祛瘀消肿汤预防老年髋部骨折术后深静脉血栓的临床观察与药物经济学分析

Clinical observation and pharmacoeconomic analysis of Quyuxiaozhong Decoction for preventing deep vein thrombosis after senile hip fracture operation

目的探讨使用经验方祛瘀消肿汤预防老年髋部骨折术后深静脉血栓(DVT)的可行性。方法选取2012年7月至2015年7月收治的老年髋部骨折患者110例,按随机数字表法分为中药组和对照组,每组55例。两组术后均采用一般性和机械性预防血栓措施。在此基础上,中药组术后使用祛瘀消肿汤、对照组使用低分子肝素预防血栓,对两组患者术后血栓发生率、血小板计数(PLT)、凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)]及D-二聚体等指标进行比较,并进行药物经济学分析。结果中药组患者术后发生DVT 4例(7.27%),对照组3例(5.45%),两组比较,差异无统计学意义(P>0.05)。两组用药后D-二聚体、APTT、PT和PLT比较,差异均有统计学意义(P<0.05)。以术后DVT发生率为疗效指标进行成本-效果分析(CEA),中药组CEA结果(1 151.60元)低于对照组(2 279.80元),差异有统计学意义(P<0.05);敏感度分析显示,中药组治疗成本提高10%后,CEA仍较对照组低。结论与低分子肝素比较,祛瘀消肿汤预防老年髋部骨折术后DVT具有疗效确切、不良反应少、花费成本低、收益大等特点,是值得选用的中药方剂。

Objective To investigate the feasibility of using the empirical method of Quyuxiaozhong Decoction for pre-venting deep vein thrombosis（DVT） after senile hip fracture operation. Methods 110 patients with hip fracture in our hospital from July 2012 to July 2015 were selected and divided into the Chinese medicine group and the control group according to the random number table method,55 cases in each group. All the cases were treated with mechanic and general method for preventing DVT. On this basis,the Chinese medicine group was given Quyuxiaozhong Decoction after operation,while the control group used low-molecular-weight heparin for preventing thrombosis. The indicators of the occurrence rate of thrombosis,PLT,prothrombin time（PT）,activated partial thromboplastin time（APTT） and D-dimer were recorded and compared between the two groups. Further more,the pharmacoeconomic analysis was performed. Results 4 cases（7.27%） of DVT occurred in the Chinese medicine group,while 3 cases（5.45%） in the control group,the difference was not statistically significant（P〈0.05）. The levels of D-dimer,APTT,PT and PLT had statistical differences between the two groups（P〈0.05）. With the DVT occurrence rate as the effect indicator, the cost effectiveness analysis（CEA） was performed,the CEA results were 1 151.60 Yuan in the Chinese medicine group,which was lower than 2 279.80 Yuan in the control group,the difference was statistically significant（P〈0.05）;the sensitivity analysis displayed that if the costs of Chinese medicine was elevated by 10%,its CEA would still be lower than that in the control group. Conclusion Compared with low molecular heparin,Quyuxiaozhong Decoction for preventing DVT has the advantages of definite effect,less adverse reactions,low costs and large earnings,and deserves to select and use as a Chinese medicine decoction.