[1]王平,卢启贵,黄东红,等.桃红四妙汤结合低分子肝素钙防治全膝关节置换术后深静脉血栓形成的临床观察[J].中医正骨,2012,24(01):27-31.
　WANG Ping*,LU Qi-gui,HUANG Dong-hong,et al.Clinical observation on the curative effect of TAOHONG SIMIAO DECOCTION combined with low molecular weight heparin calcium in the preventive treatment of deep vein thrombosis after total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2012,24(01):27-31.
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桃红四妙汤结合低分子肝素钙防治全膝关节置换术后深静脉 血栓形成的临床观察()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期数:
2012年01期
页码:
27-31
栏目:
临床研究
出版日期:
2012-01-31

文章信息/Info

Title:
Clinical observation on the curative effect of TAOHONG SIMIAO DECOCTION combined with low molecular weight heparin calcium in the preventive treatment of deep vein thrombosis after total knee arthroplasty
作者:
王平; 卢启贵; 黄东红; 孙克民; 李政; 裴代平; 高迪; 徐展
广东省深圳平乐骨伤科医院,广东 深圳 518010
Author(s):
WANG Ping*; LU Qi-gui; HUANG Dong-hong; SUN Ke-min; LI Zheng; PEI Dai-ping; GAO Di; XU Zhan.
*Shenzhen Pingle Orthopedic Hospital,Shenzhen 518010,Guangdong,China
关键词:
静脉血栓形成 关节成形术; 置换; 膝 桃红四妙汤 肝素; 低分子量 治疗; 临床研究性
Keywords:
Venous thrombosis;  Arthroplasty; replacement; knee;  TAOHONG SIMIAO DECOCTION;  Heparin; low-molecular-weight;  Therapies; investigational
摘要:
目的:探讨桃红四妙汤配合低分子肝素钙防治全膝关节置换术后深静脉血栓形成的临床疗效及安全性。方法:将符合要求的40例患者随机分为治疗组和对照组,每组20例。治疗组采用桃红四妙汤加低分子肝素钙治疗,对照组仅采用低分子肝素钙治疗。术后测定2组患者的患肢肿胀情况、凝血指标、血小板计数、切口引流量、血肿瘀斑及深静脉血栓发生情况。结果:①患肢肿胀情况。大腿周径:不同时间点周径不全相同(F=25.320,P=0.000); 2组间周径总体有差别(F=5.530,P=0.024),进一步比较显示术后第6天治疗组周径小于对照组(F=175.303,P=0.000); 治疗方法与时间因素之间存在交互作用(F=14.214,P=0.000)。小腿周径:不同时间点周径不全相同(F=67.520,P=0.000); 2组间周径总体有差别(F=5.348,P=0.026),进一步比较显示术后第2天、第6天、第10天治疗组周径小于对照组(F=13.960,P=0.001; F=42.183,P=0.000; F=7.678,P=0.009); 治疗方法与时间因素之间存在交互作用(F=22.428,P=0.000)。②凝血指标。2组患者术后第2天凝血酶原时间及活化部分凝血活酶时间比较,差异无统计学意义(t=1.480,P=0.147; t=0.821,P=0.417); 治疗组术后第14天与术后第2天凝血酶原时间及活化部分凝血活酶时间差值均大于对照组(t=2.117,P=0.041; t=2.104,P=0.042)。③血小板计数。不同时点血小板计数不全相同(F=67.155,P=0.000); 2组间血小板计数未见不同(F=0.716,P=0.403); 治疗方法与时间因素之间不存在交互效应(F=0.318,P=0.591)。④切口引流量。术后治疗组切口引流量小于对照组(t=1.520,P=0.137)。⑤血肿瘀斑发生情况。术后2组患者血肿、瘀斑发生情况比较,差异无统计学意义(P=0.244; χ2=2.667,P=0.102)。⑥深静脉血栓发生情况。治疗期间仅对照组2例发生深静脉血栓,2组患者深静脉血栓发生情况比较,差异无统计学意义(P=0.244)。结论:桃红四妙汤结合低分子肝素钙能明显延长凝血酶原时间及活化部分凝血活酶时间,明显减轻全膝关节置换术后患肢肿胀,减少术后出血,有效防治全膝关节置换术后深静脉血栓形成,并且具有较高的安全性。
Abstract:
Objective:To explore the clinical curative effect and safety of TAOHONG SIMIAO DECOCTION combined with low molecular weight heparin calcium(LMWHC)in the preventive treatment of deep vein thrombosis(DVT)after total knee arthroplasty(TKA).Methods:Forty patients met the requirements were randomly divided into treatment group and control group,20 cases in each group.Patients in the treatment group were administrated with TAOHONG SIMIAO DECOCTION combined with LMWHC,while the others in the control group were administrated with LMWHC only.The swelling situations of the affected limbs,coagulation indexes,platelet count,incision drainage,hematoncus ecchymosis and DVT occurrences of the patients in the 2 groups were measured after TKA.Results:①The swelling situations of the affected limbs:On the aspect of thigh circumference:not all of the circumferences were same at the different time points(F=25.320,P=0.000); there was difference in circumference between the 2 groups totally(F=5.530,P=0.024),the circumference of treatment group was less than that of control group at the 6th day after TKA through the further comparison(F=175.303,P=0.000); there was an interaction between treatment method and time factor(F=14.214,P=0.000).On the aspect of calf circumference:not all of the circumferences were same at the different time points(F=67.520,P=0.000); there was difference in circumference between the 2 groups totally(F=5.348,P=0.026),the circumference of treatment group was less than that of control group at the 2nd,6th,10th day after TKA through the further comparison(F=13.960,P=0.001; F=42.183,P=0.000; F=7.678,P=0.009); there was an interaction between treatment method and time factor(F=22.428,P=0.000).②Coagulation indexes:There was no statistical difference in prothrombin time(PT)and activated partial thromboplastin time(APTT)between the 2 groups at the 2nd day after TKA(t=1.480,P=0.147; t=0.821,P=0.417); The difference in PT and APTT between the 14th postoperative day value and the 2nd postoperative day value of the treatment group were all larger than those of the control group(t=2.117,P=0.041; t=2.104,P=0.042).③Platelet count:not all of the platelet counts were same at the different time points(F=67.155,P=0.000); there was no difference in platelet count between the 2 groups(F=0.716,P=0.403); there was not an interaction between treatment method and time factor(F=0.318,P=0.591).④Incision drainage of treatment group was less than that of the control group after TKA(t=1.520,P=0.137).⑤There was no statistical difference in incidence of hematoncus and ecchymosis between the 2 groups(P=0.244; χ2=2.667,P=0.102).⑥DVT occurrences:Only 2 cases with DVT were found in the control group during the treatment period; there was no statistical difference in incidence of DVT between the 2 groups(P=0.244).Conclusion:The therapy of TAOHONG SIMIAO DECOCTION combined with LMWHC of higher safety can effectively prevent DVT through obviously extension of PT and APTT,obviously relieving of the affected limb swelling situations after TKA and reduction of postoperative bleeding.

