中西医结合防治老年髋部骨折围手术期下肢深静脉血栓形成的疗效观察

Observation of Clinical Effect of Integrated Traditional Chinese and Western Medicine on Prevention of Perioperative Deep Vein Thrombosis in Lower Extremity of Hip Fracture in the Elderly

目的 探讨加味补中益气汤联合低分子量肝素钙防治老年髋部骨折围手术期下肢深静脉血栓(DVT)形成的临床价值。方法 选取2020年4月至2022年2月四川省骨科医院老年骨科1、2病房收治的符合诊断标准的78例老年髋部骨折患者为研究对象,按照随机数字表法分为对照组和试验组,每组39例。对照组给予常规剂量低分子量肝素钙治疗,试验组在对照组治疗基础上加用加味补中益气汤治疗,比较两组患者术后DVT发生率,患肢大腿、小腿周径差,血红蛋白、血小板计数和凝血四项等指标。结果 试验组术后DVT发生率低于对照组,但差异无统计学意义(P>0.05);两组患肢大、小腿周径差在术后第7天均较术前降低(P<0.05);试验组术后第7天患肢大、小腿周径差均小于对照组(P<0.05)。试验组术后第3、7天血红蛋白计数均高于对照组(P<0.05)。两组术前、术后第1、3、7天凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)计数比较,差异均无统计学意义(P>0.05)。试验组术前、术后第1、3、7天凝血酶时间(TT)指标与对照组比较,差异均有统计学意义(P<0.05);试验组术后第3、7天血清D-二聚体计数明显低于对照组(P<0.05)。结论加味补中益气汤联合低分子量肝素钙预防老年髋部骨折围手术期下肢DVT形成临床疗效确切,在改善患肢肿胀程度、提高血红蛋白计数、降低D-二聚体计数等方面均优于单用低分子量肝素钙。

Objective To explore the clinical value of Modified Buzhong Yiqi Decoction combined with low-molecular-weight heparin calcium in the prevention of deep vein thrombosis(DVT)in lower extremity during perioperative period of hip fracture in the elderly.Methods A total of 78 elderly patients with hip fracture who met the diagnostic criteria and were admitted to Ward 1 and 2 of geriatric orthopedics department of Sichuan Province Orthopedic Hospital from April 2020 to February 2022 were selected as the research subjects.They were divided into control group(n=39)and experimental group(n=39)according to random number table method.The control group was treated with conventional dose of low-molecular-weight heparin calcium,while the experimental group was additionally given Modified Buzhong Yiqi Decoction on the basis of conventional dose of low-molecular-weight heparin.The incidence of postoperative DVT,differences in circumference of lower leg and thigh between the affected limb and the healthy limb(referred to as the circumference difference),hemoglobin count,platelet count and four items of coagulation were compared between the two groups.Results The incidence of postoperative DVT in the experimental group was lower than that in the control group,but the difference was not statistically significant(P>0.05).On the 7th day after operation,the circumference differences of thigh and lower leg in both groups decreased compared with those before operation(P<0.05),and the circumference differences in the experimental group were smaller than those in the control group(P<0.05).The hemoglobin count in the experimental group was higher than that in the control group on the 3rd and 7th day after surgery(P<0.05).There was no significant difference in prothrombin time(PT),activated partial thromboplastin time(APTT)and plasma fibrinogen(FIB)count between the two groups before surgery and on the 1st,3rd and 7th days after surgery(P>0.05).There were statistically significant differences in thrombin time(TT)between the two groups before surgery and on the 1st,3rd and 7th day after surgery(P<0.05).The serum D-dimer count in the experimental group was significantly lower than that in the control group on the 3rd and 7th day after surgery,and the differences were statistically significant(P<0.05).Conclusion Modified Buzhong Yiqi Decoction combined with low-molecular-weight heparin calcium is effective in the prevention of DVT in lower extremity during perioperative period of hip fracture in the elderly.Compared with low-molecular-weight heparin calcium alone,it has obvious advantages in improving swelling of the affected limb,increasing hemoglobin count and reducing D-dimer count.