补肾活血方联合低分子肝素等防治老年髋部骨折术后下肢深静脉血栓的临床研究

张玉婷; 詹红生; 俞仲翔

doi:10.16305/j.1007-1334.2021.1910073

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补肾活血方联合低分子肝素等防治老年髋部骨折术后下肢深静脉血栓的临床研究

临床试验 | 更新时间：2022-08-03

- 补肾活血方联合低分子肝素等防治老年髋部骨折术后下肢深静脉血栓的临床研究
- Clinical study on prevention and treatment of lower extremity deep veinous thrombosis after hip fracture surgery in elderly by combining Bushen Huoxue Formula with low molecular weight heparin and other measures
- 上海中医药杂志 2021年55卷第12期页码：61-64,73
- 作者机构：
  
  1.上海中医药大学附属普陀医院（上海　200333）
  2.上海中医药大学附属曙光医院（上海　201203）
- 作者简介：
  
  张玉婷，女，硕士，主治医师，主要从事中医骨伤科的临床研究工作
  俞仲翔，主任医师；E-mail：yuzhongxiang2011@sina.com
- 基金信息：
  
  国家自然科学基金项目(81973871;81804114);教育部科学技术研究重点项目(212052);上海市重中之重临床重点学科建设项目“中医骨伤科学”(2017ZZ02024);上海申康医院发展中心临床三年行动计划项目(SHDC2020CR1051B);上海市卫计委建设项目(SHGS-2017025);上海中医药大学预算内科研项目(18LK038)
- DOI：10.16305/j.1007-1334.2021.1910073
  中图分类号：
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张玉婷, 詹红生, 俞仲翔. 补肾活血方联合低分子肝素等防治老年髋部骨折术后下肢深静脉血栓的临床研究[J]. 上海中医药杂志, 2021,55(12):61-64,73.

Yuting ZHANG, Hongsheng ZHAN, Zhongxiang YU. Clinical study on prevention and treatment of lower extremity deep veinous thrombosis after hip fracture surgery in elderly by combining Bushen Huoxue Formula with low molecular weight heparin and other measures[J]. Shanghai Journal of Traditional Chinese Medicine, 2021,55(12):61-64,73.
张玉婷, 詹红生, 俞仲翔. 补肾活血方联合低分子肝素等防治老年髋部骨折术后下肢深静脉血栓的临床研究[J]. 上海中医药杂志, 2021,55(12):61-64,73. DOI： 10.16305/j.1007-1334.2021.1910073.

Yuting ZHANG, Hongsheng ZHAN, Zhongxiang YU. Clinical study on prevention and treatment of lower extremity deep veinous thrombosis after hip fracture surgery in elderly by combining Bushen Huoxue Formula with low molecular weight heparin and other measures[J]. Shanghai Journal of Traditional Chinese Medicine, 2021,55(12):61-64,73. DOI： 10.16305/j.1007-1334.2021.1910073.

摘要

目的,2,观察补肾活血方联合低分子肝素等防治老年髋部骨折术后患者下肢深静脉血栓（LDVT）的临床疗效。,方法,2,将220例老年髋部骨折术后患者随机分为治疗组与对照组，每组110例。对照组术后予低分子肝素皮下注射联合弹力绷带及功能练习，治疗组在对照组治疗措施基础上加服补肾活血方中药。两组疗程均为14 d，观察试验期间患者LDVT及其并发症的发生情况，比较血浆凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）、D-二聚体（D-D）水平以及患肢疼痛视觉模拟评分（VAS）、肢体肿胀消退程度（大腿、小腿周径差值）指标的变化情况。,结果,2,①最终完成试验者210例，治疗组105例，对照组105例。②试验期间，治疗组3例发生LDVT（2.86%），对照组11例发生LDVT（10.48%）；组间LDVT发生率比较，治疗组明显低于对照组（,P,<,0.05）。③治疗前后组内比较，两组PT、APTT水平均明显升高，D-D水平均明显降低；组间治疗后比较，治疗组对PT、APTT、D-D水平的改善明显优于对照组（,P,<,0.05）。④组内治疗前后比较，两组患肢VAS评分均明显降低（,P,<,0.05）；组间治疗后比较，治疗组患肢VAS评分明显低于对照组（,P,<,0.05）。⑤组间治疗7 d、治疗14 d比较，治疗组大腿、小腿周径差值均明显大于对照组（,P,<,0.05）。,结论,2,补肾活血方联合低分子肝素等较单独应用低分子肝素等，可更加显著改善老年髋部骨折术后患者血液的高凝状态，降低LDVT的发生率，还能改善其下肢疼痛与肿胀。

Abstract

Objective,2,To explore the effect of Bushen Huoxue Formula combined with low molecular weight heparin (LMWH) and other measures in the prevention and treatment of lower extremity deep venous thrombosis (LDVT) after the hip fracture surgery in the elderly.,Methods,2,Two hundred and twenty elderly patients with postoperative hip fracture were randomly divided into treatment group (,n,=110) and control group (,n,=110). The control group was administered with subcutaneous injection of LMWH combined with elastic bandage and functional exercises after surgery, while the treatment group was administered with Bushen Huoxue Formula in addition to the treatment measures of the control group. Both groups were treated for 14 days. During the trial, we observed the incidence of LDVT and its complications, and compared the changes of plasma prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D) levels, as well as the pain visual analogue scale (VAS) score in the affected extremities and the degree of swelling reduction of the lower extremities (differences in circumference of thigh and calf).,Results,2,①Finally 210 cases completed the trial, 105 cases in the treatment group and 105 cases in the control group. ②During the trial, there were 3 cases of LDVT in the treatment group (2.86%) and 11 cases in the control group (10.48%); the incidence of LDVT in the treatment group was significantly lower than that in the control group (,P,<,0.05). ③The PT and APTT were significantly longer and D-D levels were significantly lower after treatment in both groups; the improvement of PT, APTT and D-D levels in the treatment group was significantly better than that in the control group (,P,<,0.05). ④The VAS scores of the affected extremities were significantly lower after treatment in both groups (,P,<,0.05); after treatment the VAS scores of the affected extremities in the treatment group were significantly lower than those in the control group (,P,<,0.05). ⑤According to the inter-group comparison after 7 days and 14 days of treatment, the differences in circumference of the thigh and calf in the treatment group were significantly greater than those in the control group (,P,<,0.05).,Conclusion,2,In the elderly patients, the combined use of Bushen Huoxue Formula with LMWH and other measures can improve the hypercoagulable state of blood and reduce the incidence of LDVT more significantly than the single use of LMWH and other measures, and it can also improve their lower limb pain and swelling.

