膝伤活血灵口服配合低分子肝素钙皮下注射对全膝关节置换术后隐性失血的影响

Effect of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of low-molecular-weight heparin on hidden blood loss after total knee arthroplasty

目的：探讨膝伤活血灵口服配合低分子肝素钙皮下注射对全膝关节置换术后隐性失血的影响。方法：初次行单侧全膝关节置换术的膝骨关节炎患者117例,随机分为2组,观察组59例,术后应用膝伤活血灵口服配合低分子肝素钙皮下注射抗凝;对照组58例,单纯应用低分子肝素钙抗凝。观察2组患者术后下肢深静脉血栓形成的发生情况及膝关节功能恢复情况,记录2组患者失血量并进行比较。结果：术后第8天,2组患者间显性失血量比较,差异无统计学意义[（447.89±138.67）mL,（456.00±132.03）mL;t=1.665,P=0.099];但观察组失血总量、隐性失血量均少于对照组,差异有统计学意义[（804.34±222.06）mL,（1 103.34±261.87）mL;t=4.665,P=0.033;（401.89±98.67）mL,（566.00±102.03）mL;t=4.871,P=0.026]。2组患者切口均甲级愈合;均无下肢深静脉血栓形成。观察组术后血红蛋白含量低于80 g·L^-14例,对照组术后血红蛋白含量低于80 g·L^-119例,输入同型浓缩红细胞4个单位后,血红蛋白含量均恢复到正常参考值范围内;2组患者术后输血例数比较,差异有统计学意义（χ2=12.498,P=0.000）。2组患者均获随访,随访时间6-11个月,中位数8个月;膝关节功能均恢复。结论：应用膝伤活血灵口服配合低分子肝素钙皮下注射预防全膝关节置换术后下肢深静脉血栓形成,疗效满意;且与单纯应用低分子肝素钙相比,可减少患者术后隐性失血。

Objective： To explore the effect of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of low- molecular- weight heparin（ LMWH） on hidden blood loss after total knee arthroplasty（ TKA）. Methods： One hundred and seventeen patients with knee osteoarthritis were treated with unilateral TKA for the first time and then they were randomly divided into 2 groups,59 cases in observation group,while 58 cases in control group. Patients in the observation group were treated with oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of LMWH for anticoagulation after TKA,while the others in the control group were treated with monotherapy of subcutaneous injection of LMWH for anticoagulation. Then the postoperative deep venous thrombosis（ DVT） in lower limbs and knee function restoration were observed,and the blood loss volume were recorded and compared between the 2 groups. Results： There was no statistical differences in the dominant blood loss volume between the 2 groups on the 8th day after TKA（ 447. 89 ＋/- 138. 67 vs 456. 00 ＋/- 132. 03 mL; t = 1. 665,P = 0. 099）; while the total blood loss volume and hidden blood loss volume in the observation group were less than those of control group respectively（ 804. 34 ＋/- 222. 06 vs 1 103. 34 ＋/- 261. 87 mL; t = 4. 665,P = 0. 033; 401. 89 ＋/- 98. 67 vs 566. 00 ＋/- 102. 03 mL; t = 4. 871,P = 0. 026）. All of the patients in the 2 groups got primary healing in the operative incisions and no DVT were found. The postoperative hemoglobin content were lower than 80 g / L in 4 patients（ observation group） and 19 patients（ control group） and were restored to normal range after the patients received 4 units concentrated red blood cells（ CRBC） with same blood- type. There was statistical differences in the number of blood transfusion cases after TKA between the 2 groups（ χ2= 12. 498,P = 0. 000）. All patients in the 2 groups were followed up for 6- 11 months with a median of 8 months,and the knee function were restored in all patients. Conclusion： The therapy of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of LMWH has satisfactory preventative effects on DVT in lower limbs after TKA,and it is better than the monotherapy of subcutaneous injection of LMWH in reducing the postoperative hidden blood loss.