【摘要】：目的：通過觀察新癀片聯(lián)合低分子肝素鈉預(yù)防髖部周圍骨折后深靜脈血栓形成的臨床療效,為中醫(yī)藥預(yù)防下肢深靜脈血栓臨床研究積累經(jīng)驗。方法：自2013年12月至2014年12月175醫(yī)院骨科醫(yī)院選擇符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的病例74例,按照入院時間的先后順序隨機(jī)數(shù)字法分為治療組(n=37)和對照組(n=37)。對照組予低分子肝素鈉注射,100 IU/kg,皮下注射,每日一次；治療組在對照組基礎(chǔ)上予口服新癀片(0.64g/次,2次／天)。記SPSS錄術(shù)中出血量、術(shù)后總引流量；分別于入院當(dāng)天及術(shù)后第3、7、12天抽血行凝血功能、D-二聚體及血小板測定,術(shù)前術(shù)后下肢深靜脈彩超檢查。并測量兩組患者患肢周徑、疼痛緩解情況,并記錄數(shù)據(jù)。所得數(shù)據(jù)用17.0統(tǒng)計學(xué)軟件進(jìn)行分析,設(shè)定P0.05具有統(tǒng)計學(xué)意義。結(jié)果：1、本研究中治療組有3例患者出現(xiàn)血栓,在入院當(dāng)天、術(shù)后第3天分別發(fā)現(xiàn)1例、2例,出現(xiàn)在股靜脈1例,胭靜脈2例,對照組有11例,在入院當(dāng)天、術(shù)后第3、7天分別發(fā)現(xiàn)3例、4例、4例,出現(xiàn)在股靜脈6例,胭靜脈5例,血栓發(fā)生率分別為8.11%、29.73%,兩組血栓發(fā)生率差異有統(tǒng)計學(xué)意義(P0.05)。2、兩組患者入院當(dāng)天的PT、APTT、FIB.D-二聚體含量差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后第3、7、12天差異有統(tǒng)計學(xué)意義(P0.05)。兩組患者INR值差異無統(tǒng)計學(xué)意義(P0.05)。3、兩組患者入院當(dāng)天及術(shù)后12天血小板計數(shù)差異無統(tǒng)計學(xué)意義(P0.05)；術(shù)后第3、7天兩組患者的血小板計數(shù)差異有統(tǒng)計學(xué)意義(P0.05)。4、兩組患者術(shù)中出血量及術(shù)后48小時引流量比較差異無統(tǒng)計學(xué)意義(P0.05)。5、術(shù)后3、7、12天,兩組患者的大腿周徑差及疼痛VAS評分比較差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論：新癀片聯(lián)合低分子肝素鈉能緩解局部腫脹和疼痛,改善血液高凝狀態(tài)、改善血液纖溶活性,對髖部周圍骨折術(shù)后深靜脈血栓形成有良好的預(yù)防效果,其療效優(yōu)于低分子肝素鈉組。在術(shù)前開始應(yīng)用新癀片預(yù)防血栓,并未增加出血的風(fēng)險,體現(xiàn)用藥的安全性,表明可以在髖部周圍骨折后即開始早期應(yīng)用中藥預(yù)防深靜脈血栓。今后可通過動物實驗,進(jìn)一步研究其預(yù)防血栓的作用機(jī)制。
[Abstract]:Objective: to observe the clinical effect of Xinhuang tablet combined with low molecular weight heparin sodium (LMWH) on the prevention of deep venous thrombosis (DVT) after perihip fracture, and to accumulate experience in the clinical study of prevention of deep venous thrombosis (DVT) in lower extremity by traditional Chinese medicine. Methods: from December 2013 to December 2014, 74 patients in orthopedic hospital of 175 hospitals were randomly divided into treatment group (n = 37) and control group (n = 37) according to the order of admission time. The control group was given low-molecular-weight heparin sodium injection, 100 IU/kg, subcutaneously once a day, and the treatment group was given 0.64g/ tablet (twice a day) on the basis of the control group. The blood coagulation function, D-dimer and platelet were measured on the day of admission and on the 7th day after operation, and the deep veins of lower extremities were examined by color Doppler ultrasonography before and after operation. The circumference of the affected limbs and pain relief were measured, and the data were recorded. The data were analyzed by 17.0 statistical software, set P0.05 has statistical significance. Results: 1Thrombosis was found in 3 patients in this study group. On the day of admission, 1 case, 2 cases were found in femoral vein, 2 cases in popliteal vein, 11 cases in control group, on the day of admission, 2 cases were found in the femoral vein, 2 cases in the popliteal vein, and 11 cases in the control group on the day of admission. On the 3rd day after operation, 3 cases, 4 cases appeared in femoral vein and 5 cases in popliteal vein, respectively. The incidence of thrombus was 8.11 and 29.73, respectively. The difference between the two groups was statistically significant (P0.05). There was no significant difference in PT,APTT,FIB.D- dimer content between the two groups on admission day (P0.05). There was significant difference on the 3rd day after operation (P0.05). There was no significant difference in INR between the two groups (P0.05). There was no significant difference in platelet count between the two groups on the day of admission and 12 days after operation (P0.05). There was significant difference in platelet count between the two groups on the 3rd and 7th day after operation (P0.05). 4. There was no significant difference between the two groups in intraoperative blood loss and 48 hours of drainage (P0.05), 3 days after operation (P0.05), 712 days after operation. There were significant differences in thigh circumference difference and pain VAS score between the two groups (P0.05). Conclusion: Xinhuang tablet combined with low molecular weight heparin sodium can relieve local swelling and pain, improve blood hypercoagulability, improve blood fibrinolytic activity and prevent deep vein thrombosis after hip fracture. The therapeutic effect was better than that of low molecular weight heparin sodium group. The application of Xinhuang tablet to prevent thrombosis before operation did not increase the risk of bleeding. It showed the safety of medication. It indicated that Chinese medicine could be used to prevent deep venous thrombosis early after fracture of hip. The mechanism of prevention of thrombus can be further studied by animal experiments in the future.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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