[1]张晓强,高菲菲,王战朝,等.膝伤活血灵口服配合低分子肝素钙皮下注射对全膝关节置换术后隐性失血的影响[J].中医正骨,2014,26(04):23-25.
　Zhang Xiaoqiang*,Gao Feifei,Wang Zhanchao,et al.Effect of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of low-molecular-weight heparin on hidden blood loss after total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(04):23-25.
点击复制

膝伤活血灵口服配合低分子肝素钙皮下注射对全膝关节置换 术后隐性失血的影响()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年04期
页码:
23-25
栏目:
临床研究
出版日期:
2014-04-30

文章信息/Info

Title:
Effect of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of low-molecular-weight heparin on hidden blood loss after total knee arthroplasty
作者:
张晓强; 高菲菲; 王战朝; 尚延春; 孟庆阳
河南省洛阳正骨医院,河南 洛阳 471002
Author(s):
Zhang Xiaoqiang*; Gao Feifei; Wang Zhanchao; Shang Yanchun; Meng Qingyang.*
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
静脉血栓形成 关节成形术; 置换; 膝 手术后并发症 出血 骨关节炎;  膝 中药疗法 肝素; 低分子量
Keywords:
Venous thrombosis;  Arthroplasty; replacement; knee;  Postoperative complications;  Hemorrhage;  Osteoarthritis; knee;  Drug therapy(TCD);  Heparin; low-molecular-weight
摘要:
目的:探讨膝伤活血灵口服配合低分子肝素钙皮下注射对全膝关节置换术后隐性失血的影响。方法:初次行单侧全膝关节置换术的膝骨关节炎患者117例,随机分为2组,观察组59例,术后应用膝伤活血灵口服配合低分子肝素钙皮下注射抗凝; 对照组58例,单纯应用低分子肝素钙抗凝。观察2组患者术后下肢深静脉血栓形成的发生情况及膝关节功能恢复情况,记录2组患者失血量并进行比较。结果:术后第8天,2组患者间显性失血量比较,差异无统计学意义[(447.89±138.67)mL,(456.00±132.03)mL; t=1.665,P=0.099]; 但观察组失血总量、隐性失血量均少于对照组,差异有统计学意义[(804.34±222.06)mL,(1 103.34±261.87)mL; t=4.665,P=0.033;(401.89±98.67)mL,(566.00±102.03)mL; t=4.871,P=0.026]。2组患者切口均甲级愈合; 均无下肢深静脉血栓形成。观察组术后血红蛋白含量低于80 g·L-14例,对照组术后血红蛋白含量低于80 g·L-119例,输入同型浓缩红细胞4个单位后,血红蛋白含量均恢复到正常参考值范围内; 2组患者术后输血例数比较,差异有统计学意义(χ2=12.498,P=0.000)。2组患者均获随访,随访时间6～11个月,中位数8个月; 膝关节功能均恢复。结论:应用膝伤活血灵口服配合低分子肝素钙皮下注射预防全膝关节置换术后下肢深静脉血栓形成,疗效满意; 且与单纯应用低分子肝素钙相比,可减少患者术后隐性失血。
Abstract:
Objective:To explore the effect of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of low-molecular-weight heparin(LMWH)on hidden blood loss after total knee arthroplasty(TKA).Methods:One hundred and seventeen patients with knee osteoarthritis were treated with unilateral TKA for the first time and then they were randomly divided into 2 groups,59 cases in observation group,while 58 cases in control group.Patients in the observation group were treated with oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of LMWH for anticoagulation after TKA,while the others in the control group were treated with monotherapy of subcutaneous injection of LMWH for anticoagulation.Then the postoperative deep venous thrombosis(DVT)in lower limbs and knee function restoration were observed,and the blood loss volume were recorded and compared between the 2 groups.Results:There was no statistical differences in the dominant blood loss volume between the 2 groups on the 8th day after TKA(447.89+/-138.67 vs 456.00+/-132.03 mL; t=1.665,P=0.099); while the total blood loss volume and hidden blood loss volume in the observation group were less than those of control group respectively(804.34+/-222.06 vs 1 103.34+/-261.87 mL; t=4.665,P=0.033; 401.89+/-98.67 vs 566.00+/-102.03 mL; t=4.871,P=0.026).All of the patients in the 2 groups got primary healing in the operative incisions and no DVT were found.The postoperative hemoglobin content were lower than 80 g/L in 4 patients(observation group)and 19 patients(control group)and were restored to normal range after the patients received 4 units concentrated red blood cells(CRBC)with same blood-type.There was statistical differences in the number of blood transfusion cases after TKA between the 2 groups(χ2=12.498,P=0.000).All patients in the 2 groups were followed up for 6-11 months with a median of 8 months,and the knee function were restored in all patients.Conclusion:The therapy of oral application of XISHANGHUOXUELING decoction combined with subcutaneous injection of LMWH has satisfactory preventative effects on DVT in lower limbs after TKA,and it is better than the monotherapy of subcutaneous injection of LMWH in reducing the postoperative hidden blood loss.

