摘要
目的探索基于益气活血法使用桃红四物汤加减方在初次全膝关节置换(TKA)术后下肢深静脉血栓(DVT)预防的临床应用效果。方法选取2023年6月至2024年11月于贵阳市第四人民医院行TKA术的80例患者(气虚血瘀证)作为观察对象,通过随机数表法分为观察组和对照组各40例。对照组予以常规抗凝药物进行治疗,观察组则在对照组基础上联用桃红四物汤加减方予以治疗。比较两组患者的术后短期恢复情况(术后首次下地活动时间、住院天数、术后出血事件发生率)、术后1个月时的DVT的发生率、术后1 d及7 d的凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)];比较两组患者的术后1 d及术后两周时的中医证候积分、血流动力学相关指标[下肢静脉血流速度(收缩期峰值流速、平均流速、舒张期末流速)]、膝关节功能[膝损伤及骨关节炎结局评分(KOOS)、关节活动度(ROM)]。记录两组患者在治疗期间的不良反应发生率。结果观察组患者的术后首次下地活动时间、住院天数、DVT阳性发生率分别为(26.83±3.72)h、(7.92±1.05)d、5.00%,均明显低于对照组的(30.17±4.16)h、(8.65±1.27)d、20.00%,差异有统计学意义(P<0.05);术后7 d时,观察组患者的PT、APTT、FIB、D-D水平分别为(13.12±0.98)s、(33.17±2.94)s、(3.52±0.58)g/L、(1.37±0.29)mg/L,均明显低于同期对照组的(13.95±1.16)s、(36.83±3.27)s、(4.27±0.63)g/L、(2.15±0.47)mg/L,差异有统计学意义(P<0.05);术后两周时,观察组患者的中医证候积分低于同期对照组[神疲乏力:(1.18±0.21)分vs(1.93±0.28)分,痛处固定不移:(1.35±0.23)分vs(2.08±0.29)分,气短懒言:(1.07±0.25)分vs(1.82±0.31)分,舌质紫暗:(1.46±0.20)分vs(2.28±0.21)分],观察组患者的静脉舒张期末流速、静脉平均流速、静脉舒张期末流速、KOOS评分、ROM分别为(17.62±2.35)cm/s、(10.37±1.42)cm/s、(4.58±0.82)cm/s、(68.92±6.27)分、(101.38±8.27)°,均显著高于同期对照组的(13.95±1.86)cm/s、(8.16±1.17)cm/s、(3.27±0.71)cm/s、(59.73±7.16)分、(96.27±9.63)°,差异均有统计学意义(P<0.05);两组患者的不良反应发生率差异无统计学意义(P>0.05)。结论基于益气活血法使用桃红四物汤加减方在初次TKA术后DVT预防的效果理想,患者气虚血瘀症状及凝血功能得到改善,膝关节的功能得到更好的恢复。
Objective To explore the clinical application effect of using a modified Taohong Siwu Decoction based on the method of reinforcing Qi and activating blood circulation in preventing deep vein thrombosis(DVT)after primary total knee arthroplasty(TKA).Methods Eighty patients(with Qi deficiency and blood stasis syndrome)who underwent TKA at the Fourth People's Hospital of Guiyang from June 2023 to November 2024 were selected as observation subjects.They were randomly divided into an observation group and a control group,with 40 patients in each group.Patients in the control group received conventional anticoagulant therapy,while those in the observation group received the conventional therapy combined with the modified Taohong Siwu Decoction.The short-term postoperative recovery(time to first ambulation,length of hospital stay,incidence of postoperative bleeding events),DVT incidence rate at 1 month postoperatively,coagulation function(prothrombin time[PT]),activated partial thromboplastin time[APTT],nese Medicine(TCM)syndrome scores,hemodynamic-related indicators(lower extremity venous blood flow velocity[peak systolic velocity,mean velocity,end-diastolic velocity]),and knee joint function(Knee injury and Osteoarthritis Outcome Score[KOOS],range of motion[ROM])on postoperative day 1 and at 2 weeks postoperatively were also compared.The incidence of adverse reactions during the treatment period was recorded for both groups.Results The time to first ambulation,length of hospital stay,and DVT positive rate in the observation group were(26.83±3.72)h,(7.92±1.05)days,and 5.00%,respectively,which were significantly lower than(30.17±4.16)h,(8.65±1.27)days,and 20.00%in the control group(P<0.05).On postoperative day 7,the levels of PT,APTT,FIB,and D-D in the observation group were(13.12±0.98)s,(33.17±2.94)s,(3.52±0.58)g/L,and(1.37±0.29)mg/L,respectively,significantly lower than(13.95±1.16)s,(36.83±3.27)s,(4.27±0.63)g/L,(2.15±0.47)mg/L in the control group at the same time point(P<0.05).At 2 weeks postoperatively,the TCM syndrome scores in the observation group were lower than those in the control group:fatigue and lack of strength,(1.18±0.21)vs(1.93±0.28);fixed pain location,(1.35±0.23)vs(2.08±0.29);shortness of breath and reluctance to spea,(1.07±0.25)vs(1.82±0.31);dark purple tongue,(1.46±0.20)vs(2.28±0.21).The venous end-diastolic velocity,mean venous velocity,venous end-diastolic velocity,KOOS score,and ROM in the observation group were(17.62±2.35)cm/s,(10.37±1.42)cm/s,(4.58±0.82)cm/s,(68.92±6.27)points,and(101.38±8.27)°,respectively,significantly higher than(13.95±1.86)cm/s,(8.16±1.17)cm/s,(3.27±0.71)cm/s,(59.73±7.16)points,(96.27±9.63)°in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The use of the modified Taohong Siwu Decoction based on the method of reinforcing Qi and activating blood circulation shows ideal effectiveness in preventing DVT after primary TKA.It improves the symptoms of Qi deficiency and blood stasis and coagulation function,and leads to better recovery of knee joint function.
作者
刘桓奇
罗冰寒
晋家辉
付永权
陈涛
戴科晶
LIU Huan-qi;LUO Bing-han;JIN Jia-hui;FU Yong-quan;CHEN Tao;DAI Ke-jing(Guizhou University of Traditional Chinese Medicine,Guiyang 550000,Guizhou,CHINA;Department of Orthopedics and Joint Surgery,the Fourth People's Hospital of Guiyang,Guiyang 550002,Guizhou,CHINA)
出处
《海南医学》
2025年第24期3529-3534,共6页
Hainan Medical Journal
基金
2025年度贵州省卫生健康委科学技术基金项目(编号:g2wkj2025-348)。
关键词
全膝关节置换术
下肢深静脉血栓
桃红四物汤加减方
益气活血法
气虚血瘀证
Total knee arthroplasty
Lower extremity deep venous thrombosis
Modified Taohong Siwu decoction
Method of reinforcing Qi and activating blood circulation
Qi deficiency and blood stasis symptom
