活血灵在老年髋部骨折围手术期预防下肢深静脉栓塞的临床观察
发布时间：2019-06-13 18:24
【摘要】：目的:通过对活血灵在老年髋部骨折围手术期应用预防下肢深静脉血栓形成(DVT)的临床观察,分析使用活血灵对老年髋部骨折术后预防DVT的临床疗效及安全性。寻找一种最优方案来预防老年髋部骨折术后下肢DVT,尽可能降低老年髋部手术术后下肢DVT的发生率,减少低分子肝素钙的用量及副作用,提高患者的生活质量。方法:选取60例老年髋部骨折患者(90周岁≥年龄≥60周岁)髋部骨折患者(股骨颈骨折及股骨转子间骨折)随机分为三组A组:低分子肝素钙组;B组:活血灵加低剂量低分子肝素组;C组:活血灵组。三组纳入病人各20例,用药疗程均为13天,分别是术前三天及术后10天,手术当天不用,其中A组给予低分子肝素4100U皮下注射,每日1次;B组除使用低分子肝素2000U皮下注射外,并给予活血灵口服,每日1剂,早晚分服,每次100ml;C组仅给予活血灵口服,每日1剂,早晚分服,每次100ml。纳入患者入院后行血常规、凝血五项、下肢彩色多普勒超声等常规术前检查,并于术后第1、2、7、14天复查血常规及D-二聚体、FIB指标,并记录术中出血量、术后引流量、总输血量、疼痛评分等指标。术后复查下肢深静脉彩色多普勒超声检查病人下肢是否有DVT形成。结果:1.通过R×C表卡方分析,说明三组间性别、年龄、患病部位、病种及手术方式数据样本三组间具可比性;经单因素方差检验,三组之间术前D-二聚体、FIB、血小板、血红蛋白、患肢周径比较差异无统计学意义(P0.05),具有可比性。2.经单因素方差分析,三组间输血量无统计学意义。但从均值图中可见输血量:低钙组低钙加活血灵组活血灵组。3.经单因素方差分析,三组数据满足正态分布及方差齐性,其中术中出血量F=0.59,P=0.560.05,故三组间术中出血量无统计学意义。但从均值图中可见术中出血量:低钙组低钙加活血灵组活血灵组。术后引流量f=3.84,p=0.030.05,故三组间术后引流量差异存在统计学意义。两两比较发现,a组与b、c组比较p=0.03;0.01均0.05,差异有统计学意义;b,c两组间比较p=0.950.05差异无统计学意义;从均值图中可见术后引流量:低钙组低钙加活血灵组活血灵组。4、三组血红蛋白数据经重复资料的方差分析示:时间因素对各组血红蛋白数据变化的影响存在统计学意义;不同时间点血红蛋白数值随分组的不同而不同,差异有统计学意义。经snk检验示:术后第1、2天,b组与a组、c组间差异均无统计学意义,a组与c组间差异存在统计学意义;术后第7、14天,a组与b组、c组间差异均有统计学意义,b组与c组间差异不存在统计学意义;根据均值图可见后期术后第7、14天b组、c组血红蛋白较a组升高。5、三组d-二聚体数据满足正态分布及方差齐性检验,重复资料的方差分析结果显示时间因素对各组d-二聚体数据变化的影响存在统计学意义;不同时间点d-二聚体数值不随分组的不同而不同,差异无统计学意义;大体上三组间同时间点d-二聚体差异均无统计学意义,但从均值图上可见术后7天及术后14天b组较a组及c组来讲,d-二聚体均数数值较低。6、三组fib数据满足正态分布及方差齐性检验,重复资料的方差分析结果显示时间因素对各组fib数据变化的影响存在统计学意义;不同时间点fib数值不随分组的不同而不同,差异无统计学意义;三组间同时间点fib差异均无统计学意义,但从均值图上可见术后14天b组较a组及c组来讲,fib均数数值较低。7、三组疼痛评分数据满足正态分布及方差齐性检验,重复资料的方差分析结果显示时间因素对各组疼痛评分变化的影响存在统计学意义;不同时间点疼痛评分不随分组的不同而不同,差异无统计学意义;除第一天a组与c组对比,p值0.05外,a组与b组,B组与C组对比,P值均0.05,差异无统计学意义,在第2、7、14天同天内B组与C组对比P值均0.05,说明两组间差异无统计学意义,余A组与B组,A组与C组对比P值均0.05,说明两组间差异存在统计学意义;从均值图上可见术后B组及C组疼痛评分较同时间A组要低。综上所述,说明BC两组在术后第1、2天患者疼痛缓解较A组快。8、经R×C表卡方分析三组下肢深静脉血栓形成数据显示:三组间下肢深静脉血栓形成数据无统计学差异,下肢DVT高发于人工全髋关节置换术后患者。结论:活血灵和低分子肝素对D-二聚体、FIB指标有明显改善,同时活血灵能够明显减少术中出血量、术后引流量、改善疼痛评分,并能提高患者血红蛋白数据指标,故将活血灵用于老年围手术期干预骨科大手术后患者,能取得较好的预防下肢DVT的作用,且三组中活血灵与低剂量低分子肝素钙联合使用对D-二聚体、FIB数据指标的改善作用最好。
[Abstract]:Objective: To observe the clinical effect and safety of the use of Huoxue Ling on the prevention of DVT after hip fracture in the elderly through the application of Huoxue Ling in the perioperative period of the old hip fracture. Find an optimal solution to prevent the lower limb DVT after the hip fracture of the old age, reduce the incidence of the lower limb DVT after the hip operation in the old age as much as possible, reduce the amount of low molecular weight heparin calcium and the side effect, and improve the quality of life of the patient. Methods:60 elderly patients with hip fracture (60 years old and 60 years old) were randomly divided into three groups: group A: low molecular weight heparin calcium group; group B: Huoxue Ling plus low dose low molecular weight heparin group; Group C: Huoxue Ling group. The three groups were included in 20 of the patients, and the course of treatment was 13 days, which were three days before operation and 10 days after operation. The operation day was not required, in which group A was given low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (2000U) for oral administration. The daily dose of 1 agent is taken in the morning and evening, and 100 ml each time; the C group only gives the Huoxue oral solution, and the daily dose of 1 agent is taken in the morning and evening, and the dosage is 100 ml each time. The routine pre-operative examinations such as blood routine, blood coagulation and color Doppler ultrasound of lower limbs were included in the patient's admission, and the blood routine and D-dimer and FIB index were re-examined at the 1st, 2nd, 7th and 14th day after operation, and the amount of blood loss, postoperative drainage, total blood transfusion, and pain score were recorded. After the operation, the lower limb deep vein color Doppler ultrasound was re-examined to see if the lower limb of the patient was formed with DVT. Results:1. The three groups of data samples of sex, age, disease, disease and operation were analyzed by R-C table chi-square analysis, and the three groups of data samples of sex, age, disease, disease and