中医药综合措施对骨科大手术后下肢深静脉血栓形成的监测和防治

Monitor and Control the Comprehensive Measures of Traditional Chinese Medicine on the Formation of Lower Extremity Deep Venous Thrombosis after Major Operation in Department of Orthopedics

目的:探讨中医药综合措施防治骨科大术后下肢深静脉血栓(DVT)形成的疗效及机理。方法:176例骨科大术后患者随机按数字法分为对照组86例和观察组90例。两组给予积极的预防性护理措施。对照组,阿司匹林,100 mg/次,口服,1次/d;低分子肝素钙注射液,2500 IU/次,腹壁皮下注射,1次/d。在对照组的基础上加用疏血通注射液,6 m L/次,静脉滴注,1次/d;利湿活络方每日1剂内服。两组均术后连续用药14天。密切观察DVT形成情况,并计算DVT发生率;观察术后伤肢肿胀程度;检查凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血清D-二聚体(D-D)、血小板α-膜颗粒蛋白(GMP-140)、血栓素B2(TXB2)和血管性假血友病因子(v WF)变化情况。结果:在术后14天的随访观察中,对照组DVT的发生率为12.79%,高于观察组的3.33%(P<0.05);观察组在术后第7、14天FIB及D-D水平均低于对照组(P<0.01);观察组术后14天血液流变学指标全血黏度(高、低切)、血浆黏度、血沉和全血还原黏度(高、低切)的改善均优于对照组(P<0.01);术后14天观察组血清GMP-140、TXB2、和v WF水平低于对照组(P<0.01)。结论:在西医常规防治的基础上,疏血通注射液联合利湿活络方能降低骨科大手术后患者DVT的发生率,其作用机制可能与下调患者FIB、D-D、GMP-140、TXB2和v WF水平,改善血液高凝状态,促进血液循环,从而抑制下肢DVT的形成有关。

Objective： To investigate the comprehensive measures of prevention and treatment of traditional Chinese Medicine Department of orthopedics high postoperative lower extremity deep vein thrombosis（ DVT） effect and mechanism of formation. Methods： 176 cases of Department of orthopedics high postoperative patients were randomly divided into the control group in 86 cases and observation group of 90 cases. The two group was given a positive preventive nursing measures. Control group,aspirin,100 mg / oral,1 times / d; Low Molecular Weight Heparin Calcium Injection,2500 IU /,abdominal subcutaneous injection,1 times / d. In the control group based on the use of Shuxuetong injection,6ml /,intravenous drip,1 times / d; dampness Huoluo Decoction daily 1 agent oral. The two groups were treated for 14 d after operation. Close observation of the formation of DVT,and calculate the DVT incidence; observation of postoperative wound of limb swelling degree; check the prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB）,serum D two dimer（ D-D）,platelet alpha granule membrane protein（ GMP-140）,thromboxane B2（ TXB2） and von Willebrand factor（ v WF） changes. Results： in the follow-up of 14 days after surgery in the control group the incidence of DVT was 12. 79%,higher than the observation group of 3. 33%（ P〈0. 05）; observation group after seventh and 14 days of FIB and D-D than that of the control group（ P〈0. 01）; observation group after 14 days of hemorheology indexes of the whole blood viscosity（ high and low shear）,plasma viscosity,erythrocyte sedimentation rate and whole blood reduced viscosity（ high and low shear） were better than the control group（ P〈0. 01）; after 14 days of serum GMP-140,TXB2,and v WF levels than the control group（ P〈0. 01）. Conclusion： on the basis of conventional western medicine prevention,Shuxuetong injection combined with dampness Huoluo decoction can reduce the Department of orthopedics after major surgery patients the incidence of DVT,its mechanism may be related to the down-regulation ofFIB patients,D-D,GMP-140,TXB2 and v WF levels,improve blood hypercoagulable state,promote blood circulation,thereby inhibiting the formation of lower extremity DVT related.