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[1]周曉聰,丁玉梅,周前,等.補(bǔ)陽還五湯加減聯(lián)合利伐沙班預(yù)防老年髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成的療效觀察及作用機(jī)制研究[J].中醫(yī)正骨,2020,32(10):35-41.
　ZHOU Xiaocong,DING Yumei,ZHOU Qian,et al.A clinical study on the curative effects and mechanism of action of oral applications of Buyang Huanwu Tang Jiajian(補(bǔ)陽還五湯加減)and Rivaroxaban for preventing deep venous thrombosis after the surgery of hip replacement in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):35-41.
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補(bǔ)陽還五湯加減聯(lián)合利伐沙班預(yù)防老年髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成的療效觀察及作用機(jī)制研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年10期
頁碼:
35-41
欄目:
臨床研究
出版日期:
2020-10-20

文章信息/Info

Title:
A clinical study on the curative effects and mechanism of action of oral applications of Buyang Huanwu Tang Jiajian(補(bǔ)陽還五湯加減)and Rivaroxaban for preventing deep venous thrombosis after the surgery of hip replacement in the aged
作者:
周曉聰; 丁玉梅; 周前; 劉武
(臺州市博愛醫(yī)院,浙江 臺州 318050)
Author(s):
ZHOU Xiaocong; DING Yumei; ZHOU Qian; LIU Wu
Taizhou Bo’ai Hospital,Taizhou 318050,Zhejiang,China
關(guān)鍵詞:
靜脈血栓形成;  關(guān)節(jié)成形術(shù); 置換; 髖;  補(bǔ)陽還五湯;  凝血酶原時間;  部分促凝血酶原時間;  凝血酶時間;  纖維蛋白原;  D-二聚體;  一氧化氮合酶;  一氧化氮;  老年人;  臨床試驗(yàn)
Keywords:
venous thrombosis;  arthroplasty; replacement; hip;  Buyang Huanwu Tang;  prothrombin time;  partial thromboplastin time;  thrombin time;  fibrinogen;  D-dimer;  nitric oxide synthase;  nitric oxide;  aged;  clinical trial
摘要:
目的:觀察補(bǔ)陽還五湯加減聯(lián)合利伐沙班預(yù)防老年髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成(deep venous thrombosis,DVT)的臨床療效,并探討其作用機(jī)制。方法:將128例接受髖關(guān)節(jié)置換術(shù)的老年患者隨機(jī)分為2組,每組64例。單純利伐沙班組于術(shù)后6 h開始口服利伐沙班片,每日1次,每次10 mg,共4周; 補(bǔ)陽還五湯加減聯(lián)合利伐沙班組在單純利伐沙班組治療方案的基礎(chǔ)上于術(shù)后第2天開始口服補(bǔ)陽還五湯加減,每日3次,共1周。分別于術(shù)前、術(shù)后4周測量并比較2組患者髕骨上15 cm處大腿周徑與踝關(guān)節(jié)上方15 cm處小腿周徑,記錄并比較2組患者術(shù)后下肢DVT的發(fā)生率,分別于術(shù)前、術(shù)后3 d測定并比較2組患者凝血酶原時間(prothrombin time,PT)、活化部分凝血活酶時間(activated partial thromboplastin time,APTT)、凝血酶時間(thrombin time,TT)及纖維蛋白原(fibrinogen,FIB)、D-二聚體的血清含量,分別于術(shù)前、術(shù)后7 d測量并比較2組患者內(nèi)皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)、一氧化氮(nitric oxide,NO)的血清含量。結(jié)果:①下肢周徑。術(shù)前2組患者大腿周徑、小腿周徑比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(40.91±3.75)cm,(40.70±3.62)cm,t=0.322,P=0.748;(27.90±2.64)cm,(28.58±2.71)cm,t=1.438,P=0.153]; 術(shù)后4周,補(bǔ)陽還五湯加減聯(lián)合利伐沙班組患者大腿周徑、小腿周徑均小于利伐沙班組[大腿周徑:(42.90±2.13)cm,(44.83±2.92)cm,t=4.272,P=0.011; 小腿周徑:(30.02±1.81)cm,(32.19±2.44)cm,t=5.714,P=0.010],2組患者大腿周徑、小腿周徑均大于術(shù)前(大腿周徑:t=3.002,P=0.003; t=7.070,P=0.000; 小腿周徑:t=5.299,P=0.000; t=7.920,P=0.000)。②DVT發(fā)生率。利伐沙班組7例發(fā)生DVT,補(bǔ)陽還五湯加減聯(lián)合利伐沙班組無DVT發(fā)生; 補(bǔ)陽還五湯加減聯(lián)合利伐沙班組DVT發(fā)生率低于利伐沙班組(χ2=5.440,P=0.020)。③凝血功能指標(biāo)。術(shù)前2組患者PT、APTT、TT及FIB、D-二聚體血清含量比較,組間差異均無統(tǒng)計(jì)學(xué)意義[PT:(11.29±1.43)s,(11.27±1.50)s,t=0.077,P=0.939; APTT:(32.06±5.02)s,(32.09±4.85)s,t=0.034,P=0.973; TT:(16.06±1.03)s,(16.10±1.06)s,t=0.217,P=0.829; FIB:(3.82±0.53)μg·L-1,(3.91±0.64)μg·L-1,t=0.866,P=0.388; D-二聚體:(164.52±35.90)μg·L-1,(163.31±37.54)μg·L-1,t=0.185,P=0.854]; 術(shù)后3 d補(bǔ)陽還五湯加減聯(lián)合利伐沙班組PT、APTT、TT均長于利伐沙班組[PT:(14.13±1.28)s,(12.27±1.39)s,t=7.875,P=0.009; APTT:(41.15±5.36)s,(36.51±5.24)s,t=4.952,P=0.010; TT:(18.01±0.84)s,(16.97±0.73)s,t=7.476,P=0.008],FIB、D-二聚體血清含量均低于利伐沙班組[FIB:(3.06±0.72)μg·L-1,(3.42±0.39)μg·L-1,t=3.517,P=0.001; D-二聚體:(1 249.46±136.81)μg·L-1,(1 623.62±154.14)μg·L-1,t=14.525,P=0.000]; 2組患者PT、APTT、TT均長于術(shù)前(PT:t=11.838,P=0.000; t=3.912,P=0.000; APTT:t=9.902,P=0.000; t=4.952,P=0.000; TT:t=11.737,P=0.000; t=5.408,P=0.000),FIB血清含量均低于術(shù)前(t=6.801,P=0.000; t=5.230,P=0.000),D-二聚體血清含量均高于術(shù)前(t=61.365,P=0.000; t=73.639,P=0.000)。