【作者】 肖署阳；

【导师】 蔡立民；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2010， 硕士

【摘要】 目的：观察活血灵片对骨科大手术后血液流变学、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)指标的变化。希望通过这些指标好转来表明活血灵片具有促进血液循环,改善血液高粘和高凝状态。降低骨科大手术术后深静脉血栓形成(DVT)的危险因素从而降低其发生率。方法：将2008年11月—2010年2月期间东莞市中医院骨科病房90例行骨科大手术住院合格病例(包括人工股骨头置换术、人工全髋关节置换术、髋部周围骨折行内固定手术和人工膝关节置换术)按分层随机分成A、B、C三组,术后12小时开始分别给予活血灵片、活血灵片+低分子肝素、低分子肝素干预,疗程均为10天。通过观察三组患者术前、术后第1、14天血液流变学、PT和APTT指标的变化。并比较三组病例DVT的发生率。结果：1血液流变学指标研究结果显示用药前三组患者血液流变学指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较血沉明显增高,有统计学差异(P<0.05)。其余血液流变学指标比较虽无统计学差异,但术后第1天大部分血液流变学指标均值比术前低。在术后第14天自身全血粘度、全血高切相对指数、全血低切相对指数、全血低切还原粘度、全血高切还原粘度均降低,有统计学差异(P<0.05)。治疗后B组患者血液流变学指标优于A、C组。而A组和C组患者大部分血液流变学指标无统计学差异(P>0.05),而血浆粘度指标比较C组、B组与A组有统计学差异(P<0.05)。2出凝血组检指标研究结果显示用药前三组患者PT和APTT指标无统计学差异(P>0.05)。三组患者术前和术后第1天自身比较PT指标有统计学差异(P<0.05),APTT指标无统计学差异(P>0.05)。在术前和术后第14天自身比较PT和APTT指标均有统计学差异(P<0.05)。A组分别与B组和C组PT比较有统计学差异(P值均<0.05),APTT比较无统计学差异(P值均>0.05)。3 DVT发生率研究结果显示90例病例中,共有8例发生DVT,总发生率为8.89%。其中B组发生2例DVT,发生率6.67%。A组和C组均发生3例DVT,发生率均为10.00%。结论：活血灵片和低分子肝素对大部分血液流变学指标均有明显改善,对于血浆粘度改善,活血灵片不如低分子肝素。同时活血灵片和低分子肝素都能明显延长PT和APTT,但低分子肝素效果优于活血灵片。故采用活血灵片干预骨科大手术后患者,能降低患者的血液流变学及延长出凝血组检指标,改善血液高粘和高凝状态。同时低分子肝素联合应用活血灵片效果更明显,故指导临床上可应用中西医结合方法预防骨科大手术后DVT。更多还原

【Abstract】 Objective:Observating the variation of hemorheology and prothrombin time and activated partial thromboplatin time after major surgery orthopedics with the tablet of Huo Xue Ling. Hope for the tablet of Huo Xue Ling has the functions of promoting blood circulation and reducing high blood coagulation, and high-viscosity through the forthebetter of these indexes. Decreasing the risk factors of deep venous thrombosis after major surgery orthopedics, consequently decreasing the rate of deep venous thrombosis.Method:90 patients with major surgery orthopedics(Including prosthetic replacement for femoral head, total hip arthroplasty, fixation around the line of hip fracture and total knee arthroplasty)were selected from Dongguan Hospital of TCM during November 2008 to February 2010, and were divided into three groups at stratified randomization. Three groups were given The tablet of Huo Xue Ling, Low molecular weight heparin and The tablet of Huo Xue Ling, Low molecular weight heparin, were using to 10 days. Compared the variation of hemorheology and prothrombin time and activated partial thromboplatin time when preoperatively, after the first and 14th day of the operation. Compared the deep venous thrombosis rate of them.Results:1. HemorheologyThe results showed that the hemorheology of these three groups had no significant difference(P>0.05)before treatment. The erythrocyte sedimentation rate of these three groups themselves had significant difference (P<0.05) between before treatment and the first day of the operation. Although the rest of hemorheology had no significant difference(P>0.05), However, The average of hemorheology after operation was lower than before treatment. The whole blood viscosity, The high-shear relative index of whole blood, The low-shear relative index of whole blood,The low-shear reduced viscosity of whole blood and The high-shear reduced viscosity of whole blood reduced when after the 14th day of the operation, showed significant difference (p<0.05). The hemorheology of group B was better than group A and C when after the 14th day of the operation. Most of hemorheology had no significant difference (P>0.05) between group A and group C. But the Plasma viscosity of group C and group B was better than group A showed significant difference(p<0.05).2. Coagulation group seized IndexThe results showed that the prothrombin time and activated partial thromboplatin time of these three groups had no significant difference(P>0.05)before treatment. The prothrombin time of these three groups themselves had significant difference(P<0.05)between before treatment and the first day of the operation. But comparing the activated partial thromboplatin time had no significant difference(P>0.05). The prothrombin time and activated partial thromboplatin time of these three groups themselves had significant difference(p<0.05)between before treatment and the 14th day of the operation. The prothrombin time of the group A had significant difference (p<0.05) among group B and group C when after the 14th day of the operation, But the activated partial thromboplatin time had no significant difference(P>0.05).3. Deep venous thrombosis rateThe results showed that Ninety cases, a total of eight cases occurred DVT, with a total incidence of 8.89 percent, in which group B occurred two cases of DVT rate of 6.67 percent, group A and group C all occurred three cases of DVT rate of 10.00 percent.Conclusion:Most of hemorheology significantly reduced after using the tablet of Huo Xue Ling or Low molecular weight heparin, Huo Xue Ling was worse than Low molecular weight heparin to reducing in plasma viscosity. The prothrombin time and activated partial thromboplatin time were significantly extended after using the tablet of Huo Xue Ling or Low molecular weight heparin, but the Low molecular weight heparin was better than Huo Xue Ling. The Hemorheology of patients can be reduced and the Coagulation group seized Index of patients can be extended and the high blood coagulation, and high-viscosity of patients can be improved after major surgery orthopedics with the tablet of Huo Xue Ling. The effect is better when using the tablet of Huo Xue Ling and Low molecular weight heparin at the same time. So we can prevent the formation of DVT after major surgery orthopedics combining treatment of traditional Chinese medicine and western medicine in clinically.更多还原