目的 观察活血通络膏联合低分子肝素钙预防全髋关节置换术(THA)术后患者下肢深静脉血栓形成的临床疗效.方法 将69例接受单侧THA手术的患者随机分为试验组33例与对照组36例.对照组给予低分子肝素钙10d,试验组在对照组基础上加用活血通络膏14 d.在术前、术后7、14 d分别检测患肢深静脉彩超,测定活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、血浆D-二聚体(D-D)及血小板计数(PLT);术前1d、术后1、7、14d分别测量患肢大腿及小腿周径.结果 试验组APTT、PT与术前比较,术后7d均明显延长;与本组术后7d比较,术后14d亦明显延长,差异具有统计学意义(P＜0.05);与对照组同时间段比较,差异均具有统计学意义(均P＜ 0.05).试验组D-D与术前比较,术后7d明显升高;与本组术后7d比较,术后14 d明显下降,差异具有统计学意义(P＜0.05);与对照组同时间段比较,术后7d差异无统计学意义(P＞0.05),术后14 d差异具有统计学意义(P＜0.05).试验组PLT与术前比较,术后7d明显升高;与本组术后7d比较,术后14d亦明显升高,差异具有统计学意义(P＜0.05);与对照组同时间段比较,差异无统计学意义(均P＞ 0.05).试验组大腿及小腿周径差值与术后1d比较,术后7d均明显减小;与本组术后7d比较,术后14d亦明显减小,差异具有统计学意义(P＜0.05);与对照组同时间段比较,术后7d大腿周径差值及术后7d、14 d小腿周径差值的差异均无统计学意义(均P＞0.05),术后14d大腿周径差值差异具有统计学意义(P＜0.05).试验组1例发生DVT(腘静脉)、对照组3例发生DVT(股静脉1例、腘静脉2例),组间差异无统计学意义(P＞0.05).所有患者治疗及随访期间均无严重并发症发生.结论 活血通络膏联合低分子肝素钙能较好地减轻THA术后患肢肿胀,明显延长APTT及PT,在安全性能方面与单纯低分子钙素钙相当.%Objective:To observe the effectiveness of the application of Huoxue Tongluo ointment combing Low-molecular-weight Heparin Calcium Injection in preventing deep venous thrombosis (DVT) after total hip arthroplasty (THA).Methods:Sixty-nine patients who underwent unilateral THA were randomly divided into 2 groups,33 cases in experimental group,and 36 cases in control group.The control group was treated with Low molecular-weight Heparin Calcium Injection for 10 d;On the basis of the control group,the experimental group was treated with Huoxue Tongluo ointment for 14 d.Limb deep venous ultrasound and APTT,PT,D-D and PLT in the preoperative and postoperative 7,14 d were detected.Measurement of the thigh and leg circumference in the preoperative 1 d and postoperative 1,7,14 d were made.Results:In the experimental group,in postoperative 7 d,the APTT and PT were significantly prolonged.Compared with the result on 7 d after operation,the result on 14 d was also significantly prolonged.The difference was statistically significant (P＜ 0.05).Compared with the control group at the same time,the difference was statistically significant(P＜ 0.05).In postoperative 7 d,the D-D in the experimental group was significantly increased.Compared with the result on 7d after operation,the result on 14 d was significantly decreased.The difference was statistically significant (P＜0.05).Compared with the control group at the same time,there was no significant difference in postoperative 7 d (P＞ 0.05),however the difference was statistically significant in postoperative 14 d (P ＜ 0.05).In postoperative 7 d,the PLT in the experimental group was significantly increased.Compared with the result on 7 d after operation,the result on 14 d was also significantly increased.The difference was statistically significant (P＜0.05).Compared with the control group at the same time,the difference was not significant difference (P＞ 0.05).In postoperative 7 d,the thigh and leg circumference in the experimental group was significantly decreased compared with the result in postoperative 1 d.Compared with the result on 7 d after operation,the result on 14 d was also significantly decreased.The difference was statistically significant (P＜ 0.05).Compared with the control group at the same time,there was no significant difference in postoperative 7 d on thigh circumference and postoperative 7 d and 14 d on leg circumference (P＞ 0.05).However the difference was statistically significant in postoperative 14 d on thigh circumference(P＜ 0.05).DVT was found in 1 case of experimental group (popliteal vein),3 cases of control group,(1 in femoral vein and 2 in popliteal vein).There was no statistical significance in the incidence of DVT between the 2 groups (P＞ 0.05).No adverse effect was observed in both groups.Conclusion:Huoxue Tongluo ointment combing Low-molecularweight Heparin Calcium Injection can effectively reduce the THA postoperative limb swelling,prolong APTT and PT.Its safety is similar to Low-molecular-weight Heparin Calcium Injection.
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