本文關(guān)鍵詞： 黃芪桂枝五物湯 膝關(guān)節(jié)置換術(shù)后 D-二聚體 血流變學(xué)　出處：《安徽中醫(yī)藥大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過觀察黃芪桂枝五物湯對人工膝關(guān)節(jié)置換術(shù)后患者血流變學(xué)、D-二聚體的影響，探討黃芪桂枝五物湯對預(yù)防人工膝關(guān)節(jié)置換術(shù)后深靜脈血栓形成的臨床療效、安全性及其可能作用機制。 方法：依據(jù)病例選擇標(biāo)準(zhǔn)選取安徽省中醫(yī)院骨二科2012年9月至2014年1月通過人工全膝關(guān)節(jié)置換術(shù)治療膝關(guān)節(jié)骨關(guān)節(jié)炎的患者50例，患者術(shù)前做下肢血管多普勒彩色超聲檢查了解下肢靜脈瓣膜功能、通常情況，并行血流變學(xué)及D-二聚體檢查。手術(shù)均由同一組醫(yī)師進行，手術(shù)均在120min內(nèi)完成，采用硬膜外麻醉，膝正中切口入路，均使用止血帶止血，時間不超過90min。術(shù)后彈力繃帶包扎，抬高患肢，進行靜脈血栓知識宣教，鼓勵患者早期行患肢功能鍛煉。將患者隨機分為治療組和對照組，每組各25例，治療組術(shù)后第1天予每天兩次服用黃芪桂枝五物湯（黃芪30g、桂枝12g、白芍12g、生姜10g、大棗8g，，由安徽省中醫(yī)院藥劑室統(tǒng)一制備）250ml，連服7d，對照組則術(shù)后12h開始口服利伐沙班10mg，每日1次。兩組患者于術(shù)前2d及手術(shù)后第1、7d行血流變學(xué)及D-二聚體檢查，術(shù)后48h拔出引流管，并記錄引流量；術(shù)后第7d行下肢血管多普勒彩色超聲探測有無下肢深靜脈血栓的形成。對照組的處理方法同治療組組。對兩組患者的D-二聚體、血流變學(xué)檢查結(jié)果進行統(tǒng)計學(xué)分析。 結(jié)果：1.治療組與對照組術(shù)前隨機各因素(性別、年齡、假體類型、部位、血流變學(xué)、D-二聚體)無顯著差異(P0.05)；2.兩組患者術(shù)后第1d血流變學(xué)指標(biāo)（全血粘度、血漿粘度、紅細(xì)胞聚集指數(shù)、血沉、纖維蛋白原）及D-二聚體水平均較術(shù)前增高，有顯著性差異(P0.01或P0.05)，從而證實TKA術(shù)后患者處于高凝狀態(tài)的論斷，兩組術(shù)后1周血流變學(xué)各項指標(biāo)均低于術(shù)后1天；3.治療組術(shù)后1周，全血粘度、纖維蛋白原、血漿粘度及血沉均低于術(shù)前，有顯著性差異（P0.01）；紅細(xì)胞聚集指數(shù)較術(shù)前無明顯差異(P0.05)。對照組術(shù)后1周，血沉低于術(shù)前，有顯著性差異（P0.01）；全血粘度、紅細(xì)胞聚集指數(shù)較術(shù)前無明顯差異(P0.05)；血漿粘度及纖維蛋白原仍高于術(shù)前；4.治療組術(shù)后1周全血粘度、血漿粘度、纖維蛋白原、血沉與對照組術(shù)后1周比較，亦有顯著性差異（P0.01或P0.05），說明治療組優(yōu)于對照組；紅細(xì)胞聚集指數(shù)無統(tǒng)計學(xué)差異(P0.05)。5.治療組組與對照組術(shù)后在總引流量上，統(tǒng)計學(xué)無差異(P0.05)；6.兩組DVT發(fā)生率的比較無統(tǒng)計學(xué)差異。 結(jié)論：黃芪桂枝五物湯具有良好的DVT預(yù)防效果，可以明顯改善TKA術(shù)后血液高凝狀態(tài)，有效降低TKA術(shù)后DVT的發(fā)生率，且黃芪桂枝五物湯無明顯不良反應(yīng)，安全、有效、價格經(jīng)濟、服用方便，是值得臨床選用的中藥方劑。
[Abstract]:Objective: to observe the effect of Huangqi Guizhi Wuwu decoction on hemorheology and D-dimer in patients with artificial knee arthroplasty. To explore the clinical efficacy, safety and possible mechanism of Huangqi Guizhi Wuwu decoction in preventing deep vein thrombosis after artificial knee arthroplasty. Methods: according to the criteria of case selection, 50 cases of osteoarthritis were treated by total knee arthroplasty from September 2012 to January 2014. The lower extremity venous valve function was studied by color Doppler ultrasound before operation. The patients underwent hemorheology and D-dimer examination. The operation was performed by the same group of doctors. The operation was performed within 120 minutes, epidural anesthesia was used, the median knee incision was used, tourniquet hemostasis was used for no more than 90 minutes, and the elastic bandage was used to bandage and elevate the affected limb. The patients were randomly divided into treatment group and control group with 25 cases in each group. The treatment group was treated with Huangqi Guizhi Wuwu decoction twice a day on the first day after operation (Astragalus 30g, Guizhi 12g, Radix Paeoniae Alba 12g, ginger 10g, jujube 8g). 