化瘀定痛液降低膝关节以下骨折血栓与出血风险的临床研究

Clinical Study of Huayu Dingtong Decoction on Reducing the Risk of Thrombus and Bleeding in Fracture below Knee Joint

目的观察口服化瘀定痛液对降低膝关节以下骨折的血栓形成和出血风险的疗效并探讨其作用机制。方法 60例患者分成中药组和对照组各30例。中药组采用术前术后口服化瘀定痛液治疗;对照组采用低分子肝素钠40 mg,每日1次皮下注射抗凝治疗。记录两组患者不同时间段的视觉模拟量表(VAS)评分,凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体水平(D-D)],出血量及术后第14日超声诊断下肢深静脉血栓结果。结果骨折第1日两组VAS评分差别不大(P> 0.05)。骨折第7日,术后第7日、第14日,两组VAS评分均较骨折第1日改善(均P <0.05);骨折第7日,术后第7日、第14日中药组疼痛改善程度均优于对照组(均P <0.05)。术后第1日两组间疼痛评分比较,差别不大(P> 0.05)。骨折第1日两组PT、APTT、D-D比较差别均不大(均P> 0.05)。骨折第7日,术后第1日、第7日、第14日对照组PT及APTT均较中药组时间明显延长(均P <0.05)。两组D-D在骨折第7日,术后第7日、第14日,均较骨折第1日均降低(均P<0.05);但中药组D-D与对照组比较,差别不大(均P> 0.05)。中药组出血量低于对照组(P <0.05)。中药组1例小腿肌间静脉血栓形成,对照组未发现,差别不大(P> 0.05)。结论膝关节以下骨折患者口服闵氏化瘀定痛液治疗可以降低深静脉血栓形成和出血风险。

Objective:To observe and study the therapeutic effect of Huayu Dingtong Decoction on reducing the risk of thrombosis and bleeding in patients with fracture below the knee joint and to explore its mechanism. Methods:60 patients were divided into TCM group and the control group. TCM group was treated with Huayu Dingtong Decoction before and after operation;the control group was injected subcutaneously(40 mg,qd)for anticoagulation. VAS score and coagulation index(PT,APTT,D-D)were recorded at different time. The bleeding volume and the results of ultrasound diagnosis on the 14th day after operation were recorded. Results:On the first day of fracture,there was no significant difference in VAS between the two groups(P > 0.05). On the 7th day of fracture,the 7th day and the 14th day after operation,VAS scores of the two groups were better than those of the 1st day(P < 0.05),and the improvement of pain in TCM group was better than that in the control group(P < 0.05). There was no significant difference in pain score between the two groups on the 1st day after operation(P > 0.05). The difference of PT,APTT and D-D between the two groups on the 1st day of fracture were not significant(P > 0.05).On the 7 th day of fracture,the 1 st,the 7th and the 14th days after operation,PT and APTT in the control group were significantly longer than those in TCM group(P < 0.05). Compared with the first day of fracture,the level of D-dimer in the two groups decreased on the 7th day of fracture,the 7th and 14th days after operation(P < 0.05).However,there was no significant difference between the two groups(P > 0.05). The bleeding volume in TCM group was lower than that in the control group(P < 0.05). There was one case of intermuscular vein thrombosis in TCM group,but it was not found in the control group;the difference was not significant(P > 0.05). Conclusion:Huayu Dingtong Decoction on patients with fracture below knee joint can reduce the risk of deep vein thrombosis and bleeding.