补阳还五汤加味防治骨科术后下肢深静脉血栓形成的临床研究

目的 探讨中药补阳还五汤加味防治骨科大手术后下肢深静脉血栓形成（deep veinthrombosis,DVT）的疗效优劣及安全性.方法 筛选60例患者随机分两组,治疗组口服补阳还五汤加味汤,2次/d;对照组皮下注射低分子肝素钠5000IU,1次/d.术后第1、7、14天观察凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和D-二聚体（D-dimer）及下肢深静脉血管彩超变化及术后48 h伤口引流量测定.结果 ①DVT发生率比较：用药后第7天治疗组DVT发生率稍高于对照组,1周后两组发生率基本相当,治疗结束后治疗组DVT发生率为6.66％（2/30）,对照组为10.0％（3/30）,两组DVT发生率比较,差异有统计学意义（P＜0.05）.②两组D-dimer变化比较：两组用药后第1天和第14天D-dimer治疗组分别为（0.782±0.472） mg/1、（0.320±0.102） mg/1;对照组分别为（0.720±0.421） mg/1、（0.417±0.217） mg/1]与同组治疗前治疗组为（0.548±0.245） mg/L；对照组为（0.560±0.195） mg/1]比较,用药后第1天D-dimer均较同组治疗前明显升高（P＜0.01）,用药后第14天D-dimer均较同组治疗前降低,但差异无统计学意义（P＞0.05）.结论 补阳还五汤加味在骨科大手术后初期疗效稍差于低分子肝素钠,但整体疗效及安全性优于对照组.

Clinical study on Buyang-huanwu decoction preventing the formation of lower limb deep vein thrombosis after major orthopedic surgery

Objective To discuss Buyang-huanwu decoction preventing the formation of lower limb deep vein thrombosis （DVT） after major orthopedic surgery.Methods 60 patients were randomly divided into a treatment group and a control group.The treatment group was treated with oral liquid of Buyang-huanwu,twice a day; while the control group was treated with 5000IU of low molecular heparin through subcutaneous injection,once daily.Prothrombin time （PT）,activated partial thromboplatin time （APTT）,fibrinogen （FIB）,D-dimer,lower limb deep vein color B ultrasonic and the wound flow changes after 48 hours were observed at 1st,7th,and 14th day after medication.Results ①）Comparison on the incidence of DVT：The incidence of DVT in the treatment group was higher than the control group at 7th day after medication,this incidence turn to equal in the two groups at the 14th day after medication,while at the end of therapy,the incidence of DVT in the treatment group was lower than the control group with significant difference （P〈0.05）.②Comparison on D-dimer changes：D-dimer at the 1st and 14th day were （0.782 ± 0.472） mg/1 and （0.320 ± 0.102） mg/1 in the treatment group and （0.720±0.421）mg/1 and （0.417 ± 0.217） mg/l in the control group.Comparing with the same group before treatment the treatment group was（0.548±0.245）mg/1; the control group was （0.560±0.195） mg/l],D-dimer was increased at the 1 st day with obvious difference （P〈 0.05）,but reduced at the 14th day,without statistical difference （P〉0.05）.Conclusion Buyang-huanwu decoction did not show good effects as low molecular heparin at the beginning of the treatment,but the its whole therapeutic effects and safety was better in treating lower limb deep vein thrombosis after major orthopedic surgery.