摘要
目的探讨八珍汤口服减少全髋关节置换术(total hip arthroplasty,THA)后低分子肝素用量的有效性和安全性。方法分析2020年6月—2022年11月在河南省洛阳正骨医院(河南省骨科医院)、北京市和平里医院住院治疗的经临床确诊为符合单侧THA手术指征的67例患者的资料,32例给予低分子肝素钙皮下注射(对照组),35例给予1/2标准剂量低分子肝素钙皮下注射,并给予八珍汤口服(试验组)。比较2组患者的活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆凝血酶原时间(prothrombin time,PT)、血浆纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)、D-二聚体(D-dimer)、血小板(platelet,PLT)计数、血液黏度(plasma viscosity,PV)、全血高切黏度(whole blood high viscosity,WBHV)、血栓弹力图数值(thromboelastogram,TEG)[包括凝血反应时间(reaction rate,R)、凝血时间(kinetics time,K)、凝固角(alpha angle,α)、血栓弹力图最大振幅(maximum amplitude,MA)及实际最大振幅后30 min的振幅衰减率(lysis 30,LY30)]、术中出血量、输血量、术后引流量、患肢最大肿胀率、深静脉血栓形成(deep venous thrombosis,DVT)发生情况及不良反应发生情况。结果与术前相比,试验组能延长患者术后APTT、PT及TT,缩短FIB、D-dimer,降低PV、WBHV、R值、K值,升高α角、MA(P<0.05);术后14 d时,试验组延长APTT、PT、TT,降低PV,改善R值、K值、α角、MA的疗效均优于对照组(P<0.05)。PLT方面,两组组间、组内差异均无统计学意义(P>0.05)。术中出血量、输血量、术后引流量及DVT发生情况方面比较,两组组间差异无统计学意义(P>0.05)。患肢最大肿胀率方面,与对照组相比,试验组能减轻患肢最大肿胀率,差异具有统计学意义(P<0.05)。并发症方面,试验组发生腹泻1例,未出现患肢青紫瘀斑;对照组出现药物过敏1例,大腿青紫6例,两组的并发症发生率比较,差异具有统计学意义(P<0.05)。结论THA术后应用八珍汤口服可减少低分子肝素用量,疗效优于单纯低分子肝素,且能减少相关并发症的发生。
Objective To investigate the efficacy and safety of Bazhen Decoction(八珍汤)in reducing the dosage of low-molecular-weight-heparin(LMWH)after total hip arthroplasty(THA).Methods Sixty-seven patients who underwent unilateral THA in Luoyang orthopedic-traumatological hospital and Beijing Hepingli hospital from June 2020 to November 2022 were randomly divided into 2 groups.Thirty-two patients were given subcutaneous injection of LMWH(control group),thirty-five patients were given subcutaneous injection of 1/2 standard dose of LMWH,combined with Bazhen decoction orally(test group).activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT),D-dimer,platelet(PLT),plasma viscosity(PV),whole blood high viscosity(WBHV),thromboelastogram(TEG)[reaction rate(R),kinetics time(K),alpha angle(α),maximum amplitude(MA),lysis 30(LY30)],intraoperative blood loss,blood transfusion volume,postoperative drainage volume,maximum swelling rate of affected limh,occurrence of DvT and occurrence of adverse reactions were compared among the two groups of patients.Results Compared with preoperative,the test group could prolong APTT,PT,TT,αand MA,shorten FIB,D-dimer,PV,WBHV,R and K(P<0.05).Fourteen days after the operation,compared with the control group,the APTT,PT and TT of the test group were prolonged,the PV were decreased,the R,K,αand MA were changed(P<0.05).In terms of PLT,there were no significant differences between the two groups(P>0.05).There was no significant difference between the two groups in terms of intraoperative blood loss,blood transfusion volume,postoperative drainage volume and the occurrence of DVT(P>0.05).In terms of the maximum swelling rate of the affected limb,compared with the control group,the test group could reduce the maximum swelling rate of the affected limb,and the difference was statistically significant(P<0.05).One case of diarrhea occurred in test group,and there was no bruising and ecchymosis on the affected limh.One case of drug allergy and six cases of postoperative thigh bruising occurred in the control group.Comparing the incidence of complications among the two groups,the difference was statistically significant(P<0.05).Conclusion Oral administration of Bazhen Decoction after THA can reduce the dosage of LMWH,and the efficacy is better than simple low molecular weight heparin.The occurrence of related complications can be reduced.
作者
李文龙
刘威
丁娟
王博
王红超
孔亮
LI Wenlong;LIU Wei;DING Juan;WANG Bo;WANG Hongchao;KONG Liang(Beijing Hepingli Hospital,Beijing 100013,China;Luoyang OrthopedicTraumatological Hospital,Luoyang 471000,Henan,China)
出处
《辽宁中医药大学学报》
CAS
2023年第9期202-206,共5页
Journal of Liaoning University of Traditional Chinese Medicine
基金
洛阳市医疗卫生领域指导性科技计划项目(2040004A)。
关键词
关节成形术
髋
静脉血栓形成
术后并发症
八珍汤
arthroplasty
hip
venous thrombosis
postoperative complications
Bazhen Decoction(八珍汤)