operation were comparable to each other, and D-dimer, FIB, platelets and hemoglobin were pre-operative among the three groups. There was no significant difference in the peripheral diameter of the affected limb (P0.05). One-factor analysis of variance, no statistical significance between the three groups. However, the blood transfusion volume is visible from the mean graph: the low-calcium group is low-calcium and the blood-activating and blood-activating group is used for promoting blood circulation. One-factor analysis of variance and three groups of data met the normal distribution and the homogeneity, and the amount of blood loss in the three groups was 0.59, P = 0.560.05, so the amount of blood loss in the three groups was not statistically significant. But the intraoperative blood loss is seen from the mean figure: the low-calcium group, the low-calcium and the blood-activating group, and the blood-activating group. The postoperative drainage flow was f = 3.84, p = 0.030.05, so there was a significant difference between the three groups. The results showed that the difference of group a and group b and c was p = 0.03, 0.01 was 0.05, the difference was statistically significant, and b, c, p = 0.950.05, there was no significant difference between the two groups. The analysis of variance of the repeated data of the three groups of hemoglobin data showed that the time factor had a statistical significance on the change of hemoglobin data in each group, and the hemoglobin values at different time points were different from those of the group, and the difference was of statistical significance. The results showed that there was no significant difference between group a and c between group b and group b after operation, and there was no statistical difference between group a and group c, and there was no statistical significance between group b and c. In group 7,14 and b after that post-operation, the mean of group c was increased in group b, and the d-dimer data of the three groups met the normal distribution and the homogeneity test. The results of variance analysis of the repeated data show that the time factor has a statistical significance on the change of d-dimer data in each group; the value of d-dimer at different time points does not differ from that of the group, and the difference is not significant; There was no significant difference in d-dimer between the three groups, but the mean value of d-dimer was lower in group A and group c after 7 days after operation and 14 days after operation. The results of variance analysis of the repeated data show that the effect of time factor on the change of the fib data in each group is of statistical significance; the fib values of the different time points do not differ from those of the group, and the difference is not significant; the difference of the three groups of time point fib is not statistically significant, However, in group a and c, that mean number of fib was lower in the 14-day b group after operation, and the three groups of pain score data met the normal distribution and the homogeneity test. The results of variance analysis of repeated data show that the effect of time factors on the change of pain scores in each group is of statistical significance; the pain scores of different time points do not differ from those of the group, and the difference is not significant; in addition to the comparison between the first and the second groups, the p-value is 0.05, and the groups a and b, In group B, there was no significant difference between group B and group C, and the difference between group B and group C was 0.05. There was no statistical difference between group A and group B. The difference between group A and group B was 0.05, and the difference between the two groups was statistically significant. The pain scores of group B and group C were lower than that in group A after operation. To sum up, in the first and second days after the operation, the pain relief of the two groups was faster than that in group A.8. The data of deep vein thrombosis of lower limbs was analyzed by R-C-meter-square