摘要
目的 探讨低分子肝素钠联合活血通脉汤对膝关节置换术后患者临床效果及静脉血栓形成、凝血功能的影响。方法 选取行膝关节置换术80例,按治疗方法不同将其分为观察组和对照组两组各40例,观察组膝关节置换术后采用低分子肝素钠联合活血通脉汤进行治疗,对照组膝关节置换术后仅采用低分子肝素钠进行治疗,观察比较两组术后1周临床治疗效果,术后1个月静脉血栓形成情况,术前24h和术后6、48、72h凝血功能指标,以及治疗期间不良反应发生情况。结果 术后1周,观察组总有效率82.5%明显高于对照组总有效率55.0%,差异有统计学意义(P<0.05)。术后1个月,观察组静脉血栓形成率2.5%明显低于对照组静脉血栓形成率17.5%,差异具有统计学意义(P<0.05)。术前24h,两组各凝血功能指标比较差异均无统计学意义(P>0.05)。术后6h,两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均较术前24h缩短,纤维蛋白原(FIB)和D二聚体(DD)均较术前24h升高;观察组PT、APTT及FIB较对照组延长或升高,DD较对照组降低,差异有统计学意义(P<0.05)。术后48h,两组PT均较术前24h缩短,APTT均较术前24h延长,FIB和DD均较术前24h升高;观察组PT和APTT长于对照组,DD低于对照组,差异有统计学意义(P<0.05)。术后72h,两组APTT及FIB、DD较术前24h延长或升高,观察组PT较术前24h延长,对照组PT较术前24h缩短;观察组PT、APTT较对照组延长,FIB和DD较对照组降低,差异有统计学意义(P<0.05)。治疗期间,观察组总不良反应发生率为10.0%低于对照组总不良反应发生率27.5%,差异有统计学意义(P<0.05)。结论 膝关节置换术患者采用低分子肝素钠联合活血通脉汤治疗效果好,可预防术后下肢静脉血栓形成,改善血液高凝状态,并可减少不良反应的发生。
Objective To investigate the clinical effect of low molecular weight heparin sodium combined with Huoxue Tongmai Decoction on knee joint replacement, and their effect on postoperative venous thrombosis and coagulation function. Methods Eighty patients undergoing knee joint replacement were selected, and then divided into control group ( n =40) and observation group ( n =40) according to different treatment methods. Patients in observation group were treated with low molecular weight heparin sodium combined with Huoxue Tongmai Decoction after knee joint replacement, and those in control group were merely treated with low molecular weight heparin sodium after knee joint replacement. Clinical efficacy at 1 week after surgery, venous thrombosis at 1 month after surgery, and coagulation function indicators at 24 h before surgery, and at 6 h , 48 h, and 72 h after surgery, and incidence of adverse reactions during treatment were compared between the two groups. Results At 1 week after surgery, the total effective rate of the observation group was 82.5%, which was significantly higher than that (55.0%) of the control group, and the difference was statistically significant ( P <0.05). At 1 month after operation, the venous thrombosis rate of the observation group was 2.5%, which was significantly lower than that (17.5%) of the control group, and the difference was statistically significant ( P <0.05). There was no significant difference in coagulation function indicators at 24 h before surgery between the two groups ( P >0.05). At 6 h after surgery, prothrombin time (PT) and activated partial thromboplastin time (APTT) in both groups were shortened compared with those at 24 h before surgery, and fibrinogen (FIB) and D-dimer (DD) in both groups were higher than those at 24 h before surgery. PT, APTT and FIB of the observation group were longer or higher than those of the control group, and the DD was lower than that of the control group, suggesting significant difference ( P <0.05). At 48 h after surgery, PT of two groups was lower than that at 24 h before surgery, while APTT was increased. FIB and DD of the two groups were higher than those at 24 h before surgery. PT and APTT were longer in observation group than in control group. The DD of the observation group was lower than that of the control group, and the difference was statistically significant ( P <0.05). At 72 h after surgery, APTT, FIB and DD were increased or prolonged compared with those at 24 h before surgery. PT of the observation group was longer than that at 24 h before surgery, while PT of the control group was shorter than that at 24 h before surgery, and the PT and APTT were longer in the observation group than in the control group, and the FIB and DD were lower than those in the control group, suggesting significant differences ( P < 0.05). During the treatment, the incidence of total adverse reactions was 10.0% in the observation group, which was lower than that (27.5%) in the control group, and the difference was statistically significant ( P <0.05). Conclusion In the treatment of patients after knee joint replacement, low molecular weight heparin sodium combined with Huoxue Tongmai Decoction has good clinical effect, which can effectively prevent venous thrombosis of lower limb, improve the blood hypercoagulability of patients, and reduce the incidence of adverse reactions.
作者
贾宏伟
王沐
JIA Hong-wei;WANG Mu(Department of Orthopaedics,People's Hospital in Xushui District,Baoding,Hebei 072550,China;Department of Pharmacy,the Fourth People's Hospital of Langfang,Langfang,Hebei 065700 China)
出处
《临床误诊误治》
2019年第8期34-39,共6页
Clinical Misdiagnosis & Mistherapy
基金
河北省科学技术厅科技支撑项目(20151636)
关键词
关节成形术
置换
膝
低分子肝素钠
活血通脉汤
静脉血栓形成
凝血功能
Arthroplasty, replacement, knee
Low molecular weight heparin sodium
Huoxue tongmai decoction
Venous thrombosis
Coagulation function
