补阳还五汤对高龄股骨转子间骨折患者髋关节置换术后凝血与血液流变学指标的影响研究

摘要

目的：探讨补阳还五汤对高龄股骨转子间骨折患者髋关节置换术后凝血与血液流变学指标的影响。方法：将70例高龄股骨转子间骨折髋关节置换术后患者随机分为2组，治疗组（n ＝35）采用中药汤剂补阳还五汤治疗，对照组（n ＝35）采用低分子肝素治疗，观察2组受试对象治疗前、后凝血指标：凝血酶原时间（Prothrombin Time，PT）、活化部分凝血活酶时间（Activated Partial Thromboplastin Time，APTT）、D-二聚体（D-dimer，D-D）与血液流变学指标：全血黏度高切、全血黏度中切、全血黏度低切、血浆黏度以及伤肢彩色多普勒超声检查结果的变化情况。结果：2组患者治疗前凝血指标：PT、APTT、D-D 与血液流变学指标：全血黏度高切、全血黏度中切、全血黏度低切、血浆黏度比较，差异均无统计学意义（均 P ＞0.05），治疗后，2组患者凝血指标：PT、APTT、D-D 与血液流变学指标：全血黏度高切、全血黏度中切、全血黏度低切、血浆黏度均显著改善，与治疗前比较，差异有统计学意义（P ＜0.05），且治疗组的改善程度明显优于对照组，差异有统计学意义（P ＜0.05）；伤肢彩色多普勒超声检查结果显示，治疗组的静脉血栓（Venous Thrombosis，DVT）发生率明显少于对照组，2组比较差异有统计学意义（P ＜0.05）。结论：补阳还五汤可以改善高龄股骨转子间骨折患者髋关节置换术后血液高凝状态，激活纤溶系统，调节血液黏度，从而降低 DVT 的发生率。%Objective:To evaluate the effect of Buyang Huanwu decoction on coagulation and blood rheology indexes in aged pa-tients who received hip replacement for intertrochanteric fracture.Methods:Seventy cases of aged patients with intertrochanteric fracture who received hip replacement were randomly selected and divided into two groups.The experimental group (n =35)re-ceived traditional Buyang Huanwu decoction and the control group (n =35)received low molecular heparin therapy.To observe the coagulation indexes and hemorheology indexes of tje two groups of subjects before and after treatment,including Prothrombin time (PT),activated partial thromboplastin time (APTT),D-dimer(D-D)and other blood rheology indexes:high shear rate of whole blood viscosity,middle shear rate of whole blood viscosity,low shear rate of whole blood viscosity and plasma viscosity.Results:The blood coagulation indexes and hemorheology indexes before treatment between the two groups had no statistical significance (P >0.05).After treatment,the two groups of patientsblood coagulation indexes and hemorheology indexes were all significantly im-proved,while the improvement of the experimental group was significantly better than the control group (P <0.05).The results of leg color doppler ultrasound examination showed that the incidence of venous thrombosis (DVT)in the experimental group is less than that in the control group,and the difference between the two groups has statistical significance(P <0.05).Conclusion:Buy-ang Huanwu decoction can improve hypercoagulable state of aged patients who suffered intertrochanteric fracture and received hip replacement,activate fibrinolytic system,regulate blood viscosity and reduce the incidence of venous thrombosis (DVT).