八珍汤减少全髋关节置换术后低分子肝素用量的临床观察  

Clinical Study of Bazhen Decoction in Reducing the Dosage of Low-molecular-weight-heparin after Total Hip Arthroplasty

作　　者：刘威 李文龙 丁娟 王博 王红超 孔亮 Liu Wei;Li Wenlong;Ding Juan;Wang Bo;Wang Hongchao;Kong Liang(Luoyang Orthopedic-Traumatological Hospital,Henan Province Orthopedic Hospital,Henan,Luoyang 471002,China)

机构地区：[1]河南省洛阳正骨医院,河南省骨科医院,河南洛阳471000 [2]北京市和平里医院,北京100013

出　　处：《中国中医急症》2023年第3期474-478,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：洛阳市医疗卫生领域指导性科技计划项目(2040004A)。

摘　　要：目的观察八珍汤口服在减少全髋关节置换(THA)术后低分子肝素(LMWH)用量方面的疗效。方法THA术后患者103例随机分为3组,对照组32例给予LMWH皮下注射,八珍汤组36例加用八珍汤口服,1/2联合组35例给予1/2标准剂量LMWH皮下注射,并给予八珍汤口服。比较3组的活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、血浆纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(D-dimer)、血小板(PLT)、血液黏度(PV)、全血高切黏度(WBHV)、血栓弹力图数值[TEG,包括凝血反应时间(R)、凝血时间(K)、凝固角(α)、最大振幅(MA)及血凝块(MA)出现30 min内TEG曲线下降面积(Ly30)]、术中出血量、输血量、术后引流量、患肢最大肿胀率、DVT及不良反应发生情况。结果与术前相比,八珍汤组、1/2联合组均能延长术后APTT、PT、TT,缩短FIB、D-dimer,降低PV、WBHV、R值、K值,升高α角、MA(P<0.05);术后14 d时,八珍汤组、1/2联合组延长APTT、PT、TT,降低PV,改善R值、α角、MA的疗效均优于对照组(P<0.05),八珍汤组缩短FIB、WBHV,改善K值的疗效均优于对照组(P<0.05),八珍汤组、联合组比较,差异无统计学意义(P>0.05)。PLT方面,3组组间、组内均未见明显差异(P>0.05)。术中出血量、输血量、术后引流量及DVT发生情况比较,3组均未见明显差异(P>0.05)。患肢最大肿胀率方面,与对照组相比,八珍汤组、联合组能减轻患肢最大肿胀率(P<0.05);两组间未见明显差异(P>0.05)。并发症发面,八珍汤组腹泻2例、大腿青紫5例;联合组腹泻1例,未出现青紫瘀斑;对照组药物过敏1例,大腿青紫6例,3组并发症发生率比较,差异有统计学意义(P<0.05),其中1/2联合组发生率低于对照组(P<0.05),八珍汤组与联合组、对照组比较,差异无统计学意义(P>0.05)。结论THA术后应用八珍汤口服可减少LMWH用量,疗效与联合标准剂量相当,均优于单纯LMWH,且能减少相关并发症的发生。Objective:To investigate the efficacy of Bazhen Decoction in reducing the dosage of low-molecularweight-heparin(LMWH)after total hip arthroplasty(THA).Methods:103 patients who underwent unilateral THA were randomly divided into 3 groups.32 patients were given subcutaneous injection of LMWH(control group),36 cases were given Bazhen Decoction orally on the basis of the control group,35 patients were given subcutaneous injection of 1/2 standard dose of LMWH combined with Bazhen Decoction orally(1/2 combination group).The APTT,PT,FIB,TT,D-dimer,PLT,PV,WBHV,the R value,K value and α angle of TEG,MA,Ly30,intraoperative blood loss,blood transfusion volume,postoperative drainage volume,maximum swelling rate of affected limb,occurrence of DVT and occurrence of adverse reactions were compared among the three groups of patients.Results:Compared with preoperative data,1/2 combination group and Bazhen Decoction group could prolong APTT,PT,TT,αand MA,shorten FIB,D-dimer,PV,WBHV,R and K(P<0.05).Fourteen days after the operation,compared with the control group,the APTT,PT and TT of the 1/2 combination group and Bazhen Decoction group were prolonged,the PV were decreased,the R,αand MA were changed(P<0.05).Bazhen Decoction group had better shortened the FIB,reduced WBHV and changed K than the control group(P<0.05).There was no difference between control group and B(P>0.05).In terms of PLT,intraoperative blood loss,blood transfusion volume,postoperative drainage volume and the occurrence of DVT,there were no significant differences among the three groups(P>0.05).In terms of the maximum swelling rate of the affected limb,compared with the control group,the 1/2 combination group and Bazhen Decoction group could reduce the maximum swelling rate of the affected limb,and the difference was statistically significant(P<0.05);there was no difference between 1/2 combinationl group and Bazhen Decoction group(P>0.05).Two cases of diarrhea and five cases of thigh bruising occurred in Bazhen Decoction group after operation.One case of diarrh

关 键 词：全髋关节关节置换术 静脉血栓 术后并发症 低分子肝素 八珍汤 

分 类 号：R687.4[医药卫生—骨科学]