250 ml of livacapan was prepared by the pharmacy room of Anhui traditional Chinese Medicine Hospital for 7 days. In the control group, 10 mg of Levashaban was given orally at 12 hours after operation, once a day. The patients in the two groups were treated 2 days before operation and 1 day after operation. Hemorheology and D-dimer examination were performed at 7 days. The drainage tube was pulled out 48 hours after operation and the drainage flow was recorded. On the 7th day after operation, the lower extremity blood vessel Doppler color ultrasound was performed to detect the formation of deep vein thrombosis in the lower extremity. The treatment method of the control group was the same as that of the treatment group. The results of hemorheology were statistically analyzed. Results 1. There was no significant difference between the treatment group and the control group in all the factors (sex, age, type of prosthesis, location, hemorheology, D- dimer) before operation (P 0.05). 2. The levels of blood rheology (whole blood viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte sedimentation rate, fibrinogen) and D-dimer were increased in both groups on the 1st day after operation. There was significant difference (P0.01 or P0.05), which confirmed that the patients after TKA were in hypercoagulable state. The hemorheology indexes of the two groups were lower than that of the first day after operation. 3.The whole blood viscosity, fibrinogen, plasma viscosity and erythrocyte sedimentation rate in the treatment group were significantly lower than those before the operation (P 0.01). There was no significant difference in erythrocyte aggregation index between before and after operation (P 0.05). The erythrocyte sedimentation rate (ESR) in the control group was lower than that before operation (P 0.01). There was no significant difference in whole blood viscosity and erythrocyte aggregation index between before and after operation (P 0.05). Plasma viscosity and fibrinogen were still higher than those before operation. 4. The whole blood viscosity, plasma viscosity, fibrinogen and erythrocyte sedimentation rate in the treatment group were significantly different from those in the control group at 1 week after operation (P0.01 or P0.05), indicating that the treatment group was superior to the control group. There was no statistical difference in erythrocyte aggregation index between the treatment group and the control group in the total drainage volume after operation, there was no statistical difference between the treatment group and the control group in the total drainage volume (P 0.05). 6. There was no significant difference in the incidence of DVT between the two groups. Conclusion: Huangqi Guizhi Wuwu decoction has a good preventive effect on DVT, can obviously improve blood hypercoagulability after TKA, and effectively reduce the incidence of DVT after TKA. And Huangqi Guizhi Wuwu decoction has no obvious adverse reaction, is safe, effective, economical and convenient to take, it is worthy of clinical selection of traditional Chinese medicine prescription.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R274.9

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