加味血府逐瘀汤联合利伐沙班对全膝关节置换术后深静脉血栓发生的影响

Effects of Jiawei Xuefu Zhuyu Decoction(加味血府逐瘀汤) Combined with Rivaroxaban on Deep Venous Thrombosis after Total Knee Replacement Patients

目的评价加味血府逐瘀汤联合利伐沙班预防膝关节骨性关节炎患者全膝关节置换术(TKA)术后深静脉血栓(DVT)的临床疗效。方法将105例TKA患者随机分为中药组、西药组和中西医结合组,每组35例。各组患者术后均给予疼痛和康复管理、抗感染治疗。术后第1天开始中药组再给予口服加味血府逐瘀汤水煎剂;西药组口服利伐沙班10 mg,每晚1次;中西医结合组口服中药和利伐沙班。各组均连续服用14天。于术前和术后3、7、14天观察DVT的发生情况、血浆D-二聚体、VAS疼痛评分、运动范围(ROM)、中医证候积分,并观察术后伤口愈合及并发症情况。结果各组患者术后3、7、14天的血浆D-二聚体水平明显高于术前(均P<0.05),术后3天中西医结合组与其他两组比较明显降低(P<0.05)。各组患者术后3、7、14天VAS评分均较术前降低(P<0.05),且术后14天中西医结合组VAS评分明显低于其他两组(P<0.05)。术后各组中医证候积分与术前比较明显降低(P<0.05),且术后14天中西医结合组中医证候积分明显低于中药组及西医组(P<0.05)。各组术后14天ROM较术前明显增大(P<0.05)。术后14天中西医结合组伤口渗出率低于中药组和西药组,中西医结合组肿胀率低于西药组(P<0.05)。结论加味血府逐瘀汤联合利伐沙班预防DVT临床疗效确切,且有助于伤口愈合。

Objective To evaluate the clinical efficacy of Jiawei Xuefu Zhuyu Decoction（ 加味血府逐瘀汤） combined with rivaroxaban in preventing deep venous thrombosis（ DVT） after total knee replacement（ TKA） of patients with knee osteoarthritis. Methods A total of 105 patients were randomly divided into Chinese medicine group（ 35 patients）,western medicine group（ 35 patients） and integrated Chinese and western medicine group（ 35 patients）.All patients in each group accepted pain and rehabilitation management and anti-infective therapy after the surgery.Jiawei Xuefu Zhuyu Decoction by oral administration was given to Chinese medicine group at the 1 st day after the surgery,10 mg rivaroxaban by oral administration to western medicine group,once every night. Jiawei Xuefu Zhuyu Decoction combined with rivaroxaban by oral administration was given to integrated Chinese and western medicine group. All groups were treated for 14 days continuously. The condition of DVT,plasma D-dimer,VAS score,range of movement（ ROM） and traditional Chinese medicine（ TCM） syndrome score were observed before the surgery and on the 3 rd,7 th,14 th day after the surgery. And the postoperative wound healing and complications were observed.Results The level of plasma D-dimer in three groups on the 3 rd,7 th,14 th day after the surgery were all significantly higher than before the surgery（ P〈0. 05）,and D-dimer level of the integrated Chinese and western medicine group on the 3 rd day after the surgery was significantly lower than that of the other 2 groups（ P〈0. 05）. VAS score in each group on the 3 rd,7 th,14 th day after the surgery were all lower than before the surgery（ P〈0. 05） and the score of integrated Chinese and western medicine group in 14 days after the surgery was obviously lower than that of the other groups（ P〈0. 05）. After surgery the TCM syndrome scores in all groups were significantly lower than those before the surgery（ P〈0. 05）,and the score in integrated Chinese and western medicine group was significantly lower than Chinese medicine group and western medicine group in 14 days after the surgery（ P〈0. 05）. The ROM score in 14 days after the surgery in all groups were significantly higher than that before the surgery（ P〈0. 05）. The swelling rate of the integrated Chinese and western medicine group was lower than that of the Chinese medicine group and western medicine group in 14 days after the surgery,and the rate of integrated Chinese and western medicine group was lower than that of the western medicine group（ P〈0. 05）. Conclusion The combination of Jiawei Xuefu Zhuyu Decoction and rivaroxaban is effective in preventing DVT,and is helpful to wound healing.