红花黄色素联合低分子量肝素钠预防全膝关节置换术后下肢深静脉血栓形成的疗效观察

发布时间：2018-03-16 00:25

本文选题：红花黄色素　切入点：低分子量肝素钠　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察红花黄色素联合低分子量肝素钠预防全膝关节置换术后下肢深静脉血栓形成的临床疗效、安全性,并初步探讨其作用机制。方法:收集自2015年11月至2016年6月收住入山东省文登整骨医院关节三科符合纳入标准的实行初次单侧全膝关节置换术患者60例,按入院先后顺序编号,依照随机数字表分为A组、B组、C组。A组于术后12小时后予低分子量肝素钠5000IU,皮下注射,每天一次。B组于术后12小时后给予注射用红花黄色素150mg,加入250ml生理盐水中静脉滴注,每天一次;同时予低分子量肝素钠5000IU,皮下注射,每天一次。C组于术后12小时后给予注射用红花黄色素150mg,加入250ml生理盐水中静脉滴注,每天一次;同时予低分子量肝素钠2500IU,皮下注射,每天一次。分别于术前、术后第1、3、14天观察比较三组患者的血浆D-二聚体、凝血酶原时间和部分凝血活酶时间、C反应蛋白、血清白介素-6值;患膝疼痛评分、术后24h引流量、血小板计数、血红蛋白含量及瘀斑面积;血栓及不良反应发生情况。对收集到的数据使用SPSS20.0软件进行统计学分析。结果:本次研究共纳入病例60例,完成随机分组后,A、B、C三组各20例。治疗期间A组1名患者自行服用阿司匹林,C组1名患者自行提前出院,实际完成58例。血浆D-二聚体、凝血酶原时间、部分凝血活酶时间、C反应蛋白、血清白介素-6、VAS评分方面,术后第1、3、14天组间同一时间点相比较,A组与B、C组有统计学差异(p0.05);B组与C组相比无统计学差差异(p0.05)。三组患者术后引流量无统计学差异。A组DVT发生率为5.26%,B、C组均为0%,三组相比较,p=0.3220.05,三组在DVT发生率上并无统计学差异。血小板计数和血红蛋白含量方面,术后第1、3、14天A、B组与C组组间同一时间点相比较,p0.05,差异有统计学意义;A组与B组相比p0.05,差异无统计学意义。患肢瘀斑面积方面比较,三组组间相比术后第一天差异无统计学意义(p0.05);术后第3、14天,C组与A、B组差异有统计学意义(p0.05),A组与B组无统计学差异(p0.05)。结论:人工全膝关节置换术后应用红花黄色素联合低剂量低分子量肝素钠,能有效改善术后血液高凝状态,减少术后出血量、减轻术后疼痛,并可有效降低IL-6、CRP水平;还可有效减少血小板及血红蛋白丢失。在预防下肢深静脉血栓形成方面临床疗效满意,且副作用小,安全性更高,值得得临床推广。
[Abstract]:Objective: to observe the clinical efficacy and safety of safflower yellow and low molecular weight heparin sodium in prevention of deep vein thrombosis after total knee arthroplasty. Methods: from November 2015 to June 2016, 60 patients with primary unilateral total knee arthroplasty who were admitted to three departments of joint in Wendeng whole Bone Hospital of Shandong Province were collected and numbered according to the order of admission. According to the random digital table, group A was divided into group A, group B, group C, group C, group A were given low-molecular-weight heparin sodium (LMWH) 5 000 IUU 12 hours after operation, group .B was injected with 150 mg of safflower yellow pigment once a day 12 hours after operation, and 250 ml of normal saline was added intravenously. At the same time, low molecular weight heparin sodium 5 000 IUS was injected subcutaneously. Group C was injected with 150 mg safflower yellow pigment 12 hours after operation, and 250 ml normal saline was added intravenously once a day. The plasma D-dimer, prothrombin time, partial thromboplastin time and serum interleukin-6 were observed and compared between the three groups before and after the operation, respectively, by subcutaneous injection of low-molecular-weight heparin sodium 2500 IUU once a day. Knee pain score, postoperative 24 hours drainage, platelet count, hemoglobin content and ecchymosis area; The incidence of thrombus and adverse reactions. The collected data were statistically analyzed using SPSS20.0 software. Results: 60 cases were included in this study. During the course of treatment, one patient in group A took aspirin and one patient in group C left hospital early, 58 cases were actually completed. Plasma D- dimer, prothrombin time, prothrombin time, plasma D- dimer, prothrombin time, plasma D- dimer, prothrombin time, prothrombin time, plasma D- dimer, prothrombin time, Partial thromboplastin time and C-reactive protein, serum interleukin-6 and VAS score, There was no statistical difference between group A and group C at the same time point on the 1st day after operation (P 0.05). There was no statistical difference between group B and group C. there was no significant difference in postoperative drainage among three groups. The incidence of DVT in group A was 0 in group C (5.26%) and in group C (0%). Compared with 0.3220.05, there was no significant difference in the incidence of DVT among the three groups. The difference between group A and group C at the same time point was significant (P 0.05). There was no significant difference between group A and group B (P 0.05), but the area of ecchymosis was not significantly different between group A and group B (P 0.05), but there was no significant difference between group A and group B (P 0.05). There was no significant difference between the three groups on the first day after operation, and there was no significant difference between group C and group A on the 14th day after operation, and there was no significant difference between group A and group B. conclusion: the application of safflower yellow pigment after total knee arthroplasty is not significant (p 0.05). Combined with low dose low molecular weight heparin sodium, It can effectively improve the state of blood hypercoagulability, reduce the amount of blood loss, relieve postoperative pain, decrease the level of IL-6 CRP, reduce the loss of platelet and hemoglobin, and is effective in preventing deep venous thrombosis of lower extremity. And the side effect is small, the safety is higher, is worth to be popularized clinically.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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