益气抗栓方在治疗骨科术后静脉血栓中的应用探讨  

Discussion on the application of Yiqi Kangshuan Formula to Sequential Antithrombotic Therapy of Venous Thrombosis after Orthopedic Surgery Combined with Western Medicine

作　　者：黄玉霞[1] 喻杉[1] 朱义芳 张峰[1] 乔勇 冯光富[1] 邹明[1] 李霞[1] Huang Yuxia;Yu Shan;Zhu Yifang;Zhang Feng;Qiao Yong;Feng Guangfu;Zou Ming;Li Xia(Sichuan orthopedic hospital,Chengdu 610041)

机构地区：[1]四川省骨科医院,成都610041

出　　处：《中药药理与临床》2020年第4期191-195,共5页Pharmacology and Clinics of Chinese Materia Medica

基　　金：四川省科技计划项目(编号:2018JY0663);四川省干部保健课题(编号:川干研2019-609)。

摘　　要：目的:研究益气抗栓组方在骨科大手术后静脉血栓中西医序贯抗栓治疗中的临床疗效及不良反应。方法:选取符合标准的骨科大手术后下肢静脉血栓形成患者103例,初期给予利伐沙班常规剂量(30 mg/d)治疗,3个月后根据其静脉血栓消融情况及D-二聚体(D-dimer, D-D)水平将患者分为治疗显效组和治疗欠佳组,对治疗显效患者停药并随访3个月,观察血栓复发情况;将疗效欠佳患者随机分为实验组和对照组,分别予以中药益气抗栓组方治疗和利伐沙班减量(10 mg/d)维持治疗,共治疗3个月。选取凝血指标活化部分凝血酶原时间(Activated Partial Thromboplastin Time,APTT)、凝血酶原时间(Prothrombin Time,PT)、国际标准化比值(International Normalized Ratio, INR)凝血酶时间(Thrombin Time,TT)、纤维蛋白原(Fibrinogen,FIB)以及纤溶指标纤维蛋白降解产物(Fibrinogen Degradation Products,FDP)、D-D、纤维蛋白单体(Fibrin Monomer, FM)为效应指标,并对患者的肝肾功、出血情况进行评价。结果:利伐沙班常规剂量治疗3月后,44例(42.7%)治疗显效者和59例(57.3%)疗效欠佳者之间,出血风险以及肝肾损伤发生率均无统计学差异(χ2=0.043~0.970,均P>0.05)。治疗显效者停药随访3个月内无血栓复发。对于疗效欠佳者而言,3个月后静脉血栓转阴率在对照组和实验组之间无统计学差异(88.89%vs 95.24%,P=0.586),实验组的D-D转阴率明显优于对照组(70.00%vs 28.57%,P=0.035)。对照组可显著降低APTT、PT、INR等凝血指标,但纤溶指标无明显改变,实验组在降低凝血指标PT、INR、TT、FIB的同时,也显著降低纤溶指标FDP、D-D、FM(P<0.01)。两种治疗方案下,患者出血风险低,实验组肝肾功能损伤的发生率均比对照组低,但差异均无统计学意义(均P>0.05)。结论:骨科大手术后静脉血栓患者,初期采用利伐沙班治疗3个月,若疗效显著者无需再用药预防。而疗效欠佳者,序贯采用益气抗栓中�Objective: To research the clinical efficacy and adverse reactions of Yiqi Kangshuan decoction in sequential antithrombotic therapy combined with western medicine on venous thrombosis after orthopedic surgery. Methods: 103 patients with lower extremity venous thrombosis after major orthopedic surgery were initially treated with rivasaban(30 mg/d). Three months later, the patients were divided into the good response group and the poor response group according to the ablation of venous thrombus and the level of D-dimer(D-D). The patients in the good response group stopped taking drugs and were followed up for 3 months to observe the recurrence of thrombus. The patients with the poor curative effect were randomly divided into the experimental group and the control group, which were treated with Yiqi Kangshuan decoction and rivasaban(reduction to 10 mg/d) for 3 months, respectively. The coagulation indicators including Activated Partial Thromboplastin Time(APTT), Prothrombin Time(PT), International Normalized Ratio(INR), Thrombin Time(TT), Fibrinogen(FIB) and fibrinolysis indicators Fibrinogen Degradation Products(FDP), D-D, Fibrin Monomer(FM) were selected as the effect indicators, and the liver and kidney functions and bleeding of the patients were evaluated. Results: There was no significant difference in the rate of bleeding and the incidence of liver and kidney injury between 44 good response cases(42.7%) and 59 poor response cases(57.3%) after rivasaban conventional dose treatment for 3 months(χ~2 = 0.043~0.970, P>0.05). There was no thrombus recurrence within 3 months of follow-up in 44 good response cases. For the 59 patients with the poor curative effect, there was no significant difference in the negative conversion rate of venous thrombosis between the control group and the experimental group after 3 months(88.89% vs. 95.24%,P=0.586). The negative conversion rate of D-D in the experimental group was significantly better than that in the control group(70.00% vs. 28.57%,P=0.035). The coagulation indexes APT

关 键 词：骨科大手术 静脉血栓方 益气抗栓 临床疗效 不良反应 

分 类 号：R274.9[医药卫生—中西医结合]