隔附子饼灸涌泉穴联合利伐沙班治疗全膝关节置换术后下肢静脉血栓:随机对照试验

Aconite-isolated moxibustion at Yongquan(KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty: a randomized controlled trial

目的:观察隔附子饼灸涌泉穴联合利伐沙班治疗全膝关节置换术后下肢静脉血栓的临床疗效及对血液高凝状态的影响。方法:将73例膝关节骨关节炎全膝关节置换术后下肢静脉血栓患者随机分为观察组(37例,脱落2例)和对照组(36例,脱落1例)。对照组患者口服利伐沙班片,每次10 mg,每日1次;在对照组的基础上,观察组患者采用隔附子饼灸患侧涌泉穴治疗,每次3壮,每日1次,两组均治疗14 d。治疗前及治疗14 d后,采用B超检测两组患者下肢静脉血栓情况;治疗前及治疗7、14 d后,比较两组患者凝血指标[血小板(PLT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)、D-二聚体]及患侧股深静脉血流速度、肢体周径;并评定两组临床疗效。结果:治疗14 d后,两组患者下肢静脉血栓情况均较治疗前好转(P<0.05),且观察组好于对照组(P<0.05)。治疗7 d后,观察组患者股深静脉血流速度较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。治疗14 d后,两组患者PT、APTT、股深静脉血流速度较治疗前升高(P<0.05),PLT、Fib、D-二聚体、肢体周径(膝关节、髌骨上10 cm、髌骨下10 cm)较治疗前降低(P<0.05);且观察组患者股深静脉血流速度高于对照组(P<0.05),PLT、Fib、D-二聚体、肢体周径(膝关节、髌骨上10 cm、髌骨下10 cm)低于对照组(P<0.05)。观察组总有效率为97.1%(34/35),高于对照组的85.7%(30/35,P<0.05)。结论:隔附子饼灸涌泉穴联合利伐沙班可有效治疗膝关节骨关节炎患者全膝关节置换术后下肢静脉血栓,改善血液高凝状态、加快下肢血流速度及减轻下肢肿胀。

Objective To investigate the clinical effect of aconite-isolated moxibustion at Yongquan(KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty and the influence on hypercoagulation.Methods Seventy-three patients of knee osteoarthritis with lower extremity venous thrombosis after total knee arthroplasty(KOA) were randomly divided into an observation group(37 cases, 2 cases dropped off) and a control group(36 cases, 1 case dropped off). The patients in the control group took orally rivaroxaban tablets, 10 mg a time, once a day. On the basis of the treatment as the control group, the aconite-isolated moxibustion was applied to Yongquan(KI 1) for the patients of the observation group, once daily and 3 moxa cones were used in each treatment. The duration of treatment was 14 days in both groups. Before treatment and 14 days into treatment, the ultrasonic B test was adopted to determine the conditions of lower extremity venous thrombosis in the two groups. Before treatment, 7 and 14 days into treatment, the coagulation indexes(platelet [PLT], prothrombin time [PT], activated partial prothrombin time [APTT], fibrinogen [Fib] and D-dimer[D-D]), the blood flow velocity of the deep femoral vein and the circumference of the affected side were compared between the two groups separately, and the clinical effect was evaluated. Results Fourteen days into treatment, the venous thrombosis of the lower extremity was relieved in both groups(P<0.05), and that of the observation group was better than the control group(P<0.05).Seven days into treatment, the blood flow velocity of the deep femoral vein was increased compared with that before treatment in the observation group(P<0.05), and the blood flow rate in the observation group was higher than that in the control group(P<0.05). Fourteen days into treatment, PT, APTT and the blood flow velocity of the deep femoral vein were increased in the two groups compared with those before treatment(P<0.05);and PLT, Fib, D-D and the circumference of the limb(knee joint, 10 cm above the patella and 10 cm below the patella) were all reduced in the two groups(P<0.05). Compared with the control group 14 days into treatment, the blood flow velocity of the deep femoral vein was higher(P<0.05), PLT,Fib, D-D and the circumference of the limb(knee joint, 10 cm above the patella and 10 cm below the patella) were all lower in the observation group(P<0.05). The total effective rate was 97.1%(34/35) in the observation group, higher than 85.7%(30/35) in the control group(P<0.05). Conclusion Aconite-isolated moxibustion at Yongquan(KI 1) combined with rivaroxaban can effectively treat lower extremity venous thrombosis after total knee arthroplasty, relieve hypercoagulation,accelerate the blood flow velocity and alleviate swelling of the lower extremity in the patients with knee osteoarthritis.