加味八珍汤联合PFNA术治疗老年股骨转子间骨折患者的临床效果及对血液流变学指标的影响

A Study on the Effect of Jiawei Bazhen Decoction Combined with PFNA on the Hemorheology of Elderly Patients with Intertrochanteric Fracture of Femur

目的:研究加味八珍汤联合股骨近端防旋髓内钉(Proximal Femoral Nail Antirotation,PFNA)对老年股骨转子间骨折患者的临床效果及对术后隐性失血和血液流变学的影响。方法:选择2014年3月至2017年3月我院收治的68例接受PFNA治疗的转子间骨折者,将其随机平均分为观察组(34例,术后口服加味八珍汤颗粒7天)、对照组(34例)。对比两组总失血量、隐性失血量、隐性失血比例、血液流变学指标(血浆粘度及全血黏度低、中、高切)、不良反应等。结果:⑴两组各剔除2例,94.12%(64/68)的受试者完成研究。⑵两组总失血量相当,差异无统计学意义(P>0.05);与对照组相比,观察组隐性失血量及隐性失血发生率均显著降低(P<0.05)。⑶治疗前,两组血浆粘度及低、中、高切全血黏度比较差异无统计学意义(P>0.05);治疗后,两组血浆粘度及低、中、高切全血黏度均显著低于本组治疗前(P<0.05),且观察组以上指标均明显低于对照组(P<0.05)。⑷观察组发生肌间静脉血栓1例,无药物过敏及毒副反应;对照组发生1例深静脉血栓、4例肌间静脉血栓。观察组不良反应率为3.125%,显著低于对照组(15.625%,P<0.05)。结论:加味八珍汤既可显著减少老年股骨转子间骨折患者PFNA术后隐性失血,又能改善血流动力学、减少并发症。

Objective: To study the clinical efficacy of Jiawei Bazhen Decoction combined with proximal femoral nail antirotation(PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture and its effect on the postoperative hidden blood loss and hemorheology. Methods: From March 2014 to March 2017, 68 cases of intertrochanteric fractures treated by PFNA in our hospital were randomly divided into the observation groups(34 cases, oral Jiawei Bazhen Tang granules for 7 days after operation) and the control group(34 cases). The total blood loss, recessive blood loss, proportion of recessive blood loss, blood rheology indexes(plasma viscosity and whole blood viscosity low, medium and high cut) and incidence of adverse reactions were compared between the two groups. Results:(1) Two cases were excluded from each group, and 94.12%(64/68) of the subjects completed the study.(2)No significant difference was found in the total blood loss between two groups(P>0.05);the amount of implicit blood loss and the incidence of implicit blood loss in the observation group were significantly lower than those of the control group(P<0.05).(3) Before treatment,there was no statistically significant difference in the plasma viscosity and low, medium and high cut whole blood viscosity between the two groups(P> 0.05);after treatment, the plasma viscosity and low, medium and high cut whole blood viscosity of both groups were significantly lower then 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). (4)One case of intramuscular venous thrombosis was found in the observation group without drug allergy and toxic and side effects;one case of deep vein thrombosis and 4 cases of intermuscular venous thrombosis were found in the control group. The adverse reaction rate in the observation group was 3.125%, which was significantly lower than that in the control group(15.625%, P<0.05). Conclusion: Jiawei Bazhen Decoction can not only significantly reduce the postoperative PFNA hidden blood loss in elderly patients with intertrochanteric fractures, but also improve the hemodynamics and safety.