参考文献/References:

[1] Canale ST.坎贝尔骨科手术学[M].卢世壁,译.9版.济南:山东科学技术出版社,2000:266.
[2] 吕厚山,徐斌.人工关节置换术后下肢深静脉血栓形成[J].中华骨科杂志,1999,19(1):155-160.
[3] 池明宇.中西医结合血栓病学[M].北京:人民卫生出版社,2004:443-444.
[4] 刘北南.伤科术后汤改善骨科术后高凝状态及防治深静脉血栓形成的临床疗效研究[D].山东:山东中医药大学,2001.
[5] 路世勇,李光磊,李福东.人工膝关节置换术后深静脉血预防及治疗[J].中国矫形外科杂志,2008,16(7):553-554.
[6] 曲洪雪,刘云鹏.骨科深静脉血栓形成危险因素及发病机制的研究进展[J].中国矫形外科杂志,2009,17(2):110-112.
[7] 刘迅,童培建,章建华.活血通脉汤防治全膝关节置换术后深静脉血栓33例[J].浙江中医药大学学报,2006,30(5):495-496.
[8] 陈灵敏,周海星.骨折患者手术前凝血功能检测临床意义[J].治疗与检验医学,2009,27(1):86.
[9] 王月梅,吕占清,陆彩云.凝血常规检测在脑血管疾病抗血栓和溶血栓治疗中的应用及评价[J].吉林医学,2008,29(15):1268-1269.
[10] 莫霄云,钱海凌,李丽.活血化瘀利水中药复方对老龄大鼠自由基和血液流变学的影响[J].辽宁中医杂志,2004,31(5):436-437.

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备注/Memo

备注/Memo:
基金项目:广东省中医药局建设中医药强省科研资助基金(粤中医药局2009036)
更新日期/Last Update: 2012-01-20