④eNOS和NO血清含量。術(shù)前2組患者eNOS和NO血清含量比較,組間差異均無統(tǒng)計(jì)學(xué)意義[eNOS:(20.03±2.35)μmol·L-1,(20.16±2.17)μmol·L-1,t=0.325,P=0.746; NO:(62.75±4.80)×103 μmol·L-1,(63.04±4.15)×103 μmol·L-1,t=0.366,P=0.715]; 術(shù)后7 d補(bǔ)陽還五湯加減聯(lián)合利伐沙班組患者eNOS和NO血清含量均高于利伐沙班組[eNOS:(29.58±2.49)μmol·L-1,(26.48±2.62)μmol·L-1,t=6.861,P=0.008; NO:(86.53±4.96)×103 μmol·L-1,(79.39±5.20)×103 μmol·L-1,t=7.949,P=0.006],2組患者eNOS和NO血清含量均高于術(shù)前(eNOS:t=22.314,P=0.000; t=14.862,P=0.000; NO:t=27.562,P=0.000; t=19.660,P=0.000)。結(jié)論:對行髖關(guān)節(jié)置換術(shù)的老年患者,術(shù)后給予補(bǔ)陽還五湯加減聯(lián)合利伐沙班治療,與單純利伐沙班治療相比,能減輕下肢腫脹,降低DVT的發(fā)生率; 其作用機(jī)制可能是通過上調(diào)eNOS和NO的表達(dá),使凝血功能得以改善,從而預(yù)防DVT的形成。
Abstract:
To observe the clinical curative effects of oral applications of Buyang Huanwu Tang Jiajian(補(bǔ)陽還五湯加減,BYHWTJJ)and Rivaroxaban for preventing deep venous thrombosis(DVT)after the surgery of hip replacement in the aged and to explore its mechanism of action.Methods:One hundred and twenty-eight aged patients who received surgery of hip replacement were randomly divided into combination therapy group and monotherapy group,64 cases in each group.All patients in the 2 groups were treated with oral application of Rivaroxaban since the postoperative hour 6,once a day,10 mg at a time for consecutive 4 weeks.Moreover,the patients in combination therapy group were treated with oral application of BYHWTJJ since the postoperative day 2,three times a day for 1 week.The perimeters of thigh(at 15 cm above the patella)and calf(at 15 cm above the ankle)were measured and compared between the 2 groups before the surgery and at 4 weeks after the surgery respectively.The incidence rate of postoperative DVT were recorded and compared between the 2 groups.The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and the serum contents of fibrinogen(FIB)and D-dimer were measured and compared between the 2 groups before the surgery and at 3 days after the surgery respectively.The serum contents of endothelial nitric oxide synthase(eNOS)and nitric oxide(NO)were measured and compared between the 2 groups before the surgery and at 7 days after the surgery respectively.Results:There were no statistical difference in the perimeters of thigh and calf between the 2 groups before the surgery(40.91+/-3.75 vs 40.70+/-3.62 cm,t=0.322,P=0.748; 27.90+/-2.64 vs 28.58+/-2.71 cm,t=1.438,P=0.153).The perimeters of thigh and calf were smaller in combination therapy group compared to monotherapy group at 4 weeks after the surgery(perimeter of thigh:42.90+/-2.13 vs 44.83+/-2.92 cm,t=4.272,P=0.011; perimeter of calf:30.02+/-1.81 vs 32.19+/-2.44 cm,t=5.714,P=0.010),and were greater at 4 weeks after the surgery compared to pre-surgery in the 2 groups(perimeter of thigh:t=3.002,P=0.003; t=7.070,P=0.000; perimeter of calf:t=5.299,P=0.000; t=7.920,P=0.000).The DVT was found in 7 patients in monotherapy group and no DVT was found in combination therapy group.The incidence rate of postoperative DVT was lower in combination therapy group compared to monotherapy group(χ2=5.440,P=0.020).等

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更新日期/Last Update: 2020-10-20