复元活血汤预防脊柱骨折术后下肢深静脉血栓形成的疗效观察

发布时间：2018-06-02 15:03

本文选题：复元活血汤 + 下肢深静脉血栓形成　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：观察复元活血汤预防脊柱骨折术后下肢深静脉血栓形成(DVT)的临床疗效,为中医药预防下肢深静脉血栓形成推广应用提供临床基础。方法：将2015年4月份至2016年1月份于广州中医药大学附属中山医院脊柱专科住院部确诊为脊柱骨折术后60例入选病例病患,采用随机数表配合信封法随机分为复元活血汤组(20例)、那曲肝素钙组(20例)、复元活血汤联合那曲肝素钙组(20例),分别对其治疗前后凝血指标、血浆D-2聚体、血液流变学,双下肢超声多普勒等以及相关安全性指标进行观察,予以统计分析,客观评价复元活血汤预防脊柱骨折术后下肢深静脉血栓形成的作用及阐释其机理。结果：1、三组患者术后第2天,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)均延长,其变化趋势基本相同,大部分指标差异有统计学意义(P0.05);纤维蛋白原(FIB)则呈下降趋势。复元活血汤组与那曲肝素钙组各项指标的升高或下降趋势大致一致,复元活血汤联合那曲肝素钙组PT、APTT、TT升高程度及FIB下降程度均优于复元活血汤组与那曲肝素钙组(P＜0.05)。2、D-2聚体水平在术后第2天有明显上升(P＜0.05),术后第7天均大幅度下降(P0.05),复元活血汤联合那曲肝素钙组对比其它组下降更加明显(P＜0.05)。3、术后第2天,三组患者大多数血液流变学结果较术前均有升高,其中全血粘度低切(BVL)、全血粘度高切(BVH)、血浆黏度(PV)、红细胞压积(HCT)、红细胞聚集指数(RE)、血沉(ESR)与术前比较有显著差异(PO.05或P＜0.01)。红细胞变形指数(TK)较术前下降,有显著变化(P＜0.01)。术后7天,大部分血液流变学指标有得到明显改善(P＜0.05或P＜0.01)。4、术后下肢静脉血栓形成情况比较,三组患者对比无显著性差异5、三组患者治疗前后VAS评分结果比较,复元活血汤组及复元活血汤联合那曲肝素钙组优于那曲肝素钙组(P＜0.05)。6、术后24小时术口引流量复元活血汤组较少,优于复元活血汤组及复元活血汤联合那曲肝素钙组优于那曲肝素钙组(P0.01),而血小板计数(PLT)统计结果提示三组无明显差别(P＞0.05)。结论：复元活血汤能够有效改善脊柱骨折术后患者改善血液高凝状态,降低粘稠度,防止深静脉血栓的形成,是临床防治DVT的有效中药方药。相比于单纯使用那曲肝素钙出血风险小,更加安全可靠,同时复元活血汤能改善患者的腰背部疼痛情况,效果明显。临床上可评估患者血液的粘稠度,从而选择单用复元活血汤或联合那曲肝素钙防治DVT。
[Abstract]:Objective: to observe the clinical effect of Fuyuan Huoxue decoction (Fuyuan Huoxue decoction) in preventing deep venous thrombosis (DVT) of lower extremity after spinal fracture, and to provide a clinical basis for the popularization and application of traditional Chinese medicine in the prevention of deep venous thrombosis of lower extremity. Methods: from April 2015 to January 2016, 60 selected patients with spinal fractures were diagnosed in the Department of Spine of Zhongshan Hospital affiliated to Guangzhou University of traditional Chinese Medicine. Twenty cases of Fuyuan Huoxue decoction group, 20 cases of Naqu heparin calcium group, and 20 cases of Fuyuan Huoxue decoction combined with Naqu heparin calcium group were randomly divided into two groups by random number table and envelope method. The coagulation index, plasma D-2 polymer and hemorheology were measured before and after treatment. The effect of Fuyuan Huoxue decoction on prevention of deep venous thrombosis after spinal fracture was evaluated objectively and its mechanism was explained. Results the prothrombin time (PTT), activated partial thromboplastin time (APTT) and thrombin time (TTT) were prolonged on the second day after operation in the three groups. The difference of most indexes was statistically significant (P 0.05), while fibrinogen FIBs showed a decreasing trend. The increasing or decreasing trend of the indexes of Fuyuan Huoxue decoction group and Naqu heparin calcium group was approximately the same. The level of FIB in Fuyuan Huoxue decoction combined with Naqu heparin calcium group was significantly higher than that in Fuyuan Huoxue decoction group and Naqu heparin calcium group (P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05) on the 7th day after operation. Yuan Huoxue Tang combined with Natrex heparin calcium group decreased more significantly than other groups (P < 0.05), and on the second day after operation, Most of the hemorheological results in the three groups were higher than those before operation, including whole blood viscosity low shear BVLA, whole blood viscosity high shear BVH, plasma viscosity PVN, hematocrit HCT, erythrocyte aggregation index (RBC) and erythrocyte sedimentation rate (ESR) significantly different from those before operation (P < 0.05 or P < 0.01). The erythrocyte deformability index (TK) was significantly lower than that before operation (P < 0.01). On the 7th day after operation, most of the hemorheological indexes improved significantly (P < 0. 05 or P < 0. 01). There was no significant difference between the three groups in venous thrombosis after operation. The VAS scores of the three groups were compared before and after treatment. Fuyuan Huoxue decoction group and Fuyuan Huoxue decoction combined with Naqu heparin calcium group were better than Naqu heparin calcium group (P < 0.05). It was better than Fuyuan Huoxue decoction group and Fuyuan Huoxue decoction combined with Naqu heparin calcium group than Naqu heparin calcium group (P 0.01), but platelet count (PLT) showed no significant difference among the three groups (P > 0.05). Conclusion: Fuyuan Huoxue decoction can effectively improve the blood hypercoagulability, reduce the viscosity and prevent the formation of deep venous thrombosis in patients with spinal fracture after operation. It is an effective prescription for clinical prevention and treatment of DVT. Compared with Naqu heparin calcium alone, the risk of bleeding is less, more safe and reliable. At the same time, Fuyuan Huoxue decoction can improve the pain of the patients' waist and back, and the effect is obvious. Clinically, we can evaluate the blood viscosity of the patients, and choose Fuyuan Huoxue decoction or Natrix heparin calcium to prevent and treat DVT.
【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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