系统评价芪红通络方配合推拿预防全膝关节置换术术后下肢静脉血栓的疗效

Effect of Qihong Tongluo Prescription(芪红通络方)Combined with Tuina on Prevention of Lower Limb Venous Thrombosis after TKA Operation

目的系统评价芪红通络方配合推拿预防全膝关节置换术(total knee arthroplasty,TKA)术后下肢静脉血栓的疗效。方法选取2021年12月—2023年1月医院收治的96例择期行TKA术的患者为研究对象,按照随机数字表法分为对照组、观察组。术后均给予抗感染、镇痛、营养支持等常规治疗,对照组同时给予推拿,观察组对照组基础上另给予芪红通络方,比较两组凝血功能指标[凝血酶时间(thrombin time,TT)、活化部分凝血酶时间(activated partial thrombin time,APTT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)]、血液流变学指标[全血高切黏度、血浆黏度、红细胞压积]、炎性因子[白细胞介素-6(interleukin-6,IL-6)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]水平。随访至术后3个月,比较两组膝关节功能恢复情况,记录两组下肢静脉血栓发生情况。结果不同组间、时点间TT、APTT、FIB、D-D的主效应差异具有统计学意义(P<0.05),组间和时点间存在交互作用(P<0.05);术后两组TT、APTT逐渐增加,FIB、D-D水平逐渐降低,且观察组术后7、14 d TT、APTT较对照组长(P<0.05),FIB、D-D水平低于对照组(P<0.05)。不同组间、时点间全血高切黏度、血浆黏度、红细胞压积的主效应差异具有统计学意义(P<0.05),组间和时点间存在交互作用(P<0.05);术后两组全血高切黏度、血浆黏度、红细胞压积水平逐渐降低,且观察组术后14 d全血高切黏度、血浆黏度、红细胞压积水平均低于对照组(P<0.05)。不同组间、时点间IL-6、hs-CRP、TNF-α的主效应差异具有统计学意义(P<0.05),组间和时点间存在交互作用(P<0.05);术后两组IL-6、hs-CRP、TNF-α水平均降低,且观察组术后7、14 d IL-6、hs-CRP、TNF-α水平均低于对照组(P<0.05)。随访发现,观察组膝关节功能优良率(89.58%,43/48)高于对照组(70.83%,34/48),下肢静脉血栓发生率(2.08%,1/48)低于对照组(14.58%,7/48),差异均具有统计学意义(P<0.05)。结论芪红通络方配合推拿抗凝、溶栓、抗炎作用更明显,可有效预防TKA术后下肢静脉血栓形成,值得临床积极推广应用。

Objective To evaluate the effect of Qihong Tongluo Prescription(芪红通络方)combined with Tuina on preventing venous thrombosis of lower extremity after total knee arthroplasty(TKA).Methods A total of 96 patients who received elective TKA from December 2021 to 20231 were selected as the study objects and were divided into control group and observation group according to random number table method.After operation,all patients were given anti-infection,analgesia,nutritional support and other conventional treatment.The control group was given Tuina at the same time,and the observation group was also given Qihong Tongluo Prescription on the basis of the control group.The coagulation function indexes[thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(FIB),D-dimer(D-D)],hemorheology indexes[whole blood high shear viscosity,plasma viscosity,hematocrit]and inflammatory factors[interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)]were compared between the two groups.The patients were followed up to 3 months after surgery,the functional recovery of knee joint was compared between the two groups,and the occurrence of lower limb venous thrombosis was recorded between the two groups.Results There were significant differences in the main effects of TT,APTT,FIB or D-D between two groups and among different time points(P<0.05),and there was interaction between two groups and among different time points(P<0.05).After surgery,the values of TT and APTT increased gradually,while the levels of FIB and D-D decreased gradually.And the values of TT and APTT in the observation group were longer than those in the control group 7 and 14 days after surgery(P<0.05),and the levels of FIB and D-D were lower than those in the control group(P<0.05).There were significant differences in the main effects of whole blood high tangential viscosity,plasma viscosity or hematocrit between two groups and among different time points(P<0.05),and there was interaction between two groups and among different time points(P<0.05).The levels of whole blood high tangential viscosity,plasma viscosity and hematocrit of the two groups were decreased gradually after surgery,and the observation group had lower mean whole blood high tangential viscosity,plasma viscosity and hydrohematocrit 14 days after surgery than the control group(P<0.05).The main effects of IL-6,hs-CRP and TNF-αbetween two groups and among different time points were statistically significant(P<0.05),and there was interaction between two groups and among different time points(P<0.05).The levels of IL-6,hs-CRP and TNF-αin both groups were decreased after surgery,and the levels of IL-6,hs-CRP and TNF-αin the observation group were lower than those in the control group 7 and 14 days after surgery(P<0.05).Follow-up showed that the excellent and good rate of knee function in the observation group(89.58%,43/48)was higher than that in the control group(70.83%,34/48),and the incidence of lower limb venous thrombosis(2.08%,1/48)was lower than that in the control group(14.58%,7/48),and the differences were statistically significant(P<0.05).Conclusion Qihong Tongluo Prescription combined with Tuina has more obvious anti-coagulation,thrombolytic and anti-inflammatory effects,which can effectively prevent the formation of lower limb vein thrombosis after TKA,and is worthy of clinical application.