围手术期血液管理与中药八珍汤对老年关节置换后血红蛋白及高凝状态的影响  

Perioperative blood management combined with Bazhen Tang improves hemoglobin and hypercoagulability in senile patients after joint replacement

作　　者：宋玉成[1] 邓迎杰[1] 刘振锋[1] 梁治权[1] 廖軍 洪汉刚[1] 方锐[1] 

机构地区：[1]新疆医科大学附属中医医院关节外科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国组织工程研究》2016年第53期7925-7931,共7页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区科技计划项目(201433110)~~

摘　　要：背景:目前对于围手术期积极采用血液管理措施已是国际骨科领域的普遍方法,而中医药应用结合围手术期血液管理对骨科大手术后血液生化及高凝状态的影响和具体机制国内外报道不多。目的:结合围术期血液管理措施,评价中药八珍汤对关节置换后老年患者血红蛋白及血液高凝状态的影响。方法:选择接受髋、膝人工关节置换的患者160例,其中全髋关节置换59例;全膝关节置换91例。所有患者按性别、年龄、疾病等随机分为2组各80例,其中行单侧初次关节置换者实验组56例,对照组54例;行双侧一期置换及髋膝翻修者实验组24例,对照组26例。实验组置换前5 d开始加用中药八珍汤加减;对照组不服中药。2组所有病例置换后常规应用利伐沙班抗凝、氨甲环酸减少出血。记录置换后第后出血3,7,14天患者外周血血红蛋白、D-二聚体、血小板、纤维蛋白原含量;记录置换量;彩超观察置换后下肢深静脉血栓形成/肺栓塞发生率。结果与结论:(1)单侧初次关节置换对照组有1例,应用异体血回输,双侧及翻修后实验组和对照组均需输异体血,但实验组输血量较少(P<0.000);(2)双侧及翻修后7,14 d实验组血红蛋白回升较对照组快(P=0.012;0.003);(3)置换后3,7 d D-二聚体实验组下降较对照组快,且2组血小板、纤维蛋白原比较差异有显著性意义(P=0.010;0.017;0.014);(4)实验组置换后下肢深静脉血栓形成9例,无肺栓塞发生;对照组置换后下肢深静脉血栓形成19例,发生肺栓塞2例(转往呼吸ICU治愈),两组并发症比较差异有显著性意义(P<0.001);(5)结果说明,应用中药八珍汤结合围手术期血液管理可能对减少老年患者关节置换后出血,促进双侧或翻修术后血液血红蛋白回升有一定作用,并通过降低D-二聚体及纤维蛋白原含量,抑制血小板聚集,改善老年患者置换后血液高凝状态,从而减少深静脉血栓形成/肺栓塞的发BACKGROUND： Perioperative blood management has been extensively used in orthopedic clinic. However, how the combination of traditional Chinese medicine and perioperative blood management influences the blood biochemical indexes and hypercoagulability after major operation is rarely reported. OBJECTIVE： To evaluate the effects of the perioperative blood management combined with Bazhen Tang on hemoglobin and hypercoagulability in senile patients after joint replacement. METHODS： 160 patients undergoing hip or knee artificial joint replacement were enrolled, including 59 cases of total hip replacement and 91 cases of total knee arthroplasty. All patients according to gender, age and disease were equivalently randomized into experimental group（56 cases of primary unilateral joint replacement and 24 cases of bilateral first stage replacement and hip-knee reversion） and control group（54 cases of primary unilateral joint replacement and 26 cases of bilateral first stage replacement and hip-knee reversion）. The experimental group patients were given appropriate Bazhen Tang at preoperative 5 days, and those controls received no intervention. All cases were treated with rivaroxaban（anticoagulation） and tranexamic acid（hemostasis） after replacement. The contents of hemoglobin, D-dimer, platelet and fibrinogen in the peripheral blood were recorded at postoperative 3, 7 and 14 days; the amount of postoperative blood loss was recorded, and the incidence rates of deep venous thrombosis and pulmonary embolism after replacement were observed by color Doppler ultrasound. RESULTS AND CONCLUSION：（1） After unilateral replacement, one case in the control group underwent allogenetic blood transfusion. After bilateral reversion, both two groups underwent allogenetic blood transfusion, but the amount of transfused blood in the experimental group was less than that in the control group（P〈0.000）.（2） Hemoglobin was significantly increased in the experimental group compared with the control groups at pos

关 键 词：中草药 血红蛋白类 老年人 血小板 深静脉血栓形成 组织工程 骨科植入物 人工假体 老年患者 八珍汤 围手术期血液管理 高凝状态 

分 类 号：R318[医药卫生—生物医学工程]