中西医结合治疗下肢深静脉血栓形成的疗效观察

An observation on efficacy of combined traditional Chinese and western medicine for treatment of patients with deep venous thrombosis in lower extremity

目的：观察中西医结合治疗下肢深静脉血栓形成（DVT）的疗效。方法采用前瞻性研究方法，将福建医科大学附属闽东医院收治的40例DVT患者按随机数字表法分为对照组和治疗组，每组20例。两组均给予常规治疗，对照组在常规治疗基础上给予低分子肝素钙3.075 kU皮下注射及口服华法林钠等治疗，重叠使用3 d后停用低分子肝素钙；治疗组在常规治疗基础上给予自拟活血通脉方（桃仁15 g，赤芍15 g，金银花15 g，泽泻12 g，薏苡仁30 g，车前子9 g，鸡血藤12 g，玄参9 g，木瓜12 g，牛膝12 g）随证加减，并用将军散（生大黄粉250 g，芒硝200 g，面粉100 g，食醋500 g，拌成糊状）外敷患处，每日1次，30 d为1个疗程，共2个疗程。观察治疗前后患肢平面周径、视觉模拟量表（VAS）评分、血管再通情况、临床疗效和不良反应发生情况。结果治疗组总有效率明显高于对照组〔90.0%（18/20）比70.0%（14/20），P＜0.05〕。两组治疗后患肢周径均较治疗前明显减小，且以治疗组变化更显著〔大腿（cm）：46.21±4.80比53.18±4.45，小腿（cm）：32.57±4.26比36.21±5.01，均P＜0.05〕；两组治疗后1个月VAS评分即明显降低，治疗2个月后达谷值，且以治疗组降低更显著（分：2.24±0.58比3.36±0.61，P＜0.01），治疗组治疗后血管再通率较对照组明显升高〔85.0%（17/20）比70.0%（14/20），P＜0.05〕。结论中西医结合治疗DVT明显优于单纯西医治疗。

ObjectiveTo investigate the clinical efficacy of combined traditional Chinese and western medicine for treatment of patients with deep venous thrombosis（DVT）in lower extremity.Methods A retrospective study was conducted. Forty patients with DVT admitted into Mindong Hospital Affiliated to Fujian Medical University were randomly divided into control and treatment groups, 20 cases in each group. Conventional therapy was given in both groups. The patients in control group were hypodermically injected with low molecular heparin 3.075 kU, and orally took warfarin sodium; the former injection was terminated on the 3rd day, and afterwards warfarin was solely administered. On the basis of the treatment in the control group, the patients in treatment group were additionally treated with Huoxue Tongmai decoction（ingredients： peach kernel 15 g, red paeonia 15 g, honeysuckle flower 15 g, rhizoma alismatis 12 g, semen coicis 30 g, semen plantaginis 9 g, suberect spatholobus stem 12 g, radix scrophulariae 9 g, pawpaw 12 g, radix achyranthis bidentatae 12 g）, the formula could be modified in accordance with patients＇ symptoms and signs, and Jiangjun powder was applied at the lesion externally（ingredients of the powder： rhubarb 250 g, mirabilite 200 g, flour 100 g, vinegar 500 g were mixed to form a smooth paste）, once a day, 30 days constituting a therapeutic course and totally 2 courses being taken. The perimeter of the affected limb, visual analogy score（VAS）, revascularization rate, curative effect and adverse reaction were observed before and after treatment and compared between the two groups.Results The total effective rate in treatment group was higher than that in control group〔90.0%（18/20） vs. 70.0%（14/20）,P〈0.05〕. After treatment, the perimeter of the affected limb in both groups was significantly smaller than that before treatment, the decrease in treatment group being more marked〔the upper leg（cm）：46.21±4.80 vs. 53.18±4.45, the lower leg（cm）： 32.57±4.26 vs. 36.21±5.01, bothP〈0.05〕. TheVAS scores were significantly decreased in both groups after treatment for 1 month, they reached the valley values after treatment for 2 months, the degree of descent being more significant in the treatment group（2.24±0.58 vs. 3.36±0.61,P〈0.01）. The revascularization rate of the treatment group after treatment was higher than that of the control group〔85.0%（17/20） vs. 70.0%（14/20）,P〈0.05〕.ConclusionThe combined treatment of traditional Chinese and western medicine was obviously superior to the sole western medicine for treatment of patients with DVT.