益气通脉法改善老年股骨转子间骨折术后患者凝血功能的临床研究

Clinical Research on the Invigorating Qi and Ventilating Veins Method for the Improvement of the Blood Coagulation Function in the Elderly Patients with Femoral Intertrochanteric Fracture

目的通过检测手术前后凝血功能相关指标及血栓弹力图(TEG)参数,评估益气通脉法对于改善老年股骨转子间骨折术后高凝状态的疗效。方法本研究采用前瞻性队列研究方法,选取2019年3月—2020年3月寿光市中医医院收治的60例老年单侧股骨转子间骨折患者,排除手术禁忌后行PFNA内固定术治疗,按照简单随机方法分为对照组(30例)和治疗组(30例),术后第1天开始,对照组予依诺肝素钠,治疗组给予益气通脉法中药口服。检测并记录手术前、术后第3天、第7天凝血功能相关指标及血栓弹力图参数,比较2组治疗前后各时间点的凝血指标、TEG参数的变化情况,评估益气通脉法在改善老年股骨转子间骨折患者术后体内凝血功能中的疗效。结果中药组、对照组数据在术后3 d、7 d均较术前有明显改善。2组数据比较,PT、TT、APTT、INR、D-二聚体在术前、术后第3天差异无统计学意义(P>0.05),在术后第7天差异有统计学意义(P<0.05);K值、CI在术前、术后第3天差异无统计学意义(P>0.05),在术后第7天差异有统计学意义(P<0.05);α角、MA值在术前、术后第3天、术后第7天均无统计学意义(P>0.05)。结论益气通脉法能明显改善老年股骨转子间骨折术后高凝状态,能有效预防术后并发症的发生。

Objective To evaluate the effect of the invigorating qi and ventilating veins method in elderly patients with intertrochanteric fractures via detecting the related indexes of blood coagulation function and parameters of thromboelastogram(TEG).Methods In our prospective cohort study,the elderly patients with unilateral femoral intertrochanteric fractures who were treated in Shuguang hospital of traditional Chinese medicine from March 2019 to March 2020 were divided into the control group(n=30)and the treatment group(n=30).All patients experienced PFNA internal fixation.Patients in the control group were administrated with enoxaparin sodium,while the patients in the treatment group were treated with traditional Chinese medicine under the theory of the invigorating qi and ventilating veins method from the first day after surgery.The parameters of blood coagulation function and thromboelastogram were detected and recorded before the surgery,3 days and 7 days after surgery.All these parameters would be compared between these two groups,to evaluate the efficiency of the invigorating qi and ventilating veins method method in elderly patients with femoral intertrochanteric fracture after PFNA surgery.Results All these parameters in each group were significantly improved postoperatively.However,the invigorating qi and ventilating veins method improved the blood coagulation function,such as PT,TT,APTT,INR,D-dimer,K value and CI on 7rd day after surgery(P<0.05).Conclusion The invigorating qi and ventilating veins method significantly improves the hypercoagulable state of elderly patients with intertrochanteric fracture perioperative,and prevent the occurrence of postoperative complications.