当归补血汤加味对人工全髋关节置换术后患者凝血功能影响的研究

发布时间：2018-01-08 04:27

本文关键词：当归补血汤加味对人工全髋关节置换术后患者凝血功能影响的研究　出处：《湖南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究拟通过观察当归补血汤加味对临床上人工全髋关节置换术后患者凝血功能包括凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-Dimer)、活化部分凝血酶原时间(APTT)及血浆凝血酶时间(TT)的影响,研究该方对其中哪几个指标有明显作用,来探讨该方对人工全髋关节置换术后早期患者凝血功能的影响,研究防治术后DVT形成的部分作用机制。方法:通过纳入及排除标准,选取符合参研的对象60名,按随机分配原则分为两组(试验组及对照组),每组各30人,两组患者性别、年龄经统计学检验无明显差异(P0.05),具有可比性。两组患者入院时行术前常规检查。术前试验组合对照组分别单独采用当归补血汤加味和单纯低分子肝素钙皮下注射预防下肢深静脉血栓形成;自入院时开始应用,术前12h停止应用,术后12h、24h给予低分子肝素钙皮下注射,后每天1次,术后用药10天,其中试验组应用当归补血汤加味口服,对照组单纯应用低分子肝素钙皮下注射。术后2组患者均采用相同的基础预防和物理预防措施,术后双下肢弹力绷带应用3天,并适当抬高患肢,术后第1天开始床上行下肢股四头肌收缩及踝关节跖曲背伸功能锻炼,术后第2天开始床上进行患肢持续功能锻炼。重点了解术前及术后第1、4、7、10天复查凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血酶原时间(APTT)及血浆凝血酶时间(TT)、D-二聚体(D-Dimer)等凝血指标的变化情况,并比较试验组和对照组之间及各组手术前后凝血功能差异并进行疗效分析。所有数据应用SPSS18.0统计软件分析。结果:两组病例分别在术前、术后第1天、第4天、第7天及第10天5个时间点对凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血酶原时间(APTT)及血浆凝血酶时间(TT)进行记录整理。并进行重复资料统计学检验。术后各时间点凝血酶原时间(PT)变化趋势两组间比较,试验组均比对照组延长,有显著性差异(P0.05);纤维蛋白原(FIB)术后第1天、第7天、第10天三个时间点试验组明显低于对照组(P0.05);活化部分凝血酶原时间(APTT)术后第1天、第4天、第7天两个时间点试验组比对照组明显延长(P0.05);血浆凝血酶时间(TT)术后第1天一个时间点试验组比对照组名选手延长(P0.05);D-二聚体(D-Dimer)术后各时段两组间比较无明显差异(P0.05);两组病例中均未出现下肢深静脉血栓(DVT)及肺栓塞(PTE)及死亡比例。两组病例术前术后常规检查比较经统计学检验。无显著性差异(P0.05)。结论:当归补血汤加味能够延长凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、降低纤维蛋白原(FIB)含量,来对全髋关节置换术后下肢深静脉血栓形成(DVT)有一定预防作用。
[Abstract]:Objective: to observe the effect of modified Danggui Buxue decoction on coagulation function of patients after total hip arthroplasty including prothrombin time (PTT) and fibrinogen (FIBB). The effects of D-Dimern, activated partial prothrombin time (APTT) and plasma thrombin time (TTT) were studied. To explore the effect of this prescription on the coagulation function of early patients after total hip arthroplasty, and to study the mechanism of prevention and treatment of DVT. Methods: by including and excluding the criteria. According to the principle of random distribution, 60 subjects were selected and divided into two groups (experimental group and control group, 30 persons in each group. There was no significant difference in sex and age between the two groups by statistical test (P0.05)). Two groups of patients received routine examination before admission. The control group was treated with Danggui Buxue decoction alone and hypodermic injection of low molecular weight heparin calcium to prevent lower extremity deep vein thrombosis. It was given hypodermic injection of low-molecular-weight heparin calcium for 12 hours after operation, once a day after operation and 10 days after operation. The experimental group was treated with Danggui Buxue decoction and the control group was treated with hypodermic injection of low-molecular-weight heparin calcium. The two groups were treated with the same basic and physical preventive measures. The elastic bandages of the lower limbs were used for 3 days and the affected limbs were raised properly. The quadriceps muscle contraction and the ankle metatarsal flexion and extension function of the lower extremities were performed on the first day after the operation. Continuous functional exercise of the affected limb was performed on the second day after operation. The focus of this study was to review the prothrombin time (PTT) and fibrinogen (FIBB) before and after the operation for 710 days. The changes of activated partial prothrombin time (APTT) and plasma thrombin time (TTT) and D-Dimer (D-Dimer). The difference of coagulation function between the test group and the control group before and after operation was compared and the curative effect was analyzed. All the data were analyzed by SPSS18.0 statistical software. Results: the two groups of patients were before operation. On the 1st, 4th, 7th and 10th day after operation, the prothrombin time (PTT) and fibrinogen (FIBB) were observed. Activated partial prothrombin time (APTT) and plasma thrombin time (TTT) were recorded. The trend of change was compared between the two groups. The experimental group was longer than the control group, and the difference was significant (P 0.05). Fibrinogen FIBs were significantly lower in the experimental group than in the control group on the 1st, 7th and 10th day after operation. The activated partial prothrombin time (APTT) on the 1st, 4th and 7th day after operation in the experimental group was significantly longer than that in the control group. Plasma thrombin time (TTT) at one time point after operation in the trial group was longer than that in the control group (P 0.05). There was no significant difference between the two groups after D-Dimer operation (P 0.05). There were no DVT (DVT), PTET (pulmonary embolism) and death ratio in the two groups. The routine examination before and after operation was statistically compared between the two groups. There was no significant difference between the two groups (P 0.05). Conclusion: modified Danggui Buxue decoction can prolong prothrombin time (PTT). Activating partial prothrombin time and reducing the content of fibrinogen FIBs can prevent DVT after total hip arthroplasty.
【学位授予单位】：湖南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

【参考文献】