中西医结合预防全膝关节置换术后下肢深静脉血栓形成30例临床观察

Clinical Observation on the Prevention of Lower Limb Deep Vein Thrombosis after Total Knee Arthroplasty with Integrated Traditional Chinese and Western Medicine in 30 Cases

目的:观察中西医结合预防全膝关节置换术后深静脉血栓形成的临床疗效。方法:将60例行全膝关节置换术的膝骨关节炎患者,随机分为观察组和对照组各30例,对照组予以低分子肝素钠注射治疗,观察组在对照组基础上予以活血止痛汤加减治疗,两组疗程均为7 d,观察两组在不同时间D-二聚体(D-D)、血浆活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平以及疼痛视觉模拟评分(VAS)、肢体肿胀消退情况(下肢周径差)、下肢静脉血栓形成率。结果:术后第7天观察组D-D、FIB低于对照组、APTT高于对照组(P<0.05);两组患肢VAS评分均显著降低,观察组VAS评分降低速率明显优于对照组(P<0.05),大小腿周径差小于对照组(P<0.05);观察组术后下肢静脉血栓发生事件2例,均为肌间静脉血栓,对照组7例,其中2例深静脉血栓,5例肌间静脉血栓;观察组治疗总有效率为93.3%,对照组总有效率为76.6%,观察组有效率明显高于对照组。结论:中西医结合治疗能有效减低D-D、FIB水平,延长APTT时间,降低DVT形成,同时能缓解术后疼痛,加快消肿速率,利于术后康复。

Objective To observe the clinical efficacy of integrated traditional Chinese and Western medicine in preventing deep vein thrombosis after total knee arthroplasty.Method Sixty patients with knee osteoarthritis undergoing total knee arthroplasty were randomly divided into an observation group and a control group with 30 cases each.The control group was treated with injection of low molecular weight heparin sodium,while the observation group was treated with modified Huoxue Zhitong Tang on the basis of the control group.The treatment courses for both groups were 7 days.D-dimer(D-D),plasma activated partial thromboplastin time(APTT),and Fibrinogen(FIB)levels,pain visual analogue score(VAS),limb swelling resolution(lower limb circumference difference),and lower limb venous thrombosis rate.Result On the 7th day after surgery,the D-D and FIB levels in the observation group were lower than those in the control group,while APTT levels were higher than those in the control group(P<0.05);Compared with the treatment between groups,the VAS scores of the affected limbs in both groups were significantly reduced,and the rate of VAS score reduction in the observation group was significantly faster than that in the control group(P<0.05);Comparison of treatment between groups showed that the difference in circumference between the big and small legs was smaller than that of the control group(P<0.05);There were 2 cases of postoperative lower limb venous thrombosis in the observation group,all of which were intramuscular venous thrombosis.There were 7 cases in the control group,of which 2 cases of deep venous thrombosis were found in the control group,and the remaining 5 cases were all intramuscular venous thrombosis;The total effective rate of the observation group was 93.3%,while the total effective rate of the control group was 76.6%.The effective rate of the observation group was significantly higher than that of the control group.Conclusion The combination of traditional Chinese and Western medicine treatment can reduce D-D and FIB levels,prolong APTT time,reduce DVT formation,alleviate postoperative pain,accelerate swelling rate,and facilitate postoperative recovery.