【作者】 秦宇航；

【导师】 黄桂成；

【作者基本信息】 南京中医药大学 ， 中医骨伤科学， 2010， 博士

【摘要】 深静脉血栓形成(DVT)是人工关节置换术后常见之并发症,可引发严重的下肢循环障碍,甚至出现致死性肺栓塞,其发病机制和危害性已被广泛关注和深入研究。据国内外报道,未采取任何预防措施的人工关节置换术后DVT发病率达40%以上,目前尚缺乏统一有效的方法以预防DVT。中医药防治血栓栓塞类疾病经验丰富、源远流长、独具特色,由于疗效确切、毒副作用少且费用低廉,易为广大患者所接受,其优势日益凸显。本文系统整理了历代中医及现代医学对DVT的认识,归纳了DVT的病因病机、治则治法和各种诊疗预防措施,从临床和实验两方面研究探讨了养阴活血汤预防人工关节置换术后下肢DVT的疗效和作用机理。临床研究以60例下肢人工关节置换术后患者为对象,证明养阴活血汤具有养阴滋血清热、活血通络益气之效。该方可明显延长凝血酶原时间,抑制术后血小板凝集,从而改善血液高凝状态、预防血栓形成；同时能显著减轻患者术后临床症状,无诱发出血倾向,安全性高。实验研究以40只DVT模型大鼠为对象,通过检测实验大鼠血浆相关凝血指标含量的变化和切片观察大鼠病变下腔静脉,证明养阴活血汤可显著升高大鼠血浆中t-PA、6-keto-PGF1α与NO的含量,同时降低PAI、TXB2与ET的含量,从而打破Virchow病理三要素,能有效抑制血栓形成和促进血栓溶解,并且保护内皮细胞,修复静脉壁损伤,维护血管功能。课题研究结果表明,养阴活血汤具有良好的DVT预防效果和优于低分子肝素的高安全性。其价格经济、服用方便、病人依从性好,是值得临床选用的中药方剂。更多还原

【Abstract】 Deep vein thrombosis (DVT) after total artificial joint replacement is a common complication, which can cause severe lower limb circulatory disturbance or even fatal pulmonary embolism. Its pathogenesis and harm has been extensively concerned and profoundly researched. According to foreign reports, the incidence rate of DVT is about 40% if having not taken any preventive measures after total joint replacement operations. It still lacks a unified and effective way to prevent the formation of DVT currently. The treatment of traditional Chinese medichine to thromboembolic diseases has experienced a long history owning unique skills, precise effects, few side effects, low cost so that it is easily accepted by the majority of patients and its advantages are increasingly obvious.This dissertation systematically analyzes the accumulated knowledge of DVT from ancient Chinese medicine to modern medicine and summarizes the causes and pathogenesis, principle and therapy, various clinical diagnostic and preventive measures. From clinical and experimental studies, it explores the efficacy and mechanism of Yang Yin Huo Xue Decoction preventing the formation of lower limb DVT after joint replacement.Clinical study taking the objects of 60 patients with lower extremity after total joint replacement proves that Yang Yin Huo Xue Decoction can nourish yin and clear away heat, dredge the channel and promote blood circulation. From significantly prolonging prothrombin time and inhibiting platelet aggregation, it can effectively improve the blood hypercoagulable state and prevent thrombosis formation, while little effect on platelet levels, non-induced bleeding tendency, significantly reducing postoperative clinical symptoms. Experimental study taking the objects of 40 rats of DVT model by detecting the levels of indicators related to blood coagulation changes in rats plasma and observing the slices of rat inferior vena cava proves that Yang Yin Huo Xue Decoction can significantly elevate t-PA,6-keto-PGF1αand NO levels, while reducing PAI, TXB2 and ET levels in rat plasma. The decoction has the super capacity of breaking the three elements of Virchow pathology, inhibiting thrombosis effectively, promoting thrombolysis, protecting endothelial cells, repairing vein wall damage, maintaining vascular function.The research results show that the Yang Yin Huo Xue Decoction for preventing DVT has good control effect and it is superior to the low molecular weight heparin on high security. With economic price, convenient taking, favorable compliance, this Chinese medicine prescription is worthy of clinical utilization.更多还原