摘要
目的观察补肾活血方联合低分子肝素等防治老年髋部骨折术后患者下肢深静脉血栓(LDVT)的临床疗效。方法将220例老年髋部骨折术后患者随机分为治疗组与对照组,每组110例。对照组术后予低分子肝素皮下注射联合弹力绷带及功能练习,治疗组在对照组治疗措施基础上加服补肾活血方中药。两组疗程均为14 d,观察试验期间患者LDVT及其并发症的发生情况,比较血浆凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、D-二聚体(D-D)水平以及患肢疼痛视觉模拟评分(VAS)、肢体肿胀消退程度(大腿、小腿周径差值)指标的变化情况。结果(1)最终完成试验者210例,治疗组105例,对照组105例。(2)试验期间,治疗组3例发生LDVT(2.86%),对照组11例发生LDVT(10.48%);组间LDVT发生率比较,治疗组明显低于对照组(P<0.05)。(3)治疗前后组内比较,两组PT、APTT水平均明显升高,D-D水平均明显降低;组间治疗后比较,治疗组对PT、APTT、D-D水平的改善明显优于对照组(P<0.05)。(4)组内治疗前后比较,两组患肢VAS评分均明显降低(P<0.05);组间治疗后比较,治疗组患肢VAS评分明显低于对照组(P<0.05)。(5)组间治疗7 d、治疗14 d比较,治疗组大腿、小腿周径差值均明显大于对照组(P<0.05)。结论补肾活血方联合低分子肝素等较单独应用低分子肝素等,可更加显著改善老年髋部骨折术后患者血液的高凝状态,降低LDVT的发生率,还能改善其下肢疼痛与肿胀。
Objective To explore the effect of Bushen Huoxue Formula combined with low molecular weight heparin(LMWH)and other measures in the prevention and treatment of lower extremity deep venous thrombosis(LDVT)after the hip fracture surgery in the elderly.Methods Two hundred and twenty elderly patients with postoperative hip fracture were randomly divided into treatment group(n=110)and control group(n=110).The control group was administered with subcutaneous injection of LMWH combined with elastic bandage and functional exercises after surgery,while the treatment group was administered with Bushen Huoxue Formula in addition to the treatment measures of the control group.Both groups were treated for 14 days.During the trial,we observed the incidence of LDVT and its complications,and compared the changes of plasma prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D)levels,as well as the pain visual analogue scale(VAS)score in the affected extremities and the degree of swelling reduction of the lower extremities(differences in circumference of thigh and calf).Results①Finally 210 cases completed the trial,105 cases in the treatment group and 105 cases in the control group.②During the trial,there were 3 cases of LDVT in the treatment group(2.86%)and 11 cases in the control group(10.48%);the incidence of LDVT in the treatment group was significantly lower than that in the control group(P<0.05)③The PT and APTT were significantly longer and D-D levels were significantly lower after treatment in both groups;the improvement of PT,APTT and D-D levels in the treatment group was significantly better than that in the control group(P<0.05).④The VAS scores of the affected extremities were significantly lower after treatment in both groups(P<0.05);after treatment the VAS scores of the affected extremities in the treatment group were significantly lower than those in the control group(P<0.05).⑤According to the intergroup comparison after 7 days and 14 days of treatment,the differences in circumference of the thigh and calf in the treatment group were significantly greater than those in the control group(P<0.05).Conclusion In the elderly patients,the combined use of Bushen Huoxue Formula with LMWH and other measures can improve the hypercoagulable state of blood and reduce the incidence of LDVT more significantly than the single use of LMWH and other measures,and it can also improve their lower limb pain and swelling.
作者
张玉婷
詹红生
俞仲翔
ZHANG Yuting;ZHAN Hongsheng;YU Zhongxiang(Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200333,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《上海中医药杂志》
2021年第12期61-64,73,共5页
Shanghai Journal of Traditional Chinese Medicine
基金
国家自然科学基金项目(81973871,81804114)
教育部科学技术研究重点项目(212052)
上海市重中之重临床重点学科建设项目(2017ZZ02024)
上海市申康医院发展中心临床三年行动计划项目(SHDC2020CR1051B)
上海市卫计委詹红生上海市名老中医学术经验研究工作室建设项目(SHGS-2017025)
上海中医药大学预算内科研项目(18LK038)。
关键词
髋部骨折
老年
下肢深静脉血栓
补肾活血方
低分子肝素
中西医结合
hip fracture
elderly
lower extremity deep veinous thrombosis
Bushen Huoxue Formula
low molecular weight heparin
integrated traditional Chinese and western medicine