关键词

髋部骨折老年下肢深静脉血栓补肾活血方低分子肝素中西医结合

Keywords

hip fractureelderlylower extremity deep veinous thrombosisBushen Huoxue Formulalow molecular weight heparinintegrated traditional Chinese and western medicine

references

MIYAMOTO R G, KAPLAN K M, LEVINE B R, et al. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures[J]. J Am Acad Orthop Surg, 2008, 16(10): 596-607.

TRIVEDI N N, SIVASUNDARAM L, WANG C, et al. Chemoprophylaxis for the hip fracture patient: a comparison of warfarin and low-molecular-weight heparin[J]. J Orthop Trauma, 2019, 33(5): 216-219.

GANSSLEN A, GRECHENIG S, GRECHENING W. Proximal femoral fractures and anticoagulation therapy-when is surgery safe? [J]. Acta Chir Orthop Traumatol Cech, 2017, 84(5): 323-329.

LIN F F, LIN C H, CHEN B, et al. Combination prophylaxis versus pharmacologic prophylaxis alone for preventing deep vein thrombosis in hip surgery[J]. Hip Int, 2016, 26(6): 561-566.

郭梦园，崔向丽，刘丽宏，等. 老年髋部骨折术前下肢深静脉血栓形成高危因素及抗凝治疗分析[J]. 中国骨与关节损伤杂志，2016, 31(12): 1268-1271.

RIESS H, BECKER L K, MELZER N, et al. Treatment of deep vein thrombosis in patients with pulmonary embolism: subgroup analysis on the efficacy and safety of certoparin vs. unfractionated heparin[J]. Blood Coaqul Fibrinolysis, 2014, 25(8): 838-844.

XIA Z N, XIAO K, ZHU W, et al. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture[J]. J Orthop Surg Res, 2018, 13(1): 291.

孙宁，杨帆，李宇能，等. 新鲜下肢骨折术前深静脉血栓形成危险程度评分量表初探[J]. 中华外科杂志，2015, 53(2): 101-105.

MOJA L, PIATTI A, PECORARO V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients[J]. PLoS One, 2012, 7(10): e6175.

中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志，2009,29(6): 602-604.

SUN G, WU J, WANG Q, et al. Factor Xa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: A systematic review and meta-analysis[J]. J Arthroplasty, 2019, 34(4): 789-800.

朱文婷. 抗血栓药物研究进展[J]. 中国临床药学杂志，2018, 27(5): 365-370.

中华医学会骨科学分会. 预防骨科大手术深静脉血栓形成指南（草案）[J]. 中国矫形外科杂志，2009, 17(2): 118-119.

李勃，辛婕琛，杨光，等. 活血化瘀法预防老年人骨科下肢大手术后深静脉血栓形成的临床观察[J]. 上海中医药大学学报，2014, 28(6): 41-43.

张淑云，沈翔. 祛瘀消肿汤防治老年髋部骨折术后深静脉血栓的临床观察[J]. 中医药导报，2015, 21(4): 28-31.

郑华，秦霞，唐超玲，等. 基于1H-NMR的当归四逆汤抗凝血作用的代谢组学研究[J]. 中国中药杂志，2015, 40(20): 4088-4093.

罗年翠，丁雯，钱大玮，等. 当归补血-活血药对功效取向研究[J]. 中国实验方剂学杂志，2013, 19(4): 240-246.

王红芹，孙明杰，武乾，等. 黄芪多糖对缺血再灌注损伤脐静脉内皮细胞抗氧化应激机制探讨[J]. 中国中医基础医学杂志，2018, 24(5): 600-603.

刘珂，邱炳勋，邹利，等. 黄芪及其有效成分对内皮细胞及其连接的保护作用及机制研究进展[J]. 中草药，2016, 47(21): 3912-3917.

姜海波，竹艳刚，刘继忠，等. 水蛭素抑制凝血作用探讨[J]. 河北中医，2011,33(8): 1236-1237.

曹文理，李菁. 重组水蛭素的抗血栓形成作用及其机制[J]. 中国应用生理学杂志，2018, 34(4): 371-374.

FRONAS S G, WIK H S, DAHN A E A, et al. Safety of D-dimer testing as a stand-alone test for the exclusion of deep vein thrombosis as compared with other strategies [J]. J Thromb Haemost, 2018, 16(12): 2471-2481.

王伯华. 运动康复处方联合补肾活血方对急性期髋部骨折髋关节功能、骨生物力学和骨密度的影响[J]. 中国中医急症，2016, 25(4): 693-695.

熊其林，范跟东. 补肾活血法联合股骨近端抗旋髓内钉治疗高龄股骨粗隆间骨折临床研究[J]. 现代中西医结合杂志，2017,26(16): 1799-1801.

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