国骨科大手术静脉血栓栓塞症预防指南》,2组予以相同的综合预防方案,同时试验组予以活血利水法代表方剂活血通脉汤治疗,每日1剂,连续14 d。分别观察2组术后第1天、第5天、第14天血清D-二聚体(D-D)、纤维蛋白原(Fg)水平并行伤肢彩色多普勒超声检查。【结果】(1)术后第1天,2组的血清D-D、Fg水平比较,差异均无统计学意义(P>0.05)。术后第5天、第14天,2组的血清D-D、Fg水平逐步下降,与术后第1天比较,差异均有统计学意义(P<0.05);且试验组下降较同期对照组显著,差异均有统计学意义(P<0.05),表明试验组在降低患者的血清D-D、Fg水平方面优于对照组;(2)彩色多普勒超声检查显示:术后第1天,2组伤肢DVT发生率比较,差异无统计学意义(P>0.05);术后第5天、第14天,试验组伤肢DVT发生率均显著低于对照组,差异均有统计学意义(P<0.05)。【结论】根据《中国骨科大手术静脉血栓栓塞症预防指南》制定综合预防方案,同时配合中医活血利水法治疗,能够降低下肢骨折术后血清D-二聚体、纤维蛋白原水平,预防伤肢深静脉血栓形成。

Objective To observe the clinical effects of therapy of activating blood and promoting diuresis for preventing deep vein thrombosis （DVT） in lower limb fracture patients after surgery. Methods According to the general conditions and fracture classification, 200 cases were equally randomized into experimental group and control group. Both groups were given the same comprehensive prevention program according to China Prevention Guideline for Venous Thromboembolism in Major Orthopedic Surgery. Additionally, the treatment group was given Huoxue Tongmai decoction, a representative prescription for activating blood circulation and promoting diuresis, once daily for 14 days. Serum D-dimer （D- D） and fibrinogen （Fg） levels as well as the color Doppler ultrasonography of the injured limb deep vein in both groups were measured on day 1, 5 and 14 after surgery. Results There were no statistically significant differences of serum D- D and Fg levels in both groups on day 1 after surgery （P〉0.05） . On day 5 and 14, serum D- D and Fg levels were decreased gradually in both groups （P〈0.05 compared with those on day 1）, and the decrease in experimental group was superior to that in the control group （P〈0.05） . The incidence of DVT in the injured limb showed by color Doppler ultrasonography was similar in both groups on day 1 after surgery （P〉0.05） , and was lower in the experimental group than that in the control group on day 5 and 14 after surgery （P〈0.05）. Conclusion When used together with Chinese herbal medicine with the actions of activating blood circulation and promoting diuresis, the comprehensive prevention program developed on the basis of China Prevention Guideline for Venous Thromboembolism in Major Orthopedic Surgery can prevent the injured limb deep vein thrombosis in lower limb fracture after surgery through reducing serum D- dimer and fibrinogen levels.