四物加味汤联合屈膝法对全膝关节置换术后失血性贫血的影响

Effect of Siwu Decoction combined with knee bending on anemia after total knee arthroplasty

目的研究四物加味汤联合屈膝法对膝关节置换术后失血性贫血的疗效。方法将2018年1月—2019年8月上海中医药大学附属光华医院收治的93例初次行全膝关节置换手术的膝骨关节炎患者随机分为联合组、中药组和屈膝组,每组31例。中药组术后第1天开始口服四物加味汤,连服14 d;屈膝组术后患肢屈膝法放置;联合组术后口服四物加味汤14 d联合患肢屈膝法放置。检测3组术后第1天、第8天、第14天血红蛋白水平和红细胞计数,比较3组术后第8天中医血虚症状积分及凝血酶原时间、部分凝血活酶时间、D-二聚体水平,比较3组术中出血量、术后输血情况、术后3个月美国特种外科医院膝关节(HSS)评分。结果术后第1天、术后第14天,3组血红蛋白水平和红细胞计数比较差异均无统计学意义(P均>0.05);术后第8天,联合组血红蛋白水平和红细胞计数均明显高于中药组和屈膝组(P均<0.05),中药组和屈膝组比较差异均无统计学意义(P均>0.05)。术后第8天,联合组血虚症状积分明显低于中药组和屈膝组(P均<0.05),且中药组明显低于屈膝组(P<0.05);3组凝血酶原时间、部分凝血活酶时间、D-二聚体水平比较差异均无统计学意义(P均>0.05)。3组术中出血量、术后输血人数比较差异均无统计学意义(P均>0.05)。3组术后3个月HSS评分均明显高于术前(P均<0.05),但3组间比较差异均无统计学意义(P均>0.05)。结论四物加味汤联合屈膝法能明显改善膝关节置换术后贫血,有利于术后早期康复。

Objective It is to study the efficacy of Siwu Decoction combined with knee bending in the treatment of anemia after total knee arthroplasty.Methods Ninety-three patients with knee osteoarthritis who underwent initial knee arthroplasty were randomly divided into the combined group,the Chinese medicine group and the knee flexion group,with 31 cases in each group.The Chinese medicine group started oral administration of Siwu Decoction on the first day after surgery,continuously treated for 14 days,the knee flexion group was treated with knee flexion method,the combined group was treated with Siwu Decoction and the knee flexion method for 14 days.The levels of hemoglobin and red blood cell counts of the three groups were detected on the first day,the eighth day and the 14th day after surgery,the blood deficiency symptom scores,prothrombin time,partial thromboplastin time and levels of D dimer on the 8th day after operation,and the intraoperative hemorrhage,postoperative blood transfusion and the HSS scores in three months after surgery were compared among the three groups.Results There was no significant difference in hemoglobin and red blood cell counts among the three groups on the first day and the 14th day after surgery(P>0.05).The hemoglobin and red blood cell counts on the 8th day after operation were significantly higher in the combined group than those in the Chinese medicine group and the knee flexion group(P<0.05),there was no significant difference between the Chinese medicine group and the knee flexion group(P>0.05);the scores of blood deficiency symptoms on the 8th day after operation in the combined group were significantly lower than those in the Chinese medicine group and the knee flexion group(P<0.05),and the symptoms of blood deficiency in the Chinese medicine group were lower than those in the knee flexion group(P<0.05).There was no significant difference in the prothrombin time,partial thromboplastin time and D-dimer level on the 8th day after operation among the three groups(P>0.05).There was no significant difference in the intraoperative hemorrhage and transfusion rate among the three groups(P>0.05).The HSS scores in 3 months after surgery were higher than those before surgery in the three groups(P<0.05),but there was no significant difference among the three groups(P>0.05).Conclusion Siwu Jiawei Decoction combined with knee flexion can significantly improve the symptoms of anemia after knee joint replacement,and is beneficial for early postoperative rehabilitation.