本文選題：復(fù)元活血湯 + 下肢深靜脈血栓形成　； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：觀察復(fù)元活血湯預(yù)防脊柱骨折術(shù)后下肢深靜脈血栓形成(DVT)的臨床療效,為中醫(yī)藥預(yù)防下肢深靜脈血栓形成推廣應(yīng)用提供臨床基礎(chǔ)。方法：將2015年4月份至2016年1月份于廣州中醫(yī)藥大學(xué)附屬中山醫(yī)院脊柱專(zhuān)科住院部確診為脊柱骨折術(shù)后60例入選病例病患,采用隨機(jī)數(shù)表配合信封法隨機(jī)分為復(fù)元活血湯組(20例)、那曲肝素鈣組(20例)、復(fù)元活血湯聯(lián)合那曲肝素鈣組(20例),分別對(duì)其治療前后凝血指標(biāo)、血漿D-2聚體、血液流變學(xué),雙下肢超聲多普勒等以及相關(guān)安全性指標(biāo)進(jìn)行觀察,予以統(tǒng)計(jì)分析,客觀評(píng)價(jià)復(fù)元活血湯預(yù)防脊柱骨折術(shù)后下肢深靜脈血栓形成的作用及闡釋其機(jī)理。結(jié)果：1、三組患者術(shù)后第2天,凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)及凝血酶時(shí)間(TT)均延長(zhǎng),其變化趨勢(shì)基本相同,大部分指標(biāo)差異有統(tǒng)計(jì)學(xué)意義(P0.05);纖維蛋白原(FIB)則呈下降趨勢(shì)。復(fù)元活血湯組與那曲肝素鈣組各項(xiàng)指標(biāo)的升高或下降趨勢(shì)大致一致,復(fù)元活血湯聯(lián)合那曲肝素鈣組PT、APTT、TT升高程度及FIB下降程度均優(yōu)于復(fù)元活血湯組與那曲肝素鈣組(P＜0.05)。2、D-2聚體水平在術(shù)后第2天有明顯上升(P＜0.05),術(shù)后第7天均大幅度下降(P0.05),復(fù)元活血湯聯(lián)合那曲肝素鈣組對(duì)比其它組下降更加明顯(P＜0.05)。3、術(shù)后第2天,三組患者大多數(shù)血液流變學(xué)結(jié)果較術(shù)前均有升高,其中全血粘度低切(BVL)、全血粘度高切(BVH)、血漿黏度(PV)、紅細(xì)胞壓積(HCT)、紅細(xì)胞聚集指數(shù)(RE)、血沉(ESR)與術(shù)前比較有顯著差異(PO.05或P＜0.01)。紅細(xì)胞變形指數(shù)(TK)較術(shù)前下降,有顯著變化(P＜0.01)。術(shù)后7天,大部分血液流變學(xué)指標(biāo)有得到明顯改善(P＜0.05或P＜0.01)。4、術(shù)后下肢靜脈血栓形成情況比較,三組患者對(duì)比無(wú)顯著性差異5、三組患者治療前后VAS評(píng)分結(jié)果比較,復(fù)元活血湯組及復(fù)元活血湯聯(lián)合那曲肝素鈣組優(yōu)于那曲肝素鈣組(P＜0.05)。6、術(shù)后24小時(shí)術(shù)口引流量復(fù)元活血湯組較少,優(yōu)于復(fù)元活血湯組及復(fù)元活血湯聯(lián)合那曲肝素鈣組優(yōu)于那曲肝素鈣組(P0.01),而血小板計(jì)數(shù)(PLT)統(tǒng)計(jì)結(jié)果提示三組無(wú)明顯差別(P＞0.05)。結(jié)論：復(fù)元活血湯能夠有效改善脊柱骨折術(shù)后患者改善血液高凝狀態(tài),降低粘稠度,防止深靜脈血栓的形成,是臨床防治DVT的有效中藥方藥。相比于單純使用那曲肝素鈣出血風(fēng)險(xiǎn)小,更加安全可靠,同時(shí)復(fù)元活血湯能改善患者的腰背部疼痛情況,效果明顯。臨床上可評(píng)估患者血液的粘稠度,從而選擇單用復(fù)元活血湯或聯(lián)合那曲肝素鈣防治DVT。
[Abstract]:Objective: to observe the clinical effect of Fuyuan Huoxue decoction (Fuyuan Huoxue decoction) in preventing deep venous thrombosis (DVT) of lower extremity after spinal fracture, and to provide a clinical basis for the popularization and application of traditional Chinese medicine in the prevention of deep venous thrombosis of lower extremity. Methods: from April 2015 to January 2016, 60 selected patients with spinal fractures were diagnosed in the Department of Spine of Zhongshan Hospital affiliated to Guangzhou University of traditional Chinese Medicine. Twenty cases of Fuyuan Huoxue decoction group, 20 cases of Naqu heparin calcium group, and 20 cases of Fuyuan Huoxue decoction combined with Naqu heparin calcium group were randomly divided into two groups by random number table and envelope method. The coagulation index, plasma D-2 polymer and hemorheology were measured before and after treatment. The effect of Fuyuan Huoxue decoction on prevention of deep venous thrombosis after spinal fracture was evaluated objectively and its mechanism was explained. Results the prothrombin time (PTT), activated partial thromboplastin time (APTT) and thrombin time (TTT) were prolonged on the second day after operation in the three groups. The difference of most indexes was statistically significant (P 0.05), while fibrinogen FIBs showed a decreasing trend. The increasing or decreasing trend of the indexes of Fuyuan Huoxue decoction group and Naqu heparin calcium group was approximately the same. The level of FIB in Fuyuan Huoxue decoction combined with Naqu heparin calcium group was significantly higher than that in Fuyuan Huoxue decoction group and Naqu heparin calcium group (P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05, P < 0.05) on the 7th day after operation. Yuan Huoxue Tang combined with Natrex heparin calcium group decreased more significantly than other groups (P < 0.05), and on the second day after operation, Most of the hemorheological results in the three groups were higher than those before operation, including whole blood viscosity low shear BVLA, whole blood viscosity high shear BVH, plasma viscosity PVN, hematocrit HCT, erythrocyte aggregation index (RBC) and erythrocyte sedimentation rate (ESR) significantly different from those before operation (P < 0.05 or P < 0.01). The erythrocyte deformability index (TK) was significantly lower than that before operation (P < 0.01). On the 7th day after operation, most of the hemorheological indexes improved significantly (P < 0. 05 or P < 0. 01). There was no significant difference between the three groups in venous thrombosis after operation. The VAS scores of the three groups were compared before and after treatment. Fuyuan Huoxue decoction group and Fuyuan Huoxue decoction combined with Naqu heparin calcium group were better than Naqu heparin calcium group (P < 0.05). It was better than Fuyuan Huoxue decoction group and Fuyuan Huoxue decoction combined with Naqu heparin calcium group than Naqu heparin calcium group (P 0.01), but platelet count (PLT) showed no significant difference among the three groups (P > 0.05). Conclusion: Fuyuan Huoxue decoction can effectively improve the blood hypercoagulability, reduce the viscosity and prevent the formation of deep venous thrombosis in patients with spinal fracture after operation. It is an effective prescription for clinical prevention and treatment of DVT. Compared with Naqu heparin calcium alone, the risk of bleeding is less, more safe and reliable. At the same time, Fuyuan Huoxue decoction can improve the pain of the patients' waist and back, and the effect is obvious. Clinically, we can evaluate the blood viscosity of the patients, and choose Fuyuan Huoxue decoction or Natrix heparin calcium to prevent and treat DVT.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R274.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李順群;;血漿D-二聚體檢測(cè)在下肢深靜脈血栓形成中的診斷價(jià)值[J];中國(guó)現(xiàn)代藥物應(yīng)用;2016年04期

