黄芪桂枝五物汤对老年糖尿病合并髋部骨折术后患者血液高凝状态的影响

Effect of Huangqi Guizhi Wuwu Decoction on Blood Hypercoagulability State in Patients with Senile Diabetes Complicated with Hip Fracture Surgery

目的:观察黄芪桂枝五物汤对老年糖尿病合并髋部骨折术后患者血液高凝状态的影响。方法:60例老年糖尿病合并髋部骨折术后患者随机平均分为对照组和观察组。两组均给予糖尿病教育、降低血糖、饮食控制及术后当天行补液、预防感染、功能锻炼等基础治疗;对照组同时给予甲钴胺片;观察组同时给予黄芪桂枝五物汤。治疗2个月后,比较两组患者治疗前后血液高凝状态变化[血浆凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板计数(blood platelet,PLT)、D-二聚体(D-Dimer,DD)]、中医证候积分、血糖水平及临床疗效。结果:两组患者术后当天PT、FIB、APTT、PLT、DD水平比较,差异无统计学意义(P>0. 05);两组患者术后第5天的APTT、PLT比较,差异无统计学意义(P> 0. 05);对照组患者术后第5天的PT、FIB、DD值均高于观察组,差异有统计学意义(P <0. 05)。治疗后对照组中医证候积分为(25. 1±4. 3)分,高于观察组的(21. 0±6. 1)分,差异有统计学意义(P <0. 05)。治疗后对照组空腹血糖、餐后2小时血糖水平均高于观察组,差异均有统计学意义(P <0. 05)。对照组患者有效率(73. 3%)低于观察组(93. 3%),差异有统计学意义(P <0. 05)。结论:黄芪桂枝五物汤治疗老年糖尿病合并髋部骨折术后患者疗效显著,能有效调节老年患者血糖水平,缓解临床症状与体征,改善髋部骨折术后血液高凝状态。

Objective: To observe the effect of Huangqi Guizhi Wuwu Decoction on blood hypercoagulability in patients with senile diabetes complicated with hip fracture surgery. Methods: 60 patients with senile diabetes complicated with hip fracture surgery were randomly divided into control group and observation group. Both groups were given diabetes education,lowering blood sugar,diet control,and the basic treatment of rehydration,infection prevention,functional exercise,etc. The control group was given mecobalamin tablets simultaneously and the observation group was given Huangqi Guizhi Wuwu Decoction at the same time. Two months after treatment,changes in blood hypercoagulability[plasma prothrombin time ( PT) , fibrinogen ( FIB) , activated partial thromboplastin time( APTT) ,blood platelet ( PLT) ,D-dimer ( D-Dimer) ],TCM syndrome score,blood glucose level and clinical efficacy before and after treatment were compared. Results: There were no significant differences in the levels of PT,FIB,APTT,PLT and D-Dimer between the two groups on the day after surgery ( P > 0. 05) . There were no significant differences in APTT and PLT between the two groups on the 5th day after operation ( P > 0. 05) . The PT,FIB and D-DIMER values in the control group were higher than those in the observation group on the 5th day after operation,and the differences were statistically significant( P < 0. 05) . After treatment,the score of TCM syndromes in the control group was ( 25. 1 ± 4. 3) which was higher than that in the observation group ( 21. 0 ± 6. 1) , and the difference was statistically significant ( P < 0. 05) . After treatment,fasting blood glucose and 2-hour blood glucose levels in the control group were higher than those in the observation group,and the difference was statistically significant ( P < 0. 05) . The effective rate of the control group ( 73. 3%) was lower than that of the observation group ( 93. 3%) , and the difference was statistically significant ( P < 0. 05) . Conclusion: Huangqi Guizhi Wuwu Decoction is effective in the treatment of patients with senile diabetes complicated with hip fracture surgery. It can effectively regulate blood sugar levels in elderly patients,relieve clinical symptoms and signs,and improve blood hypercoagulability after hip fracture.