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[1]李可大,冷重光,趙江濤,等.自擬抗栓方聯(lián)合低分子肝素鈉預(yù)防髖、膝部 手術(shù)后深靜脈血栓形成的臨床研究[J].中醫(yī)正骨,2011,23(07):12-16.
　LI Ke-da*,LENG Chong-guang,ZHAO Jiang-tao,et al.Clinical study on the self-designed antithrombotic prescription combined with low molecular weight heparin sodium in the prevention of deep vein thrombosis after operations in the hip and the knee[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(07):12-16.
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自擬抗栓方聯(lián)合低分子肝素鈉預(yù)防髖、膝部 手術(shù)后深靜脈血栓形成的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第23卷
期數(shù):
2011年07期
頁碼:
12-16
欄目:
臨床研究
出版日期:
2011-07-30

文章信息/Info

Title:
Clinical study on the self-designed antithrombotic prescription combined with low molecular weight heparin sodium in the prevention of deep vein thrombosis after operations in the hip and the knee
作者:
李可大; 冷重光; 趙江濤; 李忠強(qiáng); 金冶華; 宮云昭
遼寧中醫(yī)藥大學(xué)附屬醫(yī)院,遼寧 沈陽 110032
Author(s):
LI Ke- da*; LENG Chong-guang; ZHAO Jiang-tao; et al.*
The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China
關(guān)鍵詞:
靜脈血栓形成 手術(shù)后并發(fā)癥 血液流變學(xué) 中草藥 肝素; 低分子量
Keywords:
Key words Venous thrombosis;  Postoperative complications;  Hemorheology;  Drugs; Chinese Herbal;  Heparin; low-molecular-weight
摘要:
目的:探討自擬抗栓方預(yù)防髖、膝部手術(shù)后下肢深靜脈血栓形成的臨床療效。方法:將符合要求的133例患者隨機(jī)分為2組, Ⅰ組65例,Ⅱ組68例。術(shù)后當(dāng)天即開始預(yù)防血栓治療,Ⅰ組采用自擬抗栓方和低分子肝素鈉治療; Ⅱ組單純使用低分子肝素鈉治 療。同時(shí),2組均常規(guī)給予抗生素預(yù)防感染,并進(jìn)行功能鍛煉和康復(fù)治療。術(shù)后第8天統(tǒng)計(jì)2組患者下肢深靜脈血栓發(fā)生情況,并分 別于術(shù)前、術(shù)后2 d、術(shù)后7 d測(cè)定2組患者的全血黏度、血漿黏度、紅細(xì)胞壓積、紅細(xì)胞聚集指數(shù)及纖維蛋白原等血液流變學(xué)指 標(biāo)。結(jié)果:①Ⅰ組患者2例發(fā)生深靜脈血栓,Ⅱ組10例發(fā)生深靜脈血栓。2組患者深靜脈血栓發(fā)生情況比較,差異有統(tǒng)計(jì)學(xué)意義 (χ2=4.262,P=0.039)。②全血低切黏度:兩組治療前后不同時(shí)間全血低切黏度比較,存在時(shí)間效應(yīng) (F=135.374,P=0.000)和分組效應(yīng)(F=17.096,P=0.042); 時(shí)間與組別之間存在交互效應(yīng)(F=120.980,P=0.000); 不同時(shí)點(diǎn)組間比 較,差異均無統(tǒng)計(jì)學(xué)意義(t=0.057,P=0.957; t=-0.114,P=0.915; t=-0.900,P=0.419)。③全血高切黏度:兩組治療前后不同時(shí)間 全血高切黏度比較,存在時(shí)間效應(yīng)(F=80.971,P=0.000)和分組效應(yīng)(F=39.118,P=0.003); 時(shí)間與組別之間不存在交互效應(yīng) (F=2.102,P=0.185); 不同時(shí)點(diǎn)組間比較,差異均無統(tǒng)計(jì)學(xué)意義(t=-0.162,P=0.879; t=0.012,P=0.991; t=-0.530,P=0.624)。④ 血漿黏度:兩組治療前后不同時(shí)間血漿黏度比較,存在時(shí)間效應(yīng)(F=18.814,P=0.001)和分組效應(yīng)(F=9.265,P=0.034); 時(shí)間與組別 之間存在交互效應(yīng)(F=17.156,P=0.001); 不同時(shí)點(diǎn)組間比較,差異均無統(tǒng)計(jì)學(xué)意義(t=-0.087,P=0.935; t=-0.157,P=0.883; t=-1.469,P=0.216)。⑤紅細(xì)胞壓積:兩組治療前后不同時(shí)間紅細(xì)胞壓積比較,存在時(shí)間效應(yīng)(F=18.988,P=0.012),但不存在分組 效應(yīng)(F=0.101,P=0.767); 時(shí)間與組別之間存在交互效應(yīng)(F=7.328,P=0.016); 不同時(shí)點(diǎn)組間比較,差異均無統(tǒng)計(jì)學(xué)意義 (t=0.016,P=0.988; t=-0.106,P=0.921; t=-0.985,P=0.380)。⑥紅細(xì)胞聚集指數(shù):兩組治療前后不同時(shí)間紅細(xì)胞聚集指數(shù)比較, 存在時(shí)間效應(yīng)(F=24.763,P=0.000),但不存在分組效應(yīng)(F=0.424,P=0.550); 時(shí)間與組別之間存在交互效應(yīng)(F=35.746,P=0.000); 不同時(shí)點(diǎn)組間比較,差異均無統(tǒng)計(jì)學(xué)意義(t=-1.161,P=0.880; t=-1.106,P=0.921; t=-1.966,P=0.121)。⑦纖維蛋白原:兩組治 療前后不同時(shí)間纖維蛋白原比較,存在時(shí)間效應(yīng)(F=12.496,P=0.003),但不存在分組效應(yīng)(F=0.015,P=0.909); 時(shí)間與組別之間存 在交互效應(yīng)(F=7.874,P=0.013); 不同時(shí)點(diǎn)組間比較,差異均無統(tǒng)計(jì)學(xué)意義(t=-0.032,P=0.976; t=-0.178,P=0.867; t=- 0.555,P=0.609)。結(jié)論:自擬抗栓方聯(lián)合低分子肝素鈉能有效預(yù)防髖、膝部手術(shù)后深靜脈血栓形成,可在臨床推廣應(yīng)用。
Abstract:
