摘要
目的探讨通脉汤配合低分子肝素钙预防外伤股骨闭合骨折患者高凝状态的效果。方法选取2015年2月～2016年2月广东省佛山市中医院收治的外伤股骨闭合粉碎骨折当天人院的120例患者作为研究对象．采用随机数字法将其分为基础组、通脉汤组、低分子肝素钙组、联合组。基础组在入院后给予自制三七丸口服．在此基础上通脉汤组给予单独通脉汤治疗至术后第6天，低分子肝素钙组给予单独低分子肝素钙治疗至人院后第6天停药，术后继续使用，一般连续使用3d，联合组给予通脉汤配合低分子肝素钙治疗，用法同上。比较四组患者治疗前后凝血指标[D—D二聚体（D—Di）、血小板计数（PLT）、血小板聚集率（PAgR）]、凝血弹性描记图（TEG）指标fR时间、K时间、d角、最大幅度（MA）]和血液流变学指标（全血低切黏度、全血高切黏度、毛细血管黏度、血细胞比容、红细胞聚集指数）的变化情况。结果治疗后，通脉汤组、低分子肝素钙组及联合组患者的凝血指标（D—Di、PLT、PAgR）、TEG指标（R时间、K时间、仪角、MA）和血液流变学指标（全血低切黏度、全血高切黏度、毛细血管黏度、血细胞比容、红细胞聚集指数）均较治疗前显著改善，且明显优于基础组，差异均有统计学意义（P〈0．05），但三组之间比较差异无统计学意义（P〉0．05）。结论通脉汤与低分子肝素钙在改善外伤股骨闭合骨折患者血液高凝状态中的效果相当，但通脉汤使用更安全，可抑制血小板聚集，改变血液的流变性质，且无出血倾向，能有效地防止骨折后深静脉血栓的形成。
Objective To discuss the effect of Tongmai Decoction combined with low molecular weight heparin calcium for prevention of hypercoagulable state of patients with traumatic closed fracture of the femur. Methods One hundred and twenty cases of patients with traumatic closed fracture of the femur on the day of admission admitted to Foshan Hospital of TCM from February 2015 to February 2016 were selected as research objects, according to the random number table, the patients were divided into basic group, Tongmai Decoction group, low molecular weight heparin cal- cium group, combined group. The basic group was given self-made Sanqi Pills orally after admission, on basis of which, Tongmai Decoction group was only given Tongmai Decoction continued to the sixth day after operation, low molecular weight heparin calcium group was only given low molecular weight heparin calcium to the sixth day after admission, continued to use after operation, for 3 days generally, the combined group was given Tongmai Decoction combined with low molecular weight heparin calcium, the usage was the same as above. The changes of coagulation indicators [d- dimer concentration （D-Di）, blood platelet count （PLT）, platelet aggregation rate （PAgR）], thromboelastogram （TEG） in- dexes [R time, K time, alpha angle, max amplitude （MA）] and hemodynamic indexes （whole blood low shear viscosity, whole blood high shear viscosity, capillary viscosity, hacmatocrit, erythrocyte aggregation index） before and after treat- ment among the four groups were compared. Results After treatment, the coagulation indicators （D-Di, PLT, PAgR） and TEG indexes （R time, K time, alnha angle, MA） and hemodynamic indexes （whole blood low shear viscosity, wholeblood high shear viscosity, capillary viscosity, haematocrit, erythrocyte aggregation index） in the Tongmai Decoction group, low molecular weight heparin calcium group and combined group were all significantly improved compared with those before treatment, which were also better than those of basic group, the differences were all statistically significant （P 〈 0.05）, which there were no statistically significant differences among the three groups （P 〉 0.05）. Conclusion Tongmai Decoction and low molecular weight heparin calcium has similar effect in improving the blood hypercoagulable state of patients with traumatic closed fracture of the femur, but Tongmai Decoction can inhibit the platelet aggregation, change the rheological properties of blood, without bleeding tendency, which can effectively prevent the formation of deep ve- nous thrombosis after fracture.
出处
《中国医药导报》
CAS
2016年第21期177-180,184,共5页
China Medical Herald
基金
广东省佛山市医学类科技攻关项目(2014AB00323)
关键词
外伤股骨闭合骨折
高凝状态
通脉汤
低分子肝素钙
Traumatic closed fracture of the femur
Hypercoagulable state
Tongmai Decoction
Low molecular weightheparin calcium
