中医药特色疗法预防髋膝关节术后下肢深静脉血栓临床研究  

Clinical Study on the Prevention of Deep Venous Thrombosis after Hip or Knee Surgery by TCM Characteristic Therapy

作　　者：张中义[1] 李帅垒[1] 王上增[1] 刘亚东[2] 刘晓雅 郑永智 阎亮[2] 贺自克[2] 

机构地区：[1]河南中医药大学第二附属医院/河南省中医院,河南郑州450000 [2]河南中医学院,河南郑州450046

出　　处：《中医学报》2017年第12期2509-2511,共3页Acta Chinese Medicine

摘　　要：目的:探讨中医药特色疗法预防髋膝关节置换术后下肢深静脉血栓的临床疗效。方法:将80例患者按采用随机数字表法分为对照组和试验组,每组40例。试验组(1)术后第2天口服中药成方抗栓通脉汤(水蛭10 g,黄芪30 g,茯苓30 g,当归15 g,桃仁15 g,红花15 g,地龙15 g,木瓜15 g,赤芍12 g,甘草10 g),10剂,每日1剂煎400 m L,每次200 m L,早晚各1次。统一由本院制剂室熬制,并有专人配送。(2)术后即进行双下肢间歇充气加压装置气治疗,每日两次,早晚各1次,连用12 d。针刺足三里穴、三阴交穴,每日1次,连用12 d,由统一培训的专业针灸师完成,神阙穴穴位贴敷,每日1次,连用3 d。功能锻炼有同一康复师进行。对照组(1)术后第2天给予低分子肝素钙注射液皮下注射,5 000 IU,每日1次,连用14 d。(2)术后即进行双下肢间歇充气加压装置气治疗,每日2次,早晚各1次,连用12 d。针刺足三里穴、三阴交穴,每日1次,连用12 d,由统一培训的专业针灸师完成,神阙穴穴位贴敷,每日1次,连用3 d。比较两组患者术后3 d,术后10 d,术后1个月,术后3个月血小板(blood platelet,PLT)、凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(partial thromboplastin time,APPT)、D二聚体、双下肢静脉彩超、肢体肿胀情况、肢体功能活动情况等各项指标变化。结果:两组患者术后3 d,术后10 d、术后30 d、术后90 d,两组患者PLT、PT、APPT、DD比较,差异均无统计学意义(P>0.05),且术后30 d,术后90 d各项指标恢复正常;术后10 d时试验组血红蛋白基本恢复正常,明显优于对照组,差异有统计学意义(P<0.05);试验组出现皮下瘀斑2例,对照组出现7例;彩超发现血栓共6例,试验组3例,对照组3例,6例血栓形成部位全部为腓肠肌肌间静脉,全部为膝关节置换患者。结论:中医药特色疗法预防血栓形成及溶解微血栓的同时,减少伤口渗血和术后贫血,体现了中药双向调节的特点。Objective： To explore the clinical effect of TCM characteristic therapy for preventing deep venous thrombosis after hip or knee arthroplasty. Methods： 80 patients with the random number table,they were divided into two groups,experimental group with the characteristics of traditional Chinese medicine therapy of lower extremity deep venous thrombosis after total hip or knee arthroplasty to prevent formation,control group was treated with low molecular weight heparin calcium after hip or knee replacement surgery to prevent lower limb deep vein thrombosis formation,platelet（ PLT）,prothrombin time（ PT）,activated partial thromboplastin time（ APPT）,D dimer,lower extremity venous ultrasound,swelling of limbs,limb functional activities were compared between the two groups of patients after 3 days,10 days after operation,1 month after surgery,postoperative 3 months. Results： 3 days after operation,the patients in the two groups,10 days after operation,postoperative 30 days,after 90 days,two groups compared PLT,PT,APPT,DD had no statistical significance,and 30 days after surgery,postoperative 90 days of the index returned to normal; 10days postoperative hemoglobin in test group recovered normal. It is much better than that of the control group; of experiment group were subcutaneous ecchymosis in 2 cases,control group had 7 cases; color Doppler ultrasound thrombus was found in 6 cases. The experimental group in 3 cases,3 cases in the control group,6 cases of thrombosis formation all parts for gastrocnemius vein. All of the patients with total knee arthroplasty. Conclusion： the characteristics of traditional Chinese medicine therapy for prevention of thrombus formation and dissolution of micro thrombosis at the same time,reduce the oozing of blood and postoperative anemia,reflecting the characteristics of traditional Chinese medicine in the regulation of the two-way and equal in the prevention of Western medicine alone.

关 键 词：髋膝关节术后下肢深静脉血栓 中医药特色疗法 抗栓通脉汤 中医药疗法 中西医结合 

分 类 号：R274.39[医药卫生—中医骨伤科学]