血府逐瘀汤对半髋关节置换术后深静脉血栓预防作用的研究

Study on the Effect of Using Xuefu Zhuyu Decoction to Prevent Deep Vein Thrombosis after Hemiarthroplasty

目的:观察血府逐瘀汤对预防半髋关节置换术治疗高龄不稳定型股骨粗隆间骨折患者深静脉血栓形成的作用。方法:选取我院进行半髋关节置换术治疗的高龄不稳定型股骨粗隆间骨折且早期出现气滞血瘀症状的患者90例为研究对象,随机分为观察组(n=45)和对照组(n=45),观察组患者在术后第1天口服血府逐瘀汤水煎剂,对照组口服阿司匹林片剂,在术后第2天,术后第7天和术后第15天分别对两组患者的各项指标进行比较。结果:1两组患者术后不同时间点PT和APTT均显著长于术前(P<0.05);观察组的INR在术后第15天显著高于术前(P<0.05)。同一时间点组间的比较结果显示,在术后第7天和术后第15天观察组的PT均长于对照组(P<0.05),而观察组的APTT在术后第15天长于对照组(t=5.384,P<0.0001)。术后,两组患者出现深静脉血栓的发生率无显著性差别(χ2=0.327,P>0.05)。2不同时间点两组间HGB水平和D-二聚体均无明显差异(P>0.05)。术后第7天,观察组和对照组的HGB水平较术前均显著降低(P<0.05)。D-二聚体的水平在术后第2天和术后第7天与术前差异显著(P<0.05)。3不同时间点两组间TXB2和6-Keto-PGF-α水平均无明显差异(P>0.05)。术后不同时间点两组患者TXB2水平均显著低于术前(P<0.05);而6-Keto-PGF-α水平在术后第7天和术后第15天明显高于术前水平(P<0.05)。4术后第15天观察组患者VWF水平显著低于对照组患者VWF水平(t=3.271,P=0.002),其余时间点两组间VWF水平和GMP-140水平均无显著性差异(P>0.05)。组内的比较结果显示,术后各时间点GMP-140水平均显著低于术前(P<0.05),而VWF水平在术后第7天和术后第15天明显高于术前水平(P<0.05)。结论:血府逐瘀汤的预防治疗可明显改善半髋关节置换术治疗的高龄不稳定型股骨粗隆间骨折患者的凝血指标,对深静脉血栓形成的预防作用与口服阿司匹林相当,值得在临床上推广。

Objective： To investigate the effects of Xuefu Zhuyu Decoction on preventing deep vein thrombosis in aged unstable intertrochanteric fractures patients underwent hemiarthroplasty treatment. Methods： 90 aged patients with unstable intertrochanteric fractures underwent hemiarthroplasty treatment in our hospital were selected for the study. These patients were randomly divided into observation group（ n = 45） and controlled group（ n = 45）. Patients in the observation group were orally treated with Xuefu Zhuyu Decoction after first day of hemiarthroplasty while the controlled group was treated with aspirin tablet. Two groups of prothrombin time（ PT）,thrombin time（ APTT）,international normalized ratio（ INR）,hemoglobin（ HGB）,D- dimer,thromboxane B2（ TXB2）,6- keto- prostaglandin Prime F1α（ 6- Keto- PGF- α）,α- granule membrane glycoprotein（ GMP- 140） and von willebrand factor（ VWF） in 2day,7day and 15 day after surgery were compared respectively. Results： 1Two groups of PT and APTT at different time points were significantly longer than that before surgery（ P〈0. 05）. The value of INR in observed group after 15 days was significantly higher than that of preoperative（ P〈0. 05）. The PT after 7and 15 days in observed group were longer than that in the control group（ P〈0. 05）,while the APTT in observed group after 15 days were markedly longer than that in the control group（ t = 5. 384,P〈0. 0001）. After surgery,The incidence of deep vein thrombosis in two groups indicated no significant difference（ χ2= 0. 327,P〈0. 05）. 2Different time points of HGB and D- dimer levels between the two groups were not significantly different（ P〈0. 05）. The first seven days after surgery,HGB level in two group after7 days were significantly lower than that before surgery（ P〈0. 05）. While D- dimer levels after 2and 7day of surgery showed with significant difference compared with that of preoperative（ P〈0. 05）. 3Different time points of TXB2 and 6- Keto- PGF-α levels between the two groups were not significantly different（ P〈0. 05）. Different time points of TXB2 in two groups after surgery were both significantly lower than that of preoperative（ P〈0. 05）. And 6- keto- PGF- α levels after 7and 15 days were both significantly higher than that of the preoperative（ P〈0. 05）. 4VWF levels in observed group was significantly lower than that in control group after 15days（ t = 3. 271,P = 0. 002）. Other time points of VWF between the two groups as well as GMP-140 levels were not significantly different（ P〈0. 05）. Comparison within the group showed that,each time point of GMP-140 were significantly lower than that of preoperative（ P〈0. 05）,while VWF levels at 7and 15 days after surgery were significantly higher than that of preoperative（ P〈0. 05）. Conclusion： The prevention treatment of Xuefu Zhuyu Decoction can significantly improve the coagulation index of patients with elderly unstable intertrochanteric fractures after hemiarthroplasty. This effect on preventing deep vein thrombosis is equal to that of aspirin,which is worth promotion in clinic.