2 王茂軍;何夢(mèng)娟;;D-二聚體及其在骨科手術(shù)前后監(jiān)測(cè)的臨床意義[J];大家健康(學(xué)術(shù)版);2015年23期

3 許大勇;;復(fù)元活血湯對(duì)脊柱骨折患者術(shù)后炎性因子、凝血功能及疼痛程度的影響[J];中藥藥理與臨床;2015年03期

4 杜景文;;桃紅四物湯預(yù)防腰椎骨折術(shù)后下肢深靜脈血栓形成的臨床觀察[J];光明中醫(yī);2015年02期

5 覃方明;張超紅;楊松濤;;活血化瘀法預(yù)防骨科術(shù)后深靜脈血栓探析[J];國(guó)醫(yī)論壇;2015年01期

6 方榮偉;馮偉;;熏洗方預(yù)防骨折術(shù)后深靜脈血栓形成40例[J];河南中醫(yī);2014年11期

7 陳友銀;郭劍華;代亮;;桃紅四物湯預(yù)防粗隆間骨折術(shù)后深靜脈血栓形成療效觀察[J];實(shí)用中醫(yī)藥雜志;2014年05期

8 周宗元;王建;馬驍;;穿山甲的研究進(jìn)展[J];中藥與臨床;2014年01期

9 李曦;張麗宏;王曉曉;楊雯;金玉青;呂光華;;當(dāng)歸化學(xué)成分及藥理作用研究進(jìn)展[J];中藥材;2013年06期

10 列蓮麗莎;;電針加溫針治療下肢靜脈血栓[J];中國(guó)醫(yī)藥指南;2013年09期

相關(guān)會(huì)議論文 前3條

1 陶樹(shù)貴;付嵐嵐;;秦學(xué)賢治療股腫的經(jīng)驗(yàn)[A];中華中醫(yī)藥學(xué)會(huì)周?chē)懿》謺?huì)第五屆學(xué)術(shù)大會(huì)暨黑龍江省中醫(yī)周?chē)懿?013年學(xué)術(shù)討論會(huì)學(xué)術(shù)論文集[C];2013年

2 王晉軍;姜桂喜;胡文賢;李強(qiáng);李林;;中藥熏洗配合正負(fù)壓治療下肢深靜脈血栓形成的臨床觀察[A];2010年中國(guó)中西醫(yī)結(jié)合周?chē)芗膊W(xué)術(shù)交流會(huì)論文集[C];2010年

3 劉新科;于淑華;;針刀治療深靜脈栓塞及下肢靜脈曲張療效觀察[A];2011年全國(guó)第三屆微創(chuàng)針刀學(xué)術(shù)年會(huì)論文匯編[C];2011年

，

本文編號(hào)：1969196