益气化瘀通脉汤联合穴位按摩对股骨颈骨折术后深静脉血栓形成患者血液流变学、纤维蛋白原、D-二聚体及炎症因子的影响

Effects of Yiqi Huayu Tongmai decoction combined with acupoint massage on hemorheology,fibrinogen and D-dimer in patients with deep venous thrombosis after surgery for femoral neck fracture

目的观察益气化瘀通脉汤联合穴位按摩治疗股骨颈骨折术后深静脉血栓形成患者的临床疗效及对血液流变学、纤维蛋白原(FIB)、D-二聚体(D-D)和炎症因子的影响。方法将2018年4月—2019年1月在青岛市海慈医疗集团治疗的110例股骨颈骨折术后深静脉血栓形成患者随机分为对照组和观察组各55例。对照组给予常规西医溶栓、抗凝治疗,观察组在对照组治疗基础上给予益气化瘀通脉汤联合穴位按摩治疗,2组均连续治疗3周。观察2组治疗后下肢周径差值、血液流变学(全血高切黏度、血浆黏度、血小板黏附率和血细胞比容)、FIB、D-D、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和C反应蛋白(CRP)水平变化,统计2组患者中医证候疗效、血栓溶解疗效及不良反应情况。结果治疗3周后,2组患者的小腿和大腿周径差值、全血高切黏度、血浆黏度、血小板黏附率、血细胞比容及血清FIB、D-D、TNF-α、IL-6和CRP水平均明显低于治疗前(P均<0.05),且观察组患者上述指标均明显低于对照组(P均<0.05);观察组患者的中医证候总有效率为92.7%(51/55),血栓溶解总有效率为87.3%(48/55),对照组分别为74.6%(41/55)和61.8%(34/55),观察组均明显高于对照组(P均<0.05);治疗期间2组患者均未见不良反应。结论益气化瘀通脉汤联合穴位按摩治疗可明显改善股骨颈骨折术后深静脉血栓形成患者血液高黏、高凝状态,减轻炎症反应,临床疗效明显优于单纯西医治疗,且安全。

Objective It is to observe the clinical efficacy of acupoint massage combined with Yiqi Huayu Tongmai decoction in patients with deep venous thrombosis(DVT)after surgery for femoral neck fracture and its influence on hemorheology,fibrinogen(FIB),D-dimer and inflammatory factors.Methods 110 patients with DVT after surgery for femoral neck fracture treated in Qingdao Haici Medical Group from May 2018 to January 2019 were randomly divided into control group and observation group,55 cases in each group.The control group was given conventional western medicine such as thrombolysis and anticoagulation therapy,and the observation group was given Yiqi Huayu Tongmai decoction combined with acupoint massage on the basis of the control group.Both groups were treated for 3 weeks.The changes of lower limb circumference difference,levels of hemorheology(high shear viscosity of whole blood,plasma viscosity,platelet adhesion rate and hematocrit),FIB,DD,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C reactive protein(CRP)before and after treatment were observed,the TCM syndrome efficacy,thrombolysis efficacy and side effects were evaluated or recorded in the two groups.Results After 3 weeks of treatment,the difference of circumferences between calf and thigh,whole blood high shear viscosity,plasma viscosity,platelet adhesion rate,hematocrit and the levels of serum FIB,DD,TNF-α,IL-6 and CRP of the two groups were significantly lower than those before treatment(P<0.05),and the above indicators in the observation group were significantly lower than those in the control group(P<0.05);the total effective rate of TCM syndromes and thrombolysis in the observation group was 92.7%(51/55)and 87.3%(48/55),,respectively,while those in the control group were 74.6%(41/55)and 61.8%(34/55),respectively.The rates in the observation group were significantly higher than those in the control group(P<0.05).There were no adverse reactions in the two groups during the treatment period.Conclusion Acupoint massage combined with Yiqi Huayu Tongmai decoction can significantly improve the hyperviscosity and hypercoagulability and relieve inflammation in patients with DVP after femoral neck fracture surgery.The clinical efficacy is significantly better than that of western medicine alone,and it is safe.