通腹逐瘀颗粒预防肝硬化脾切除术后门静脉血栓形成临床研究  

Prevention of Tongfu Zhuyu granules on portal vein thrombosis after splenectomy in liver cirrhosis

作　　者：王鹏利 周小燕 王少辉 罗璐 白垚 白子墨 WANG Pengli;ZHOU Xiaoyan;WANG Shaohui;LUO Lu;BAI Yao;BAI Zimo(Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]陕西中医药大学附属医院,陕西咸阳712000

出　　处：《陕西中医》2025年第2期206-210,共5页Shaanxi Journal of Traditional Chinese Medicine

基　　金：陕西省中医药管理局中医药科研课题(LCWS046)。

摘　　要：目的:探究通腹逐瘀颗粒对肝硬化患者经脾切除术后发生门静脉血栓的预防效果。方法:选取肝硬化失代偿期后出现门静脉高压症伴脾大、脾功能亢进的患者,给予脾切除术联合贲门胃底周围血管离断术,收集其中150例患者随机分为试验组、对照组、空白组各50例,其中试验组运用通腹逐瘀颗粒治疗,对照组术后3 d开始常规使用低分子肝素钠针剂皮下注射,空白组仅给予常规综合治疗,不做干预。于术后7 d、15 d检测患者的纤维蛋白原(FIB)、D-二聚体、丙氨酸氨基转移酶(ALT)、D-乳酸水平,门静脉平均血流速度及门静脉直径,记录并比较三组患者的术后首次排气、排便时间及术后住院时间,并且在术后7 d、15 d、3个月及6个月时,采用彩色多普勒超声检查监测门静脉血栓的发生情况,以此评估预防措施的有效性。结果:对三组患者检测指标进行分析,除术后7 d门静脉直径外,其他所有指标差异均有统计学意义(P<0.05)。在术后的7 d、15 d,试验组在FIB、D-二聚体、ALT、D-乳酸以及门静脉平均血流速度方面,与空白组比较差异具有统计学意义(P<0.05),其中试验组术后7 d、15 d的ALT、D-乳酸水平低于对照组(P<0.05),试验组术后15 d的FIB、D-二聚体、门静脉平均血流速度与对照组比较差异具有统计学意义(P<0.05)。术后15 d,试验组与对照组的门静脉直径大于空白组,试验组大于对照组(P<0.05)。术后恢复上,试验组与对照组的首次排气、排便、总住院时间较空白组明显缩短,试验组较对照组也显著缩减(P<0.05)。术后B超随访,试验组术后6个月内门静脉血栓总发生率低于空白组(P<0.05)。结论:运用通腹逐瘀颗粒能对肝硬化脾切除患者术后预后起到较为良好的效果,可预防门静脉血栓的形成。Objective:To explore the preventive effect of Tongfu Zhuyu granules on portal vein thrombosis after splenectomy in patients with liver cirrhosis.Methods:Patients with portal hypertension,splenomegaly and hypersplenism after decompensated cirrhosis were selected and treated with splenectomy combined with pericardial and fundocial devascularization.The clinical data of 150 patients were collected and randomly divided into three groups:the experimental group(n=50),the control group(n=50)and the blank group(n=50).The treatment group was treated with Tongfu Zhuyu granule,the control group was treated with low-molecular-weight heparin sodium injection from the third day after operation,and the blank group was only treated with conventional comprehensive treatment without intervention.The levels of fibrinogen(FIB),D-dimer,alanine aminotransferase(ALT),D-lactic acid,mean portal vein blood flow velocity and portal vein diameter were measured on the 7th and 15th day after operation.The first postoperative exhaust time,defecation time and postoperative hospital stay were recorded and compared among the three groups.At the same time,color Doppler ultrasound was performed on the 7th day,15th day,3 months and 6 months after operation to detect the occurrence of portal vein thrombosis and evaluate the prevention effect.Results:Except for portal vein diameter on the 7th day after operation,the other indicators of the three groups were statistically significant(P<0.05).The levels of FIB,D-dimer,ALT,D-lactic acid and mean portal blood flow velocity in the experimental group were significantly different from those in the blank group at 7 and 15 days after operation(P<0.05).The levels of ALT and D-lactic acid in the experimental group were lower than those in the control group at 7 and 15 days after operation(P<0.05).FIB,D-dimer and portal vein blood flow velocity in the experimental group were significantly different from those in the control group 15 days after operation(P<0.05).At 15 days after operation,the diameter of portal ve

关 键 词：肝硬化 通腹逐瘀颗粒 脾切除术 门静脉血栓 纤维蛋白原 D-二聚体 

分 类 号：R575.2[医药卫生—消化系统]