黄芪桂枝五物汤预防膝关节置换术后深静脉血栓的临床研究

发布时间：2018-01-22 08:37

本文关键词： 黄芪桂枝五物汤膝关节置换术后 D-二聚体血流变学　出处：《安徽中医药大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过观察黄芪桂枝五物汤对人工膝关节置换术后患者血流变学、D-二聚体的影响，探讨黄芪桂枝五物汤对预防人工膝关节置换术后深静脉血栓形成的临床疗效、安全性及其可能作用机制。方法：依据病例选择标准选取安徽省中医院骨二科2012年9月至2014年1月通过人工全膝关节置换术治疗膝关节骨关节炎的患者50例，患者术前做下肢血管多普勒彩色超声检查了解下肢静脉瓣膜功能、通常情况，并行血流变学及D-二聚体检查。手术均由同一组医师进行，手术均在120min内完成，采用硬膜外麻醉，膝正中切口入路，均使用止血带止血，时间不超过90min。术后弹力绷带包扎，抬高患肢，进行静脉血栓知识宣教，鼓励患者早期行患肢功能锻炼。将患者随机分为治疗组和对照组，每组各25例，治疗组术后第1天予每天两次服用黄芪桂枝五物汤（黄芪30g、桂枝12g、白芍12g、生姜10g、大枣8g，，由安徽省中医院药剂室统一制备）250ml，连服7d，对照组则术后12h开始口服利伐沙班10mg，每日1次。两组患者于术前2d及手术后第1、7d行血流变学及D-二聚体检查，术后48h拔出引流管，并记录引流量；术后第7d行下肢血管多普勒彩色超声探测有无下肢深静脉血栓的形成。对照组的处理方法同治疗组组。对两组患者的D-二聚体、血流变学检查结果进行统计学分析。结果：1.治疗组与对照组术前随机各因素(性别、年龄、假体类型、部位、血流变学、D-二聚体)无显著差异(P0.05)；2.两组患者术后第1d血流变学指标（全血粘度、血浆粘度、红细胞聚集指数、血沉、纤维蛋白原）及D-二聚体水平均较术前增高，有显著性差异(P0.01或P0.05)，从而证实TKA术后患者处于高凝状态的论断，两组术后1周血流变学各项指标均低于术后1天；3.治疗组术后1周，全血粘度、纤维蛋白原、血浆粘度及血沉均低于术前，有显著性差异（P0.01）；红细胞聚集指数较术前无明显差异(P0.05)。对照组术后1周，血沉低于术前，有显著性差异（P0.01）；全血粘度、红细胞聚集指数较术前无明显差异(P0.05)；血浆粘度及纤维蛋白原仍高于术前；4.治疗组术后1周全血粘度、血浆粘度、纤维蛋白原、血沉与对照组术后1周比较，亦有显著性差异（P0.01或P0.05），说明治疗组优于对照组；红细胞聚集指数无统计学差异(P0.05)。5.治疗组组与对照组术后在总引流量上，统计学无差异(P0.05)；6.两组DVT发生率的比较无统计学差异。结论：黄芪桂枝五物汤具有良好的DVT预防效果，可以明显改善TKA术后血液高凝状态，有效降低TKA术后DVT的发生率，且黄芪桂枝五物汤无明显不良反应，安全、有效、价格经济、服用方便，是值得临床选用的中药方剂。
[Abstract]:Objective: to observe the effect of Huangqi Guizhi Wuwu decoction on hemorheology and D-dimer in patients with artificial knee arthroplasty. To explore the clinical efficacy, safety and possible mechanism of Huangqi Guizhi Wuwu decoction in preventing deep vein thrombosis after artificial knee arthroplasty. Methods: according to the criteria of case selection, 50 cases of osteoarthritis were treated by total knee arthroplasty from September 2012 to January 2014. The lower extremity venous valve function was studied by color Doppler ultrasound before operation. The patients underwent hemorheology and D-dimer examination. The operation was performed by the same group of doctors. The operation was performed within 120 minutes, epidural anesthesia was used, the median knee incision was used, tourniquet hemostasis was used for no more than 90 minutes, and the elastic bandage was used to bandage and elevate the affected limb. The patients were randomly divided into treatment group and control group with 25 cases in each group. The treatment group was treated with Huangqi Guizhi Wuwu decoction twice a day on the first day after operation (Astragalus 30g, Guizhi 12g, Radix Paeoniae Alba 12g, ginger 10g, jujube 8g). 250 ml of livacapan was prepared by the pharmacy room of Anhui traditional Chinese Medicine Hospital for 7 days. In the control group, 10 mg of Levashaban was given orally at 12 hours after operation, once a day. The patients in the two groups were treated 2 days before operation and 1 day after operation. Hemorheology and D-dimer examination were performed at 7 days. The drainage tube was pulled out 48 hours after operation and the drainage flow was recorded. On the 7th day after operation, the lower extremity blood vessel Doppler color ultrasound was performed to detect the formation of deep vein thrombosis in the lower extremity. The treatment method of the control group was the same as that of the treatment group. The results of hemorheology were statistically analyzed. Results 1. There was no significant difference between the treatment group and the control group in all the factors (sex, age, type of prosthesis, location, hemorheology, D- dimer) before operation (P 0.05). 2. The levels of blood rheology (whole blood viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte sedimentation rate, fibrinogen) and D-dimer were increased in both groups on the 1st day after operation. There was significant difference (P0.01 or P0.05), which confirmed that the patients after TKA were in hypercoagulable state. The hemorheology indexes of the two groups were lower than that of the first day after operation. 3.The whole blood viscosity, fibrinogen, plasma viscosity and erythrocyte sedimentation rate in the treatment group were significantly lower than those before the operation (P 0.01). There was no significant difference in erythrocyte aggregation index between before and after operation (P 0.05). The erythrocyte sedimentation rate (ESR) in the control group was lower than that before operation (P 0.01). There was no significant difference in whole blood viscosity and erythrocyte aggregation index between before and after operation (P 0.05). Plasma viscosity and fibrinogen were still higher than those before operation. 4. The whole blood viscosity, plasma viscosity, fibrinogen and erythrocyte sedimentation rate in the treatment group were significantly different from those in the control group at 1 week after operation (P0.01 or P0.05), indicating that the treatment group was superior to the control group. There was no statistical difference in erythrocyte aggregation index between the treatment group and the control group in the total drainage volume after operation, there was no statistical difference between the treatment group and the control group in the total drainage volume (P 0.05). 6. There was no significant difference in the incidence of DVT between the two groups. Conclusion: Huangqi Guizhi Wuwu decoction has a good preventive effect on DVT, can obviously improve blood hypercoagulability after TKA, and effectively reduce the incidence of DVT after TKA. And Huangqi Guizhi Wuwu decoction has no obvious adverse reaction, is safe, effective, economical and convenient to take, it is worthy of clinical selection of traditional Chinese medicine prescription.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R274.9

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