参芎葡萄糖注射液协同防治重症患者深静脉血栓的临床疗效

摘要

Objective:To investigate the preventive effect of shen-xiong glucose injection on deep venous thrombosis(DVT) in critical patients and its mechanism.Method:141 critical patients were enrolled in this study.They were divided into the control group (n=68) and the observation group(n=73) according to whether they used shen-xiong glucose injection.The control group received the standardized treatment and anticoagulation therapy.The observation group received same treatment,combined with the shen-xiong glucose injection (100ml iv drip,1 times/d).Both groups were treated for 7 days.The incidence of DVT and the indexes of hemorheology(high and low shear viscosity rate,plasma viscosity shear rate,plasma viscosity shear rate,hematocrit,platelet aggregation rate) before and after treatment were recorded.The changes of coagulation and fibrinolysis indexes[plasma prothrombin time (PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),two D-dimer(D-D) and platelet count (PLT)] and inflammatory factors [tumor necrosis factor-α (TNF-α),interleukin-1 (IL-1),interleukin-6 (IL-6)] were measured.Bleeding event was followed up.Results:After treatment,the incidence of DVT in observation group was significantly lower than that in control group (P＜0.05).The effect of reduction was mainly manifested in stroke,traumatic brain injury,chronic heart failure and advanced tumor (P＜0.01).Compared with before treatment,The hemodynamic parameters,coagulation and fibrinolysis indicators not hematokrit in both group were significantly improved after treatment(P＜0.05),especially in the observation group (P＜0.05).After treatment,the levels of serum inflammatory factors in the two groups were significantly lower than those before treatment (P＜0.01),especially in the observation group (P＜0.01).During follow-up,the bleeding rate in the observation group was slightly higher than that in the control group,but not showed the difference (P＞0.05).Conclusion:Shen-xiong glucose injection has a good preventive effect on DVT in critical patients.It dose not increase the bleeding events,which may be related to the improvement of blood rheology,coagulation indicators and the reduction of inflammation.%目的:观察参芎葡萄糖注射液防治重症患者深静脉血栓形成疗效并探讨其机制.方法:141例继发性血栓倾向重症患者按其治疗方法分为对照组(n=68)和观察组(n=73).对照组采用标准化常规抗凝治疗;观察组在对照组基础上加用参芎葡萄糖注射液(100ml静滴,1次/天),两组疗程均为7天.比较两组治疗后深静脉血栓发生率和治疗前后血液流变学指标(高切和低切全血表观黏度、血浆黏度、红细胞压积、血小板聚集率)、凝血纤溶指标[血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)、血小板计数(PLT)]以及炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)]水平变化.观察治疗期间两组患者出血事件发生率.结果:治疗后观察组深静脉血栓发生率明显低于对照组(P＜0.01),降低效应主要体现在脑卒中、颅脑外伤、慢性心力衰竭及肿瘤晚期等疾病(P＜0.01).所有患者治疗后血液流变学指标(红细胞压积除外)及凝血纤溶指标均较治疗前改善(P＜0.01);观察组治疗后较对照组治疗后改善更明显(P＜0.01).治疗后两组血清炎性因子水平亦较治疗前明显下降(P＜0.01);观察组治疗后较对照组治疗后下降更显著(P＜0.01).观察组出血等不良反应发生率稍高于对照组,但差异无统计学意义(P＞0.05).结论:参芎葡萄糖注射液能较好地协同防治深静脉血栓形成,且不增加出血事件,这可能与其改善血液流变学及凝血指标,减轻炎症有关.