下肢骨科手术后深静脉血栓的治疗与超声检测  

作　　者：胡琴[1] 董磊[1] 沈晓青[1] 

机构地区：[1]浙江省绍兴市中医院特检超声科,312000

出　　处：《浙江临床医学》2017年第6期1124-1125,共2页Zhejiang Clinical Medical Journal

摘　　要：目的探讨中西医结合治疗骨科手术术后下肢深静脉血栓（DVT）的临床效果，及超声对血栓吸收情况评价。方法将62例骨科大手术术后DVT患者随机分为联合组（31例）和对照组（31例）。所有患者均给予低分子肝素抗凝治疗，连用1周；联合组在此基础上，给予加味桃核承气汤治疗，疗程均为1周；观察两组患者凝血功能的改变、疼痛缓解情况。采用彩色多普勒超声观察治疗后血栓变化。结果治疗后1周，两组活化的部分凝血活酶时间、凝血酶原时间明显延长，纤维蛋白原水平明显降低（P〈0．05），而联合组各凝血功能指标均明显优于对照组（P〈0．05）；治疗后1周，两组VAS评分均明显改善（P〈0．05），而联合组VAS评分明显低于对照组（P〈0．05）；与治疗后1周比较，两组治疗后1个月，超声评价有效率均显著升高（P〈0．05）。结论对于骨科手术后下肢DVT患者，中西医联合治疗可改善凝血功能，促进血栓吸收，缓解疼痛症状；超声技术有助于准确评价血栓的血流信号改变，及时观察临床疗效。Objective To explore clinical effect of TCM combined with western medicine in treating deep venous thrombus （ DVT ） after orthopedic surgery, and to evaluate the thrombus absorption by ultrasound. Methods 62 cases of DVT after orthopedic surgery were randomly divided into combined group and control group. Control group （ 31 cases ） was treated with low-molecular-weight heparin, and combined group （ 31 cases ） was treated with Jiawei Taohechengqi decoction additionally. The treatment course was 7 days in both groups, and the change of coagulation function, pain release in two groups were compared.The change of thrombus after treatment were observed by color doppler flow imaging. Results At 1 week after treatment, the levels ofAPTT, PT in both groups were prolonged, FIB was significantly reduced （ P〈0.05 ） , while coagulation parameters in combined group were significantly better than that of control group （ P〈0.05 ） . At 1 week after treatment, VAS score in both groups were significantly improved （ P〈0.05 ） , while VAS score in the combined group was significantly lower than that of control group （ P〈0.05 ） .Compared with 1 week after treatment, the effective rate evaluated by echocardiography at 1 month after treatment in both groups was significantly increased （P〈0.05） . Conclusions For deep venous thrombus after orthopedic surgery, TCM with western medicine can improve coagulation function, promote thrombosis absorption and relieve pain. CDFI can contribute to evaluate blood flow changes of thrombus and timely grasp the clinical curative effect.

关 键 词：骨科手术 深静脉血栓 中西医结合 超声 

分 类 号：R543.6[医药卫生—心血管疾病]