益气活血通脉汤联合气压治疗对脊柱术后DVT的预防作用及血液流变学和凝血功能的影响  

Preventive Effect of Combining Pneumatic Therapy with Yiqi Huoxue Tongmai Decoction on DVT after Spinal Surgery and Its Influence on Hemorheology and Coagulation Function

作　　者：刘欣燕 杨波 黄雪强 王宏飞 崔丽 杨延龙 LIU Xinyan;YANG Bo;HUANG Xueqiang;WANG Hongfei;CUI Li;YANG Yanlong(Department of Traditional Chinese Medicine Surgery,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China;a.Department of Orthopedics,Shanghai Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200082,China;Department of Acupuncture and Moxibustion,Shanghai Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200082,China;Department of Vascular Surgery,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]海军军医大学第一附属医院中医外科,上海200433 [2]上海中医药大学附属上海市中西医结合医院骨科,上海200082 [3]上海中医药大学附属上海市中西医结合医院针灸科,上海200082 [4]上海中医药大学附属曙光医院血管外科,上海201203

出　　处：《医学综述》2021年第24期4964-4969,共6页Medical Recapitulate

基　　金：上海市进一步加快中医药事业发展三年行动计划(2018年-2020年)项目(ZY(2018-2020)-FWTX-3026)。

摘　　要：目的分析益气活血通脉汤联合气压治疗对脊柱术后深静脉血栓形成(DVT)的预防作用及血液流变学和凝血功能的影响。方法选取2018年6月至2021年6月在上海中医药大学附属上海市中西医结合医院骨科行脊柱手术的80例患者为研究对象,按照治疗方法不同分为研究组和对照组,每组40例,其中对照组术后应用气压治疗仪预防DVT,研究组术后应用益气活血通脉汤联合气压治疗仪预防DVT,均连续治疗14 d。观察并比较两组患者下肢DVT发生情况、治疗前后血液流变学指标(全血低切黏度、全血高切黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、红细胞沉降率)、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血浆D-二聚体]、下肢周径差、视觉模拟评分法(VAS)评分及不良反应发生情况。结果研究组DVT总发生率低于对照组[7.50%(3/40)比25.00%(10/40)](P<0.05)。全血低切黏度、全血高切黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、红细胞沉降率的组间与时点间存在交互作用(P<0.01),治疗3 d、7 d研究组全血低切黏度、全血高切黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、红细胞沉降率均低于对照组(P<0.05)。PT、APTT、FIB、D-二聚体的组间与时点间存在交互作用(P<0.01),治疗3 d、7 d研究组PT、APTT、FIB、D-二聚体均低于对照组(P<0.05)。膝上周径差、膝下周径差、VAS评分组间与时点间存在交互作用(P<0.01),治疗3 d、7 d研究组膝上周径差、膝下周径差、VAS评分均低于对照组(P<0.05)。研究组与对照组总不良反应发生率比较差异无统计学意义[12.50%(5/40)比10.00%(3/40)](P>0.05)。结论益气活血通脉汤联合气压治疗可有效预防脊柱术后DVT,在一定程度上改善患者血液流变学和凝血功能指标,并减轻患者疼痛,不会明显增加不良反应。Objective To analyze the preventive effect of combining Yiqi Huoxue Tongmai decoction and pneumatic therapy on deep vein thrombosis(DVT)after spinal surgery and its influence on hemorheology and coagulation function.Methods A total of 80 patients receiving spinal surgery in the Department of Orthopedics,Shanghai Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine First Affiliated Hospital of Naval Military Medical University from Jun.2018 to Jun.2021 were included,and were divided into a research group and a control group according to different treatment methods,40 cases in each group.The control group applied pneumatic therapy instrument to prevent DVT after surgery,and the research group applied Yi Qi Huoxue Tongmai decoction combined with pneumatic therapy instrument to prevent DVT after surgery,and all patients were treated for 14 days.The lower extremity DVT occurrence,hemorheology indexes before and after the treatment(whole blood low shear viscosity,whole blood high shear viscosity,plasma viscosity,erythrocyte aggregation index,erythrocyte deformation index,erythrocyte sedimentation rate),blood coagulation function index[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),plasma D-dimer],lower extremity circumference difference,visual analogue scoring scheme(VAS)scoring and incidence of adverse reactions of the two groups were observed and compared.Results The overall incidence of DVT was lower in the research group than in the control group[7.50%(3/40)vs 25.00%(10/40)](P<0.05).There were interactions between groups and time points in whole blood low shear viscosity,whole blood high shear viscosity,plasma viscosity,erythrocyte aggregation index,erythrocyte deformation index and erythrocyte sedimentation rate(P<0.01);and whole blood low sehar viscosity,whole blood high shear viscosity,plasma viscosity,erythrocyte aggregation index,erythrocyte deformation index and erythrocyte sedimentation rate after 3 d and 7 d of

关 键 词：骨科手术 深静脉血栓形成 益气活血通脉汤 气压治疗仪 血液流变学 凝血功能 

分 类 号：R681.5[医药卫生—骨科学]