早期活血化瘀干预对急性肢体创伤血栓形成的影响

Effects of early blood-activating and stasis-eliminating intervention on the formation of acute limb traumatic thrombosis

目的观察早期活血化瘀干预对急性肢体创伤血栓形成的影响。方法选取2020年5月至2022年5月于咸阳市中心医院就诊的急性肢体创伤患者102例,采用随机数表法分为观察组和对照组各51例。对照组患者给予常规手术联合低分子肝素钙治疗,观察组在对照组治疗方案的基础上加用活血化瘀方治疗。两组患者均治疗14 d。比较两组患者治疗14 d后的临床疗效及术后1 d、术后14 d的凝血功能指标[凝血酶原时间(PT)、D-二聚体(D-D)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)]、血栓弹力图指标[反应时间(R值)、凝血时间(K值)、凝固角(α角)、最大振幅(MA值)]、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、内皮素(ET-1)]水平,并记录其治疗过程中的下肢深静脉血栓(DVT)发生率。结果治疗14 d后,观察组患者的治疗总有效率为94.12%,明显高于对照组的80.39%,差异有统计学意义(P<0.05);治疗14 d后,两组患者的部分凝血指标(DD、FIB)、炎症因子(IL-6、ET-1、TNF-α)、部分血栓弹力图指标(α角、MA值)明显低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05);治疗14 d后,两组患者的PT、APTT水平与治疗前比较差异均无统计学意义(P>0.05);治疗14 d后,两组患者的R值、K值水平明显高于治疗前,且观察组患者的R值、K值分别为(5.43±0.31)min、(2.01±0.37)min,明显高于对照组的(3.10±0.98)min、(1.70±0.39)min,差异均有统计学意义(P<0.05);治疗过程中,观察组患者的DVT发生率为5.88%,明显低于对照组的为19.61%,差异有统计学意义(P<0.05)。结论早期活血化瘀方联合常规治疗方案对急性肢体创伤患者具有较好的治疗效果,可有效减轻患者的炎症反应,恢复凝血功能水平,从而有效降低DVT发生风险。

Objective To observe the effects of early blood-activating and stasis-eliminating intervention on the formation of acute limb traumatic thrombosis.Methods A total of 102 patients with acute limb trauma who were treated in Xianyang Central Hospital from May 2020 to May 2022 were selected.They were divided into an observation group(n=51)and a control group(n=51)according to the random number table method.The patients in control group were given routine surgery combined with low molecular weight heparin calcium,and the patients in observation group were additionally given blood-activating and stasis-eliminating on the basis of treatment regimen in the control group.Both groups of patients were treated for 14 days.The clinical efficacy after 14 days of treatment,and coagulation function indexes[prothrombin time(PT),D-dimer(D-D),activated partial thromboplatin time(APTT),fibrinogen(FIB)],thromboelastography indexes[reaction time(R value),coagulation time(K value),coagulation angle(αangle),maximum amplitude(MA value)],and inflammatory factors[interleukin IL-6(IL-6),tumor necrosis factor(TNF-α),endothelin(ET-1)]levels at 1 day and 14 days after surgery were compared between the two groups of patients,and the incidence rate of lower limb deep vein thrombosis(DVT)during treatment was recorded.Results After 14 days of treatment,the total effective rate of treatment was 94.12%in observation group,which was significantly higher than 80.39%in the control group(P<0.05).After 14 days of treatment,the partial coagulation indexes(D-D,FIB),inflammatory factors(IL-6,ET-1,TNF-α)and partial thromboelastography indexes(αangle,MA value)in the two groups were significantly lower than those before treatment,and the above indexes in observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).There were no significant changes in the levels of PT and APTT in the two groups after 14 days of treatment compared with those before treatment(P>0.05).After 14 days of treatment,the R value and K value in the two groups were significantly higher than those before treatment,and the above indexes in the observation group were(5.43±0.31)min and(2.01±0.37)min,which were significantly higher than(3.10±0.98)min and(1.70±0.39)min in the control group(P<0.05).During treatment,the incidence rate of DVT was 5.88%in the observation group,which was significantly lower than 19.61%in the control group(P<0.05).Conclusion Early Huoxue Huayu decoction combined with routine treatment regimen has good therapeutic effects on the clinical symptoms of patients with acute limb trauma,and it can effectively relieve the inflammatory response and restore the coagulation function of patients,thus effectively reduce the risk of DVT.