健脾益气汤预防膝关节置换术后深静脉血栓形成的疗效观察_许兴辉.pdf

海南医学2023年7月第34卷第13期Hainan Med J,Jul.2023,Vol.34,No.13健脾益气汤预防膝关节置换术后深静脉血栓形成的疗效观察许兴辉，侯凯，王世华，刘一飞宝鸡市中医医院骨关节一科，陕西宝鸡721001【摘要】目的观察健脾益气汤对膝关节置换术后患者下肢深静脉血栓(DVT)形成的预防效果。方法前瞻性选取2021年3月至2022年3月宝鸡市中医医院收治的150例行膝关节置换术患者作为研究对象，按住院号分为对照组76例(采用常规方法治疗)和观察组74例(采用常规疗法联合健脾益气汤方治疗)。两组患者均治疗14 d，比较两组患者术前、术后2 d、术后14 d的凝血功能指标、患肢大小腿周径，治疗前、治疗14 d后的中医症状积分变化，治疗14 d后的患肢功能疗效及DVT和不良反应发生情况。结果两组患者术后2 d的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)均较术前缩短，纤维蛋白原(FIB)水平较术前升高，术后14 d的PT、APTT均较术后2 d延长，FIB水平较术后2 d降低，且术后14 d，观察组患者的PT、APTT均较对照组长，FIB水平较对照组低，差异均有统计学意义(P0.05)；两组患者术后2 d的大小腿周径较术前增加，术后14 d的大小腿周径较术后2 d缩小，且术后14 d时，观察组患者的上述大小腿周径均小于对照组，差异均有统计学意义(P0.05)；治疗后，两组患者的患肢肿胀、胀痛及青筋曲张症状积分均降低，且观察组明显低于对照组，差异均有统计学意义(P0.05)；观察组患者的患肢功能临床有效率为95.95%，明显高于对照组的86.84%，DVT发生率为2.70%，明显低于对照组的11.84%，差异均有统计学意义(P0.05)。结论自拟健脾益气汤方用于治疗膝关节置换术可有效调节患者凝血功能，预防DVT的形成，促进下肢肿痛消退。【关键词】健脾益气汤；膝关节置换术；下肢深静脉血栓；预防；疗效【中图分类号】R687.4【文献标识码】A【文章编号】10036350（2023）13186605Clinical efficacy of Jianpi Yiqi decoction on preventing deep venous thrombosis formation after kneearthroplasty.XU Xing-hui,HOU Kai,WANG Shi-hua,LIU Yi-fei.The First Department of Bone and Joint,Baoji Hospitalof Traditional Chinese Medicine,Baoji 721001,Shaanxi,CHINA【Abstract】ObjectiveTo observe the preventive effect of Jianpi Yiqi decoction on the formation of lower limbdeep venous thrombosis(DVT)in patients after knee arthroplasty.MethodsA total of 150 patients undergoing knee ar-throplasty in Baoji Hospital of Traditional Chinese Medicine from March 2021 to March 2022 were prospectively select-ed and divided into a control group(76 cases,conventional therapy)and an observation group(74 cases,conventionaltherapy combined with Jianpi Yiqi decoction)according to the hospitalization number.Both groups were treated for 14days.The coagulation function indicators,thigh circumference,and shank circumference of the affected limbs before sur-gery and at 2 days and 14 days after surgery,TCM symptoms scores before treatment and after 14 days of treatment,functional efficacy of affected limb,occurrence of DVT,and adverse reactions were compared between the two groups.ResultsAt 2 days after surgery,the prothrombin time(PT)and activated partial thromboplastin time(APTT)in thetwo groups were shortened compared with those before surgery,and the fibrinogen(FIB)was enhanced compared withthat before surgery;PT and APTT in the observation group at 14 days after surgery were longer than those in controlgroup,and FIB level was lower than that in control group;the differences were