發(fā)布時間：2018-04-23 08:57

  本文選題：益氣活血通絡(luò)湯 + 股骨轉(zhuǎn)子間骨折　； 參考：《湖南中醫(yī)藥大學》2015年碩士論文

【摘要】：目的：觀察自擬益氣活血通絡(luò)湯聯(lián)合低分子肝素鈣減少老年股骨轉(zhuǎn)子間骨折術(shù)后下肢深靜脈血栓形成(DVT)的臨床療效,減輕術(shù)后并發(fā)癥,分析益氣活血通絡(luò)湯聯(lián)合低分子肝素鈣的臨床安全性,為臨床中進一步推廣提供理論依據(jù)。 方法：將納入研究的80例老年股骨轉(zhuǎn)子間骨折患者采用隨機分組方法,分為對照組和治療組。對照組：于術(shù)后12-24小時皮下給予常規(guī)劑量(4100u)低分子肝素鈣；皮下注射。每日一次,術(shù)后第1天至第14天。試驗組：益氣活血通絡(luò)湯煎服,一日2次,一次200m1。于術(shù)后第一天到第十四天服用；低分子肝素鈣于術(shù)后12-24小時給予常規(guī)劑量(4100u)皮下注射。每日一次,術(shù)后第1天至第14天。兩組患者入院時行常規(guī)檢查,所有患者圍手術(shù)期采用統(tǒng)一的治療措施。統(tǒng)計術(shù)后引流量,凝血五項及雙下肢動靜脈彩超檢查等,觀察是否有DVT發(fā)生。所得數(shù)據(jù)均采用SPSS19.0統(tǒng)計軟件進行分析。 結(jié)果：試驗組在術(shù)后患肢疼痛、腫脹和瘀斑面積方面優(yōu)于對照組,差異有統(tǒng)計學意義；試驗組的術(shù)后引流量少于對照組,差異有統(tǒng)計學意義；試驗組在凝血五項方面優(yōu)于對照組,差異有統(tǒng)計學意義。根據(jù)下肢深靜脈形成的診斷標準,術(shù)后兩組共出現(xiàn)9例DVT患者,發(fā)生率為23.4%,血栓均發(fā)生在患側(cè)肢體。其中對照組7例,發(fā)生率為18.4%,試驗組2例,發(fā)生率為5%。經(jīng)統(tǒng)計學分析,試驗組在血栓發(fā)生率方面優(yōu)于對照組,差異有統(tǒng)計學意義。所有病例中未出現(xiàn)肺栓塞(PTE)及死亡病例。所有患者入院時與術(shù)后肝腎功能等檢查結(jié)果經(jīng)統(tǒng)計學分析,無明顯差異,所有患者無不良反應(yīng)發(fā)生。 結(jié)論：自擬益氣活血通絡(luò)湯聯(lián)合低分子肝素鈣能明顯降低下肢深靜脈血栓的發(fā)生率,具有明顯的抗凝作用.效果優(yōu)于單純應(yīng)用低分子肝素鈣；益氣活血通絡(luò)湯聯(lián)合低分子肝素鈣能減少患肢疼痛、腫脹和瘀斑面積和術(shù)后引流量,減輕了術(shù)后一系列并發(fā)癥；兩組患者均未發(fā)生全身和局部的不良發(fā)應(yīng),益氣活血通絡(luò)湯聯(lián)合低分子肝素是較為安全的臨床藥物。
[Abstract]:Objective: to observe the clinical effect of self-made decoction of supplementing qi and activating blood circulation and Tongluo decoction combined with low molecular weight heparin calcium in reducing DVT of lower extremity deep vein thrombosis after operation of intertrochanteric fracture of femur in elderly patients, and to reduce postoperative complications. The clinical safety of Yiqi Huoxue Tongluo decoction combined with low molecular weight heparin calcium was analyzed. Methods: 80 elderly patients with intertrochanteric fracture of femur were randomly divided into control group and treatment group. Control group: 12-24 hours after operation subcutaneous administration of conventional dose of 4 100 u) low molecular weight heparin calcium; subcutaneous injection. Once a day, 1 to 14 days after operation. Test group: Yiqi Huoxue Tongluo decoction decoction, 2 times a day, 200 ml. Low molecular weight heparin calcium was injected subcutaneously from the first day to the fourteenth day after operation. Once a day, 1 to 14 days after operation. Routine examination was performed on admission in both groups, and all patients were treated with uniform treatment during perioperative period. Postoperative drainage, coagulation and lower extremity arteriovenous ultrasonography were analyzed to determine whether DVT occurred. The data were analyzed by SPSS19.0 software. Results: the experimental group was superior to the control group in the area of pain, swelling and ecchymosis of the affected limbs after operation, the difference was statistically significant, and the postoperative drainage volume in the test group was less than that in the control group, and the difference was statistically significant. The test group was superior to the control group in five aspects of coagulation, the difference was statistically significant. According to the diagnostic criteria of deep vein formation in the lower extremity, 9 cases of DVT were found in the two groups after operation, the incidence rate was 23.4%, and the thrombus occurred in the affected limbs. There were 7 cases in the control group (18. 4%) and 2 cases in the experimental group (5 cases). By statistical analysis, the experimental group was superior to the control group in the incidence of thrombus, the difference was statistically significant. There were no PTEs and death in all cases. There was no significant difference in the results of liver and kidney function between the patients after admission and after operation, and no adverse reactions occurred in all patients. Conclusion: combined with low molecular weight heparin calcium can obviously reduce the incidence of deep vein thrombosis of lower extremity and has obvious anticoagulant effect. The effect was better than that of using low molecular weight heparin calcium alone, Yiqi Huoxue Tongluo decoction combined with low molecular weight heparin calcium could reduce the pain, swelling, ecchymosis area and drainage flow of the affected limbs, and lighten a series of complications after operation. There was no systemic or local adverse reaction in both groups. Yiqi Huoxue Tongluo decoction combined with low molecular weight heparin was a safe clinical drug.
【學位授予單位】：湖南中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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