补阳还五汤对老年股骨粗隆间骨折PFNA术后凝血功能影响

发布时间：2018-01-06 05:16

本文关键词：补阳还五汤对老年股骨粗隆间骨折PFNA术后凝血功能影响　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过对老年股骨粗隆间骨折患者进行股骨近端防旋髓内钉(PFNA)内固定治疗,术后给予中药方补阳还五汤口服,观察对比手术前后患者凝血功能相关指标变化,为改善老年股骨粗隆间骨折PFNA内固定术后高凝状态,预防凝血相关并发症发生提供明确有效的中药治疗方法和客观的临床依据。方法：选取广州中医药大学附属骨伤科医院2015年4月至2016年2月期间,符合研究标准的单侧股骨粗隆间骨折患者共73例,经过随机化分为实验组36例及对照组37例,分别进行PFNA手术治疗。于术后第2天开始,实验组给予补阳还五汤口服加低分子肝素钙注射液治疗,对照组给予低分子肝素钙注射液治疗,所有患者均接受术后常规治疗。检测并记录手术前后不同时间点各项凝血功能相关指标,比较组间治疗前后不同时间节点各个指标变化情况。结果：1.两组患者在入院时血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)及D-二聚体(D-Dimer)无明显差异,差异无统计学意义(P0.05)。2.所有患者的PLT、PT、INR、APTT、D-Dimer在手术前后对比,有明显差异。其中术后患者PLT较术前减少,PT、INR、APTT较术前缩短,D-Dimer升高,且差异有统计学意义(P0.05),而TT及FIB差异均无统计学意义(P0.05),两组患者手术前后凝血功能差值差异无统计学意义(P0.05)。3.两组患者在用药后PT、INR、APTT、TT均逐渐延长,且差异有统计学意义(P0.05)；FIB下降,组间差异无统计学意义(P0.05)；D-Dimer下降,组间差异无统计学意义(P0.05)；PLT变化,组间差异无统计学意义(P0.05)。4.两组患者不同时间节点对比,PT、INR、APTT、TT差异在术后当天均无统计学意义(P0.05),差异在术后第5天,第7天有统计学意义(P0.05)；两组患者FIB及PLT在术后各个时间节点对比差异均无统计学意义(P0.05)；D-Dimer差异在术后当天无统计学意义(P0.05),而在术后第5天及第7天差异均有统计学意义(P0.05)。结论：老年股骨粗隆间骨折患者经PFNA内固定术治疗后会使患者的凝血功能改变,使PT、INR、APTT、TT缩短,D-Dimer升高,形成高凝状态,补阳还五汤的运用能够改善这一状态,延长P T、INR、APTT、TT,降低D-Dimer,激活纤溶系统。
[Abstract]:Objective: to elderly patients with femoral intertrochanteric fracture of proximal femoral nail anti rotation (PFNA) internal fixation, postoperative prescription positive also five soup orally, the observed changes of coagulation function in patients with contrast before and after surgery, to improve the elderly femoral intertrochanteric fracture between the hypercoagulable state of PFNA internal fixation after the operation, the effective method of treatment of traditional Chinese medicine provides a clear and objective clinical basis for the prevention of coagulation related complications. Methods: from orthopedics hospital affiliated to Guangzhou University of Chinese Medicine from April 2015 to February 2016, meet the study criteria of unilateral femoral intertrochanteric fracture patients with a total of 73 cases were randomized divided into experimental group 36 cases and control group 37 cases. Compared with PFNA surgery. On the second day after surgery, the experimental group was given Buyanghuanwu Decoction and five patients in control group were given treatment of Low Molecular Weight Heparin Calcium Injection, Low Molecular Weight Heparin Calcium Injection The treatment, all patients received routine postoperative treatment. To detect and record the coagulation function before and after operation in different time points related indicators were compared between before and after treatment in different time points of each index changes. Results: 1. of two patients on admission of platelet (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB) and two D- dimer (D-Dimer) had no obvious difference, the difference was not statistically significant (P0.05.2.) of all patients with PLT, PT, INR, APTT, D-Dimer before and after operation in comparison, have obvious difference. The postoperative PLT decreased, PT, INR, APTT were shorter, D-Dimer increased, and the difference was statistically significant (P0.05), while there was no significant difference between TT and FIB (P0.05), there was no significant difference of blood coagulation function in two groups of patients before and after surgery (P0.0 5).3. patients in the two groups after treatment PT, INR, APTT, TT were gradually increased, and the difference was statistically significant (P0.05); FIB decreased, no significant difference between the groups (P0.05); D-Dimer decreased, no significant difference between the groups (P0.05); the change of PLT, there were no significant differences between groups (P0.05).4. two groups of patients with different time points PT, INR, APTT, TT, the difference in postoperative day showed no statistically significant difference (P0.05), on the fifth postoperative day, the seventh day was statistically significant (P0.05); two patients of FIB and PLT in the postoperative time points comparing the difference of each day there was no significant difference in D-Dimer (P0.05); the day after the surgery was not statistically significant (P0.05), and after fifth days and 7 days there were statistically significant differences (P0.05). Conclusion: the patients with PFNA fixation will cause the change of coagulation function in patients with senile femoral intertrochanteric fractures to PT INR, APTT, TT shortened, D-D IMER increased and formed a hypercoagulable state. The use of Buyang five soup could improve this state, prolong P T, INR, APTT, TT, reduce D-Dimer, and activate fibrinolysis system.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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