statistically significant(P0.05).Thethigh circumference and shank circumference in both groups were lengthened at 2 days after surgery compared to thosebefore surgery,and were shortened at 14 days after surgery compared with those at 2 days after surgery;the circumfer-ences of thigh and shank in the observation group were shorter than those in control group at 14 days after surgery;thedifferences were statistically significant(P0.05).After treatment,the scores of swelling of the affected limb,swellingpain,and varicose veins in the two groups were decreased,and the scores in the observation group were significantlylower than those in the control group(P0.05).The clinical effective rate of affected limb function in the observationgroup was significantly higher compared with that in the control group(95.95%vs 86.84%),while the incidence rate ofDVT was significantly lower than that in the control group(2.70%vs 11.84%),with statistically significant differences(P0.05).ConclusionSelf-made Jianpi Yiqi decoc-tion in the treatment of patients with knee arthroplasty can effectively regulate the coagulation function,prevent the for-mation of DVT,and promote the subsidence of lower limb swelling pain.【Key words】Jianpi Yiqi decoction;Knee arthroplasty;Lower limb deep venous thrombosis;Prevention;Efficacy 论著 doi:10.3969/j.issn.1003-6350.2023.13.010基金项目：陕西省社会发展科技攻关项目(编号：2016SF-187)。第一作者：许兴辉(1978)，男，硕士，副主任医师，主要研究方向：中医骨科。通讯作者：侯凯(1982)，男，硕士，副主任医师，主要研究方向：中医骨科，E-mail：。1866Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期下肢深静脉血栓(DVT)是膝关节置换术后常见并发症1，由于手术创伤、应激和麻醉因素等引起凝血异常，导致下肢深静脉腔内形成血栓，影响静脉回流受阻，引发下肢水肿、继发性静脉曲张或溃疡等症状，严重则可致肺栓塞甚至死亡。因此，对于该并发症的防治不可忽视。目前西医主要以低分子肝素等抗血小板聚集药物防治或弹力袜等物理防治方法为主，DVT发生率仍较高，且西药治疗会增加出血风险，不利于患者的整体健康2。有研究证实益气活血类中药方治疗在预防下肢骨科手术后DVT形成中效果明显3。在中医学中，DVT属于脉痹、肿胀范畴，气虚血瘀、湿阻脉络是主要病机，依据辨证施治原则需益气活血、祛湿通络4。但目前尚缺少中药方在膝关节置换术后DVT预防应用研究。基于此，本研究将自拟健脾益气汤方用于防治膝关节置换术患者术后DVT，以探讨健脾益气汤对膝关节置换术后DVT的预防价值。1资料与方法1.1一般资料前瞻性选取2021年3月至2022年3月宝鸡市中医医院收治的150例行膝关节置换术的患者作为研究对象，以住院号末位数字奇偶区别进行分组，末位数为奇数者纳入对照组，共76例；末位数字为偶数者纳入观察组，共74例。纳入标准：(1)行单侧全膝关节置换术；(2)年龄4575岁；(3)符合中医诊断标准，属脾肾阳虚型5：主证为患肢肿胀、沉重胀痛、青筋迂曲扩张，次证为腰酸畏寒、食欲差、倦怠无力、舌胖大苔白腻、脉沉细；(4)认知正常，可配合治疗。排除标准：(1)既往DVT病史或肺栓塞病史者；(2)存在其他严重功能性疾病或癌症者；(3)存在其他出血性创口或合并消化性溃疡者；(4)近1个月内有使用抗凝药物治疗者；(5)对本研究所用药物过敏者。本研究经医院伦理委员会批准(伦理批准号：BJSZYYY-LWTG-20221102)，所有患者均签署知情同意书。1.2治疗方法两组患者均由同组医师进行手术，术中均采用膝关节正中切口+内侧髌旁入路，均采用全麻；术后均常规予以抗炎及营养支持等治疗。1.2.1对照组该组患者采用常规方法预防血栓。具体方法：抬高患肢，并使用梯度压力弹力袜促进静脉回流。术后12 h进行皮下静脉注射低分子肝素钙注射液 0.4 mL(深圳赛保尔生物药业有限公司；国药准字H20060191；规格0.5 mL：5000AXa IU)0.5 mL 次-1 d-1，至术后10 d，术后第11天开始改为口服 利 伐 沙 班 片(齐 鲁 制 药 有 限