[1]周晓聪,丁玉梅,周前,等.补阳还五汤加减联合利伐沙班预防老年髋关节置换术后深静脉血栓形成的疗效观察及作用机制研究[J].中医正骨,2020,32(10):35-41.
　ZHOU Xiaocong,DING Yumei,ZHOU Qian,et al.A clinical study on the curative effects and mechanism of action of oral applications of Buyang Huanwu Tang Jiajian(补阳还五汤加减)and Rivaroxaban for preventing deep venous thrombosis after the surgery of hip replacement in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):35-41.
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补阳还五汤加减联合利伐沙班预防老年髋关节置换术后深静脉血栓形成的疗效观察及作用机制研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年10期
页码:
35-41
栏目:
临床研究
出版日期:
2020-10-20

文章信息/Info

Title:
A clinical study on the curative effects and mechanism of action of oral applications of Buyang Huanwu Tang Jiajian(补阳还五汤加减)and Rivaroxaban for preventing deep venous thrombosis after the surgery of hip replacement in the aged
作者:
周晓聪; 丁玉梅; 周前; 刘武
(台州市博爱医院,浙江 台州 318050)
Author(s):
ZHOU Xiaocong; DING Yumei; ZHOU Qian; LIU Wu
Taizhou Bo’ai Hospital,Taizhou 318050,Zhejiang,China
关键词:
静脉血栓形成;  关节成形术; 置换; 髋;  补阳还五汤;  凝血酶原时间;  部分促凝血酶原时间;  凝血酶时间;  纤维蛋白原;  D-二聚体;  一氧化氮合酶;  一氧化氮;  老年人;  临床试验
Keywords:
venous thrombosis;  arthroplasty; replacement; hip;  Buyang Huanwu Tang;  prothrombin time;  partial thromboplastin time;  thrombin time;  fibrinogen;  D-dimer;  nitric oxide synthase;  nitric oxide;  aged;  clinical trial
摘要:
目的:观察补阳还五汤加减联合利伐沙班预防老年髋关节置换术后深静脉血栓形成(deep venous thrombosis,DVT)的临床疗效,并探讨其作用机制。方法:将128例接受髋关节置换术的老年患者随机分为2组,每组64例。单纯利伐沙班组于术后6 h开始口服利伐沙班片,每日1次,每次10 mg,共4周; 补阳还五汤加减联合利伐沙班组在单纯利伐沙班组治疗方案的基础上于术后第2天开始口服补阳还五汤加减,每日3次,共1周。分别于术前、术后4周测量并比较2组患者髌骨上15 cm处大腿周径与踝关节上方15 cm处小腿周径,记录并比较2组患者术后下肢DVT的发生率,分别于术前、术后3 d测定并比较2组患者凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及纤维蛋白原(fibrinogen,FIB)、D-二聚体的血清含量,分别于术前、术后7 d测量并比较2组患者内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)、一氧化氮(nitric oxide,NO)的血清含量。结果:①下肢周径。术前2组患者大腿周径、小腿周径比较,组间差异均无统计学意义[(40.91±3.75)cm,(40.70±3.62)cm,t=0.322,P=0.748;(27.90±2.64)cm,(28.58±2.71)cm,t=1.438,P=0.153]; 术后4周,补阳还五汤加减联合利伐沙班组患者大腿周径、小腿周径均小于利伐沙班组[大腿周径:(42.90±2.13)cm,(44.83±2.92)cm,t=4.272,P=0.011; 小腿周径:(30.02±1.81)cm,(32.19±2.44)cm,t=5.714,P=0.010],2组患者大腿周径、小腿周径均大于术前(大腿周径:t=3.002,P=0.003; t=7.070,P=0.000; 小腿周径:t=5.299,P=0.000; t=7.920,P=0.000)。②DVT发生率。利伐沙班组7例发生DVT,补阳还五汤加减联合利伐沙班组无DVT发生; 补阳还五汤加减联合利伐沙班组DVT发生率低于利伐沙班组(χ2=5.440,P=0.020)。③凝血功能指标。术前2组患者PT、APTT、TT及FIB、D-二聚体血清含量比较,组间差异均无统计学意义[PT:(11.29±1.43)s,(11.27±1.50)s,t=0.077,P=0.939; APTT:(32.06±5.02)s,(32.09±4.85)s,t=0.034,P=0.973; TT:(16.06±1.03)s,(16.10±1.06)s,t=0.217,P=0.829; FIB:(3.82±0.53)μg·L-1,(3.91±0.64)μg·L-1,t=0.866,P=0.388; D-二聚体:(164.52±35.90)μg·L-1,(163.31±37.54)μg·L-1,t=0.185,P=0.854]; 术后3 d补阳还五汤加减联合利伐沙班组PT、APTT、TT均长于利伐沙班组[PT:(14.13±1.28)s,(12.27±1.39)s,t=7.875,P=0.009; APTT:(41.15±5.36)s,(36.51±5.24)s,t=4.952,P=0.010; TT:(18.01±0.84)s,(16.97±0.73)s,t=7.476,P=0.008],FIB、D-二聚体血清含量均低于利伐沙班组[FIB:(3.06±0.72)μg·L-1,(3.42±0.39)μg·L-1,t=3.517,P=0.001; D-二聚体:(1 249.46±136.81)μg·L-1,(1 623.62±154.14)μg·L-1,t=14.525,P=0.000]; 2组患者PT、APTT、TT均长于术前(PT:t=11.838,P=0.000; t=3.912,P=0.000; APTT:t=9.902,P=0.000; t=4.952,P=0.000; TT:t=11.737,P=0.000; t=5.408,P=0.000),FIB血清含量均低于术前(t=6.801,P=0.000; t=5.230,P=0.000),D-二聚体血清含量均高于术前(t=61.365,P=0.000; t=73.639,P=0.000)。