骨一方联合低分子肝素对人工全髋关节置换术后深静脉血栓形成的预防作用  

Prevention of Deep Vein Thrombosis by Guyi Decoction and Low Molecular Weight Heparin Following Total Hip Replacement

作　　者：涂泽松[1] 包杭生[1] 冯宗权[1] 邱华耀[1] 

机构地区：[1]广州中医药大学附属佛山市中医院,广东佛山528000

出　　处：《广州中医药大学学报》2015年第2期199-203,207,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家临床重点专科建设项目(中医专业);佛山市科技局医学科技攻关项目(编号:201308016)

摘　　要：【目的】探讨骨一方联合低分子肝素对人工全髋关节置换(THR)术后深静脉血栓形成(DVT)的预防作用。【方法】采用前瞻随机对照临床试验设计方法,根据性别、年龄、病患部位、就诊时间将100例THR术后病例分成试验组48例和对照组52例。根据《中国骨科大手术静脉血栓栓塞症预防指南》,2组均给予皮下注射低分子肝素,同时试验组给予骨一方治疗,每日1剂,连续7 d。分别观察2组受试对象试验前后凝血功能、血液流变学指标及伤肢彩色多普勒超声检查结果的变化情况。【结果】(1)试验后,2组全血粘度高切、全血粘度中切、全血粘度低切、血浆粘度等血液流变学指标均显著改善(P<0.05),且试验组的改善作用均优于对照组(P<0.05)。(2)试验后,试验组的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)相对缩短,D-二聚体(D-D)水平显著升高(P<0.05);而对照组的PT、APTT相对延长,D-D水平显著升高(P<0.05);组间比较差异均有统计学意义(P<0.05)。说明骨一方能在一定程度上拮抗低分子肝素对凝血功能的影响而降低诱发出血的可能性。(3)2组试验后伤肢彩色多普勒超声检查结果显示,试验组的伤肢DVT发生率显著低于对照组(P<0.05)。【结论】骨一方联合低分子肝素能够改善人工全髋关节置换术后血液高凝状态,激活纤溶系统,调节血液流变学状态,预防伤肢深静脉血栓形成,同时又能降低诱发出血的可能性,是有效、安全的治疗方案,值得临床推广应用。Objective To explore the therapeutic effect of Guyi decoction combined with low molecular weight heparin on preventing deep vein thrombosis（ DVT） following total hip replacement（ THR）. Methods The prospective, randomized, controlled clinical trial design was adopted. According to the gender, age, affected region and treatment time, 100 cases following THR were divided into experimental group（N=48） and control group（ N =52）. With reference to China Prevention Guideline for Venous Thromboembolism Following Major Orthopedic Surgery, both groups were treated with subcutaneous injection of low molecular weight heparin, and additionally the experimental group was given Guyi decoction orally, one dose a day, for 7 continuous days.Before and after treatment, we observed the changes of outcomes such as blood coagulation function,hemorheologic indices, and color Doppler ultrasonography for the injured limb of both groups. Results After treatment, coagulation function indexes including prothrombin time（ PT） and activated partial thromboplastin time（ APTT） were shortened, and D-dimer（ D-D） level was increased mildly（ P〈0.05） in the experimental group; in the control group, PT and APTT were prolonged and D-D level was increased（P〈0.05）. The differences were significant bebween the two groups, indicating the possibility of Guyi decoctiom in reducing DVT incidence by counteracting the effect of low molecular weight heparin. Hemorheologic indices including high-, middle-and low-shear whole blood viscosity and plasma viscosity were much improved in the two groups（P〈0.05） compared with those before treatment）, and the improvement of the outcomes in the experimental group was superior to that of the control group（P〈0.05）. The incidence of DVT of the injured limb showed by color Doppler ultrasonography in the experimental group was lower than that of the control group, and the difference was significant（ P〈0.05）.Conclusion Guyi decoction combined with low molecular weight h

关 键 词：骨一方/治疗应用 低分子肝素 人工全髋关节置换术 深静脉血栓形成 

分 类 号：R274.9[医药卫生—中西医结合]