参考文献/References:

[1] 中华医学会外科学分会血管外科学组.静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科杂志,2012,50(7):611-614.
[2] 高乐才,吴文元,魏金栋,等.术后抗凝对膝关节置换术后隐性出血影响的临床观察[J].河北医药,2013,35(6):880-882.
[3] 罗涛,黄伟杰,吴伟,等.肥胖对半髋关节置换术围手术期失血的影响[J].中国矫形外科杂志,2011,19(17):1419-1422.
[4] Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
[5] Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
[6] 邱贵兴,杨庆铭,余楠生,等.低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究[J].中华骨科杂志,2006,26(12):819-822.
[7] 李禄,孙波,刘世珑.全髋关节置换及全膝关节置换术后隐性失血的研究进展[J].中医正骨,2012,24(1):40-42.
[8] 沈素红.活血灵预防骨科术后下肢深静脉血栓形成的临床研究[D].长沙:湖南中医药大学,2012.
[9] 沈素红,郭艳幸,席占国,等.洛阳正骨传统方药活血灵预防骨科术后下肢深静脉血栓形成的临床研究[J].中国中医骨伤科杂志,2011,19(3):21-22.
[10] 丁雯,钱大伟,段金廒,等.当归赤芍药对中阿魏酸和没食子酸在大鼠血浆和尿液中的代谢物研究[J].药学学报,2012,37(3):366-371.
[11] 刘超,王静,杨军.赤芍总甙活血化瘀作用的研究[J].中药材,2000,23(9):557-560.
[12] 王珍.羌活的质量评价及药效学研究[D].北京:北京中医药大学,2012.
[13] 曹飞,童平,高书荣.川牛膝治疗高血压病研究进展[J].现代中西医结合杂志,2012,21(25):2849-2850.
[14] 范莉,濮润,赵海誉,等.红花抗ADP诱导的血小板聚集活性研究[J].中国中药杂志,2011,36(9):1242-1244.
[15] McManus KT,Velchik MG,Alavi A,et al.Non-invasive assessment of postoperative bleeding in TKA patients with Tc-99m RNCs[J].J Nuclear Med,1987,28:565-567.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]李翰林,童培建.利福平联合用药配合保留假体清创治疗 人工关节置换术后早期感染及低毒性感染[J].中医正骨,2015,27(09):56.
[3]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[4]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):11.
[5]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[6]张维平,康两期,陈卫,等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨,2015,27(08):61.
[7]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[8]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[9]徐伟锋,叶健,吴连国.强骨饮对骨质疏松性股骨颈骨折患者全髋关节置换术后 血清骨代谢生化指标和骨密度的影响[J].中医正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(强骨饮,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):12.
[10]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[11]许 敏.老年糖尿病患者人工全膝关节置换术后深静脉血栓形成的预防[J].中医正骨,2013,25(06):72.
[12]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.
　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(04):27.

更新日期/Last Update: 1900-01-01