④eNOS和NO血清含量。术前2组患者eNOS和NO血清含量比较,组间差异均无统计学意义[eNOS:(20.03±2.35)μmol·L-1,(20.16±2.17)μmol·L-1,t=0.325,P=0.746; NO:(62.75±4.80)×103 μmol·L-1,(63.04±4.15)×103 μmol·L-1,t=0.366,P=0.715]; 术后7 d补阳还五汤加减联合利伐沙班组患者eNOS和NO血清含量均高于利伐沙班组[eNOS:(29.58±2.49)μmol·L-1,(26.48±2.62)μmol·L-1,t=6.861,P=0.008; NO:(86.53±4.96)×103 μmol·L-1,(79.39±5.20)×103 μmol·L-1,t=7.949,P=0.006],2组患者eNOS和NO血清含量均高于术前(eNOS:t=22.314,P=0.000; t=14.862,P=0.000; NO:t=27.562,P=0.000; t=19.660,P=0.000)。结论:对行髋关节置换术的老年患者,术后给予补阳还五汤加减联合利伐沙班治疗,与单纯利伐沙班治疗相比,能减轻下肢肿胀,降低DVT的发生率; 其作用机制可能是通过上调eNOS和NO的表达,使凝血功能得以改善,从而预防DVT的形成。
Abstract:
To observe the clinical curative effects of oral applications of Buyang Huanwu Tang Jiajian(补阳还五汤加减,BYHWTJJ)and Rivaroxaban for preventing deep venous thrombosis(DVT)after the surgery of hip replacement in the aged and to explore its mechanism of action.Methods:One hundred and twenty-eight aged patients who received surgery of hip replacement were randomly divided into combination therapy group and monotherapy group,64 cases in each group.All patients in the 2 groups were treated with oral application of Rivaroxaban since the postoperative hour 6,once a day,10 mg at a time for consecutive 4 weeks.Moreover,the patients in combination therapy group were treated with oral application of BYHWTJJ since the postoperative day 2,three times a day for 1 week.The perimeters of thigh(at 15 cm above the patella)and calf(at 15 cm above the ankle)were measured and compared between the 2 groups before the surgery and at 4 weeks after the surgery respectively.The incidence rate of postoperative DVT were recorded and compared between the 2 groups.The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and the serum contents of fibrinogen(FIB)and D-dimer were measured and compared between the 2 groups before the surgery and at 3 days after the surgery respectively.The serum contents of endothelial nitric oxide synthase(eNOS)and nitric oxide(NO)were measured and compared between the 2 groups before the surgery and at 7 days after the surgery respectively.Results:There were no statistical difference in the perimeters of thigh and calf between the 2 groups before the surgery(40.91+/-3.75 vs 40.70+/-3.62 cm,t=0.322,P=0.748; 27.90+/-2.64 vs 28.58+/-2.71 cm,t=1.438,P=0.153).The perimeters of thigh and calf were smaller in combination therapy group compared to monotherapy group at 4 weeks after the surgery(perimeter of thigh:42.90+/-2.13 vs 44.83+/-2.92 cm,t=4.272,P=0.011; perimeter of calf:30.02+/-1.81 vs 32.19+/-2.44 cm,t=5.714,P=0.010),and were greater at 4 weeks after the surgery compared to pre-surgery in the 2 groups(perimeter of thigh:t=3.002,P=0.003; t=7.070,P=0.000; perimeter of calf:t=5.299,P=0.000; t=7.920,P=0.000).The DVT was found in 7 patients in monotherapy group and no DVT was found in combination therapy group.The incidence rate of postoperative DVT was lower in combination therapy group compared to monotherapy group(χ2=5.440,P=0.020).等

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更新日期/Last Update: 2020-10-20