通络祛风散沐足联合气压治疗预防腰椎内固定术后下肢深静脉血栓的临床观察

Clinical Observation of Tongluo Qufeng Powder Foot Bath Combined with Barotherapy for Preventing Deep Venous Thrombosis of Lower Extremities After Lumbar Internal Fixation

【目的】探讨应用通络祛风散沐足联合气压治疗仪预防腰椎内固定术后患者下肢深静脉血栓(DVT)的临床效果。【方法】将160例腰椎内固定术后患者随机分成对照组、气压组、沐足组和联合组,每组各40例。对照组给予术前常规宣教及术后运动指引,在此基础上,气压组给予气压治疗仪按摩双下肢治疗,沐足组给予通络祛风散沐足治疗,联合组给予通络祛风散沐足联合气压治疗仪按摩双下肢治疗,连续治疗7 d。观察各组患者术前、术后第1天和第7天血浆D-二聚体(D-D)和凝血功能指标[凝血酶原时间(PT)、凝血酶原标准化比率(PT-INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]的变化情况,运用彩色多普勒超声检查观察各组患者下肢DVT的发生情况。【结果】(1)术后第1天和第7天,各组患者的血浆PT、PT-INR、APTT水平均无明显变化,术前术后及组间比较差异均无统计学意义(P>0.05);而术后血浆FIB水平均有升高趋势,但术前术后及组间比较差异均无统计学意义(P>0.05)。(2)术后各组患者的血浆D-D水平均呈现出先上升后下降趋势,且在术后第7天,各组患者的血浆D-D水平仍高于术前,但术前术后及组间比较差异均无统计学意义(P>0.05)。(3)术前,各组患者彩超提示均无下肢DVT;术后第7天,复查彩超提示对照组有10例发生DVT,气压组和沐足组各有2例发生DVT,但均尚未出现明显的临床症状,联合组均未发生DVT。各组患者DVT发生率比较,差异有统计学意义(P<0.05)。【结论】通络祛风散沐足联合气压治疗可有效预防腰椎内固定术后下肢DVT,且不影响患者的凝血功能及手术效果,联合应用的效果略优于单一预防措施。

Objective To investigate the clinical effect on deep venous thrombosis(DVT)of lower extremities in patients after lumbar internal fixation treated by Tongluo Qufeng Powder foot bath combined with barotherapy.Methods One hundred and sixty patients after lumbar internal fixation were randomly divided into 4 groups:40 cases in the control group,40 in the barotherapy group,40 in the foot bath group,and 40 in the combined group.The control group was given postoperative routine health training.On the basis of postoperative routine health training,the barotherapy group was given massage of the lower extremities with air pressure therapeutic apparatus,the foot-bath group was treated by Tongluo Qufeng Powder foot bath,and the combined group was treated by Tongluo Qufeng Powder foot bath combined with massage of the lower extremities with air pressure therapeutic apparatus.The treatment covered 7 days.Before operation and on postoperative day one and 7,the plasma D-dimer(D-D)level and coagulation function indicators such as prothrombin time(PT),thrombin timeinternational normalized ratio(PT-INR),activated partial thromboplastin time(APTT),and fibrinogen(FIB)in the four groups were observed.All patients underwent color Doppler ultrasonography for assessing the incidence of DVT in the lower limbs.Results(1)On postoperative day one and 7,no obvious changes of PT,PT-INR,or APTT were shown in the 4 groups,the plasma FIB showed an increasing trend after treatment,but the differences among the 4 groups as well as in the same group before and after treatment were insignificant(P>0.05).(2)The plasma D-D level in the 4 groups presented the fluctuation changes of ascending first and then descending,and the level on postoperative day 7 was still higher than that before operation,but the differences among the 4 groups as well as in the same group before and after treatment were insignificant(P>0.05).(3)No DVT in the lower limb was shown in various groups before operation.On postoperative day 7,the color Doppler ultrasonography showed that 10 cases of DVT occurred in the control group,2 cases of DVT occurred in the barotherapy group and 2 cases of DVT occurred in the foot bath group,but no obvious clinical symptoms were found in the DVT cases.No DVT was found in the combined group.The difference of DVT incidence among the 4 groups was statistically significant(P<0.05).Conclusion Tongluo Qufeng Powder foot bath combined with barotherapy can effectively prevent the incidence of deep venous thrombosis of lower extremities after lumbar internal fixation,while has no side effect on coagulation function or operation outcome,indicating that the combined therapy is superior to the single preventive measure.