中药对全膝关节置换术后早期应激反应及DVT发生的影响

Effect of Chinese medicine on stress response and occurrence of deep vein thrombosis in total knee arthroplasty

[目的]评价术前人参四逆颗粒加用术后补中益气颗粒联合低分子肝素钠在预防膝关节置换术后下肢深静脉血栓形成的疗效。[方法] 60例全膝关节置换患者随机分为两组,治疗组术前每日3次服用人参四逆颗粒连用3d、术后每日3次服用补中益气颗粒连用7 d;对照组术前3 d服用安慰剂加术后7 d服用安慰剂,术后两组均联合依诺肝素钠治疗。比较两组术后血栓发生情况,以及应激、炎性和凝血指标。[结果]术后6 d下肢深静脉彩色超声检查显示。治疗组30中,有1例(3.33%)发生DVT,而对照组30例中有8例(26.67%)发生DVT,两组间差异有统计学意义(P<0.05)。治疗组术后血糖、皮质醇、ACTH水平高于对照组(P<0.05);C-反应蛋白、中性粒细胞百分比、D二聚体和血浆纤维蛋白原均低于对照组(P<0.05)。[结论]术前人参四逆颗粒加术后补中益气颗粒联合依诺肝素钠可有效降低术后深静脉血栓的诱发因素,减少术后DVT的发生。

[Objective] To explore the effect of preoperative Ginseng Sini granules and postoperative Buzhong Yiqi granules combined with enoxaparin sodium on stress reaction and deep venous thrombosis(DVT) of lower extremity in primary total knee arthroplasty(TKA).[Methods] A total of 60 patients who underwent TKA were enrolled into this study, and randomly divided into two groups. The treatment group with 30 patients was given Ginseng Sini Granules for 3 days before surgery and Buzhong Yiqi Granules 3 times per day for 7 days after surgery combined with enoxaparin sodium injection, while the control group with 30 patients was given placebo at corresponding time points and enoxaparin sodium injection after surgery. The occurrence of DVT, parameter regarding to stress reaction, inflammation response and coagulation were compared between the two groups.[Results] The color Doppler ultrasound at 6 days postoperatively revealed that only 1 patient(3.33%) in the treatment group had DVT, whereas 8 patients(26.67%) in the control group suffered from DVT, which was statistically significant(P<0.05). The treatment group proved of significantly higher levels in glucose, cortisol, ACTH, and the significantly lower levels in white blood cell count, C-reactive protein, neutrophil percentage, D-dimer and fibrinogen than the control group postoperatively, which all were statistically significant(P<0.05).[Conclusion] The preoperative Ginseng Sini granules followed by Buzhong Yiqi granule combined with enoxaparin sodium injection is an effective prevention of deep vein thrombosis after toal knee arthroplasty.