analysis. There was no statistical difference between three groups of lower limb deep vein thrombosis. The high incidence of DVT in the lower limb is higher than that of the patients after the total hip replacement. Conclusion: Huoxue Ling and low molecular weight heparin can obviously improve the D-dimer and FIB index, while the Huoxue Ling can obviously reduce the intraoperative blood loss, post-operative drainage, improve the pain score, and improve the hemoglobin data index of the patient. Therefore, Huoxue Ling is used in the post-operative intervention of the old patients, and the effect of the lower limb DVT can be effectively prevented, and the combination of the Huoxue and the low-dose low-molecular heparin calcium in the three groups has the best effect on the improvement of the D-dimer and the FIB data index.
【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】：2016
【分类号】：R274.1
本文编号：2498719
[Abstract]:Objective: To observe the clinical effect and safety of the use of Huoxue Ling on the prevention of DVT after hip fracture in the elderly through the application of Huoxue Ling in the perioperative period of the old hip fracture. Find an optimal solution to prevent the lower limb DVT after the hip fracture of the old age, reduce the incidence of the lower limb DVT after the hip operation in the old age as much as possible, reduce the amount of low molecular weight heparin calcium and the side effect, and improve the quality of life of the patient. Methods:60 elderly patients with hip fracture (60 years old and 60 years old) were randomly divided into three groups: group A: low molecular weight heparin calcium group; group B: Huoxue Ling plus low dose low molecular weight heparin group; Group C: Huoxue Ling group. The three groups were included in 20 of the patients, and the course of treatment was 13 days, which were three days before operation and 10 days after operation. The operation day was not required, in which group A was given low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (4100U) for subcutaneous injection, and the group B was given a low molecular weight heparin (2000U) for oral administration. The daily dose of 1 agent is taken in the morning and evening, and 100 ml each time; the C group only gives the Huoxue oral solution, and the daily dose of 1 agent is taken in the morning and evening, and the dosage is 100 ml each time. The routine pre-operative examinations such as blood routine, blood coagulation and color Doppler ultrasound of lower limbs were included in the patient's admission, and the blood routine and D-dimer and FIB index were re-examined at the 1st, 2nd, 7th and 14th day after operation, and the amount of blood loss, postoperative drainage, total blood transfusion, and pain score were recorded. After the operation, the lower limb deep vein color Doppler ultrasound was re-examined to see if the lower limb of the patient was formed with DVT. Results:1. The three groups of data samples of sex, age, disease, disease and operation were analyzed by R-C table chi-square analysis, and the three groups of data samples of sex, age, disease, disease and operation were comparable to each other, and D-dimer, FIB, platelets and hemoglobin were pre-operative among the three groups. There was no significant difference in the peripheral diameter of the affected limb (P0.05). One-factor analysis of variance, no statistical significance between the three groups. However, the blood transfusion volume is visible from the mean graph: the low-calcium group is low-calcium and the blood-activating and blood-activating group is used for promoting blood circulation. One-factor analysis of variance and three groups of data met the normal distribution and the homogeneity, and the amount of blood loss in the three groups was 0.59, P = 0.560.05, so the amount of blood loss in the three groups was not statistically significant. But the intraoperative blood loss is seen from the mean figure: the low-calcium group, the low-calcium and the blood-activating group, and the blood-activating group. The postoperative drainage flow was