益气活血通络方用于全髋关节置换术后下肢深静脉血栓形成的预防效果

Preventive effect of Yiqi Huoxue Tongluo Decoction on lower extremity deep venous thrombosis in patients underwent total hip replacement

目的观察益气活血通络方用于全髋关节置换术后下肢深静脉血栓形成的防治效果。方法选取2015年1月~2017年4月宝鸡市中医医院收治的174例择期行全髋关节置换术的患者作为研究对象。采用随机数字表法将其分为观察组和对照组,每组各87例。对照组给予低分子肝素钙皮下注射,观察组在此基础上联合益气活血通络方。于术前和术后1、7、14 d检测患者凝血指标[包括凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]和血小板计数(PLT)情况,统计两组患者术中出血量、术后引流量和总输血量。随访至术后3个月,记录两组患者下肢深静脉血栓的发生率。结果经方差分析显示,不同时间点PT、TT、APTT、FIB、D-D和PLT差异有统计学意义(P<0.05),处理因素与时间点间未见交互作用(P>0.05),不同处理因素的PT、TT、APTT、FIB、D-D和PLT差异无统计学意义(P>0.05)。两组术中出血量、总输血量比较,差异无统计学意义(P>0.05)。观察组术后引流量低于对照组,差异有统计学意义(P<0.05)。随访过程中观察组脱落7例,对照组脱落5例。观察组下肢深静脉血栓发生率[21.25%(17/80)]低于对照组[35.37%(29/82)],差异有统计学意义(P<0.05)。结论益气活血通络汤具有明显的抗凝、溶栓作用,能明显改善临床症状,减少术后引流量,降低全髋关节置换术后下肢深静脉血栓发生率,值得临床推广应用。

Objective To observe the preventive effect of Yiqi Huoxue Tongluo Decoction in lower extremity deep venous thrombosis after total hip replacement. Methods One hundred and seventy-four patients underwent total hip re placement in Baoji Hospital of Traditional Chinese Medicine from January 2015 to April 2017 were selected as research objects, and they were randomly assigned into control group and observation group by random number table, with 87 cases in each group. The control group was given low molecular weight heparin calium by subcutaneous injection, on basis of which, the observation group was added with Yiqi Huoxue Tongluo Decoction. The parameters of coagulation func tion [prothrombin time （PT）, thrombin time （TT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB）, D-Dimer （D-D）] and blood platelet count （PLT） were detected before operation and after operation for 1, 7, 14 days. The intraoperative blood loss, postoperative volume of drainage and total blood transfusion volume of the two groups were collected. Follow-up for 3 months after operation, the incidence of lower extremity deep venous thrombosis of the two groups was recorded. Results Through analysis of variance, the differences of PT, TF, APTF, FIB, D-D and PLT at different time points were statistically significant （P 〈 0.05）, the treatment factors and timing showed no reciprocal action （P 〉 0.05）, the PT, TT, APTT, FIB, D-D and PLT among different treatment factors had no statistically significant differences （P 〉 0.05）. The intraoperative blood loss and total blood transfusion volume between the two groups had no statistically significant differences （P 〉 0.05）. The postoperative volume of drainage in the observation group was less than that of control group, the difference was statistically significant （P 〈 0.05）. During follow-up, 7 cases in observation group and 5 cases in control group failed to finish the study. The incidence of lower extremity deep venous thrombosis in the observation group was 21.25% （17/80）, which was lower than that of control group [35.37% （29/82）], the difference was statistically significant （P 〈 0.05）. Conclusion Yiqi Huoxue Tongluo Decoction has significant anticoagulation, thrombolysis effects, which can significantly improve clinical symptoms, reduce postoperative volume of drainage, decrease the incidence of lower extremity deep venous thrombosis after total hip replacement, it is worthy of clinical promotion and application.