Objective:To explore the clinical curative effects of the self-designed antithrombotic prescription in the prevention of deep vein thrombosis(DVT)after operations in the hip and the knee.Methods:One hundred and thirty-three patients met the criteria were randomly divided into 2 groups.Sixty-five cases in groupⅠ,while the others in groupⅡ.Treatment of preventing thrombus was carried out on that day after the operation.Patients in groupⅠwere administrated with self-designed antithrombotic prescription combined with low molecular weight heparin sodium,while the others in groupⅡwere administrated with low molecular weight heparin sodium only.Meanwhile,patients in the 2 groups were routinely given antibiotics to prevent infection and were administrated with functional exercise and rehabilitation therapy.Occurrences of DVT for patients in the 2 groups were recorded in the 8th day after operation,and their blood viscosity,plasma viscosity,hematocrit,erythrocyte aggregation indexes,fibrinogen and other blood rheology indexes were measured before the operation,in the 2nd and the 7th day after operation respectively.Results:①Two DVT cases were found in groupⅠ,and 10 DVT cases were found in groupⅡ.There was statistical difference in the incidence of DVT between the 2 groups(χ2=4.262,P=0.039).②On the aspect of low shear blood viscosity:there were time effect(F=135.374,P=0.000),group effect(F=17.096,P=0.042)and interaction between times and groups (F=120.980,P=0.000); there was no statistical difference between the 2 groups in different time points (t=0.057,P=0.957; t=-0.114,P=0.915; t=-0.900,P=0.419).③On the aspect of high shear blood viscosity:there were time effect(F=80.971,P= 0.000)and group effect(F=39.118,P=0.003),but there was no interaction between times and groups (F=2.102,P=0.185); there was no statistical difference between the 2 groups in different time points(t=- 0.162,P=0.879; t=0.012,P=0.991; t=-0.530,P=0.624).④On the aspect of plasma viscosity:there were time effect (F=18.814,P=0.001),group effect(F=9.265,P=0.034)and interaction between times and groups(F=17.156,P=0.001); there was no statistical difference between the 2 groups in different time points(t=-0.087,P=0.935; t=- 0.157,P=0.883; t=-1.469,P=0.216).⑤On the aspect of hematocrit:there were time effect(F=18.988,P=0.012)and interaction between times and groups(F=7.328,P=0.016),but there was no group effect(F=0.101,P=0.767); there was no statistical difference between the 2 groups in different time points(t=0.016,P=0.988; t=-0.106,P=0.921; t=- 0.985,P=0.380).⑥On the aspect of erythrocyte aggregation indexes:there were time effect(F=24.763,P=0.000)and interaction between times and groups(F=35.746,P=0.000),but there was no group effect(F=0.424,P=0.550); there was no statistical difference between the 2 groups in different time points(t=-1.161,P=0.880; t=-1.106,P=0.921; t=-1.966,P=0.121).⑦On the aspect of fibrinogen:there were time effect(F=12.496,P=0.003)and interaction between times and groups(F=7.874,P=0.013),but there was no group effect(F=0.015,P=0.909); there was no statistical difference between the 2 groups in different time points(t=-0.032,P=0.976; t=-0.178,P=0.867; t=- 0.555,P=0.609).Conclusion:Self-designed antithrombotic prescription combined with low molecular weight heparin sodium is effective in the prevention of deep vein thrombosis after operations in the hip and the knee,and it is worth popularizing in the clinic.

參考文獻(xiàn)/References:

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基金項(xiàng)目:沈陽市科技局課題(1063245-3-00)
更新日期/Last Update: 2011-07-30