针药联合防治创伤骨折后高血凝状态临床观察

Clinical Observation of Acupuncture Combined with Chinese Herbal Medicine for Prevention and Treatment of Post-Fracture Hypercoagulability

目的:观察术前应用针刺联合中药治疗创伤骨折后高血凝状态的临床疗效。方法:将90例符合研究条件的股骨干骨折患者随机分成中药组、针药组和西药组各30例。中药组予活血通脉汤治疗;针药联合组在中药组的基础上联合针刺治疗;西药组予以低分子肝素钙皮下注射治疗。三组治疗均至术前1 d。观察各组治疗前后血栓弹力图各参数凝血反应时间(R时间)、凝固时间(K时间)、凝固角(α角)、血栓最大幅度值(MA)和血栓硬度值(G值)、D-二聚体(D-dimer)水平变化及深静脉血栓DVT情况。结果:治疗后,三组的R、K时间均延长,α角、MA值、G值和D-dimer均减小(P<0.05或P<0.01),针药组和西药组各指标比较差异无统计学意义(P>0.05),而针药组及西药组的R时间延长幅度及MA值、G值、D-dimer减小幅度大于中药组(P<0.05)。术前1 d,B超发现中药组有6例DVT形成,西药组有3例DVT形成,而针药组无DVT形成,针药组与中药组比较差异有统计学意义(P<0.05)。结论:针药联合能改善创伤骨折后的高血凝状态,降低术前DVT形成风险,且疗效优于单用中药治疗。

Objective：To observe the therapeutic effect of acupuncture combined with Chinese herbal medicine for post-fracture hypercoagulability. Methods：Ninety patients with femoral shaft fracture were ran- domly divided into the Chinese herbal medicine group,the Chinese herbal medicine and acupuncture group and the western medicine group,30 cases in each group. The Chinese herbal medicine group was treated with Huoxue Tongmai decoction,the Chinese herbal medicine group and acupuncture group was treated with acupuncture and Huoxue Tongmai decoction,and the western medicine group was given subcutaneous injec- tion of low-molecular-weight heparin calcium. All patients were treated until one day before surgery. Before and after treatment,the changes of the thromboelastogram（TEG） parameters（R,K,cL,G and MA）,D-dimer and the occurrence of deep venous thrombosis（DVT） were observed. Results：After treatment,in the three groups, R and K were prolonged,a,MA,G and D-dimer decreased（P〈0.05 or P〈0.01）. Compared with the Chinese herbal medicine group,R was significantly prolonged（P〈0.05）,and MA,G and D-dimer significantly decreased （P〈0.05） in the Chinese herbal medicine and acupuncture group and western medicine group. No patient suffered from DVT in the Chinese herbal medicine and acupuncture group,while 6 patients suffered from DVT in the Chinese herbal medicine group,and 3 cases suffered from DVT in the western medicine group on the day before operation. There was significant difference between the Chinese herbal medicine and acupuncture group and the Chinese medicine group（P〈0.05）. Conclusion：Preoperative application of com- bining acupuncture and Chinese herbal medicine could reduce high blood coagulation state after traumatic fractures ,and the effect is superior to that of the Chinese herbal medicine alone.