定痛和血汤联合低分子肝素治疗老年髋部骨折术后血栓前状态临床研究  

Clinical Study on Dingtong Hexue Decoction Combined with Low Molecular Weight Heparin for Prethrombotic State in Senile Patients After Surgery of Hip Fracture

作　　者：殷浩 余利军 吴华杰 YIN Hao;YU Lijun;WU Huajie(Chun'an County Hospital of Chinese Medicine,Chun'an Zhejiang 311700,China)

机构地区：[1]淳安县中医院,浙江淳安311700

出　　处：《新中医》2023年第16期65-69,共5页New Chinese Medicine

摘　　要：目的:观察在常规术后治疗措施基础上采用定痛和血汤联合低分子肝素治疗老年髋部骨折术后血栓前状态的效果。方法:回顾性分析86例血瘀型老年髋部骨折术后血栓前状态患者的临床资料,根据术后治疗方法分为对照组和观察组各43例。2组均予常规术后治疗措施与低分子量肝素钠注射液皮下注射,观察组加予定痛和血汤加减治疗。2组均以5 d为1个疗程,连续治疗2个疗程。比较2组术后10 d肺栓塞、下肢深静脉血栓(DVT)、皮下瘀斑的发生率,评定髋部疼痛视觉模拟评分法(VAS)评分,记录术后48 h内的切口总引流量,检测血栓前状态指标[血管性血友病因子(v WF)、D-二聚体(D-D)、P-选择素]。结果:观察组术后48 h切口总引流量少于对照组(P<0.05)。2组术后疼痛VAS评分随着时间的延长逐渐降低。2组术后5 d、10 d的VAS评分均较术后1 d降低(P<0.05);2组术后10 d的VAS评分均较术后5 d降低(P<0.05)。观察组术后5 d、10 d的VAS评分均低于对照组(P<0.05)。术后10 d,2组vWF、D-D、P-选择素水平均较术后1 d下降(P<0.05),观察组vWF、D-D、P-选择素水平均低于对照组(P<0.05)。2组肺栓塞发生率、下肢DVT发生率、皮下瘀斑发生率比较,差异均无统计学意义(P>0.05)。结论:在常规术后治疗措施基础上采用定痛和血汤联合低分子量肝素治疗,能有效纠正老年髋部骨折术后患者的血栓前状态,预防下肢DVT形成,减轻术后痛感,在预防术后出血倾向方面具有优势。Objective:To observe the effect of therapy of Dingtong Hexue Decoction combined with low molecular weight heparin on prethrombotic state in senile patients after surgery of hip fracture based on routine postoperative treatment measures.Methods:After the retrospective analysis of clinical data of prethrombotic state in 86 senile patients after surgery of hip fracture of blood stasis type,the patients were divided into the control group and the observation group according to the postoperative treatment methods,with 43 cases in each group.The two groups were given routine postoperative treatment measures and subcutaneous injection with low molecular weight heparin,and the observation group was additionally treated with oral administration of modified Dingtong Hexue Decoction.With 5 days as a course of treatment,the two groups were treated for 2 courses.After 10 days of surgery,the incidence of pulmonary embolism,deep vein thrombosis(DVT)of lower extremities and subcutaneous ecchymosis were compared between the two groups;the scores of Visual Analogue Scale(VAS)for hip pain were evaluated;the total drainage volume of incision within 48 hours after surgery was recorded;the indexes of prethrombotic state were detected,including von willebrand factor(vWF),D-dimer(D-D)and P-selectin.Results:The total drainage volume of incision within 48 hours after surgery was less than that in the control group(P<0.05).The VAS scores of postoperative pain in the two groups were gradually decreased as time increased.The VAS scores in both groups after 5 and 10 days of surgery were decreased when compared with those after 1 day of surgery,respectively(P<0.05);the VAS scores in both groups after 10 days of surgery were decreased when compared with those after 5 days of surgery(P<0.05).The VAS scores in the observation group after 5 and 10 days of surgery were lower than those in the control group,respectively(P<0.05).After 10 days of surgery,the levels of vWF,D-D and P-selectin in both groups were decreased when compared with those after

关 键 词：髋部骨折 血栓前状态 血瘀证 定痛和血汤 肺栓塞 深静脉血栓 

分 类 号：R274.1[医药卫生—中医骨伤科学]