f = 3.84, p = 0.030.05, so there was a significant difference between the three groups. The results showed that the difference of group a and group b and c was p = 0.03, 0.01 was 0.05, the difference was statistically significant, and b, c, p = 0.950.05, there was no significant difference between the two groups. The analysis of variance of the repeated data of the three groups of hemoglobin data showed that the time factor had a statistical significance on the change of hemoglobin data in each group, and the hemoglobin values at different time points were different from those of the group, and the difference was of statistical significance. The results showed that there was no significant difference between group a and c between group b and group b after operation, and there was no statistical difference between group a and group c, and there was no statistical significance between group b and c. In group 7,14 and b after that post-operation, the mean of group c was increased in group b, and the d-dimer data of the three groups met the normal distribution and the homogeneity test. The results of variance analysis of the repeated data show that the time factor has a statistical significance on the change of d-dimer data in each group; the value of d-dimer at different time points does not differ from that of the group, and the difference is not significant; There was no significant difference in d-dimer between the three groups, but the mean value of d-dimer was lower in group A and group c after 7 days after operation and 14 days after operation. The results of variance analysis of the repeated data show that the effect of time factor on the change of the fib data in each group is of statistical significance; the fib values of the different time points do not differ from those of the group, and the difference is not significant; the difference of the three groups of time point fib is not statistically significant, However, in group a and c, that mean number of fib was lower in the 14-day b group after operation, and the three groups of pain score data met the normal distribution and the homogeneity test. The results of variance analysis of repeated data show that the effect of time factors on the change of pain scores in each group is of statistical significance; the pain scores of different time points do not differ from those of the group, and the difference is not significant; in addition to the comparison between the first and the second groups, the p-value is 0.05, and the groups a and b, In group B, there was no significant difference between group B and group C, and the difference between group B and group C was 0.05. There was no statistical difference between group A and group B. The difference between group A and group B was 0.05, and the difference between the two groups was statistically significant. The pain scores of group B and group C were lower than that in group A after operation. To sum up, in the first and second days after the operation, the pain relief of the two groups was faster than that in group A.8. The data of deep vein thrombosis of lower limbs was analyzed by R-C-meter-square analysis. There was no statistical difference between three groups of lower limb deep vein thrombosis. The high incidence of DVT in the lower limb is higher than that of the patients after the total hip replacement. Conclusion: Huoxue Ling and low molecular weight heparin can obviously improve the D-dimer and FIB index, while the Huoxue Ling can obviously reduce the intraoperative blood loss, post-operative drainage, improve the pain score, and improve the hemoglobin data index of the patient. Therefore, Huoxue Ling is used in the post-operative intervention of the old patients, and the effect of the lower limb DVT can be effectively prevented, and the combination of the Huoxue and the low-dose low-molecular heparin calcium in the three groups has the best effect on the improvement of the D-dimer and the FIB data index.
【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】：2016
【分类号】：R274.1
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