活血化瘀通络方内服外敷对高龄髋部骨折患者术后深静脉血栓的影响
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R683.42

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河南省中医药科学研究专项课题(2016ZY2078)


Effect of Oral Administration and External Application of Huoxue Huayu Tongluo Prescription on Deep Vein Thrombosis in Elderly Patients After Surgery of Hip Fracture
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    摘要:

    目的:观察活血化瘀通络方内服外敷对高龄髋部骨折患者术后深静脉血栓(DVT)的影响。方法:将 123 例高龄髋部骨折患者随机分为内服组、外敷组及内服外敷组各 41 例。术后叮嘱患者常规卧床休息,抬高患肢,采用肝素进行抗凝,尿激酶进行溶栓。在此基础上,内服组予活血化瘀通络方内服,外敷组予活血化瘀通络方外敷,内服外敷组同时予活血化瘀通络方内服与外敷。比较各组临床治疗疗效、血流动力学指标、血液流变学指标以及下肢运动功能恢复情况,并观察术后 DVT 发生率以及不良反应发生率。结果:临床疗效总有效率内服外敷组 92.68%,明显高于内服组 75.61%、外敷组 53.66%,差异有统计学意义(P<0.05),且内服组明显高于外敷组,差异有统计学意义 (P<0.05)。治疗后,内服外敷组心率明显低于内服组、外敷组,差异有统计学意义(P<0.05),平均动脉压、中心静脉压明显高于内服组、外敷组(P<0.05),内服组、外敷组以上血流动力学指标比较,差异均无统计学意义(P>0.05);内服外敷组毛细管血黏度、全血高切黏度、全血低切黏度、红细胞聚集指数以及血细胞比容明显低于内服组、外敷组(P<0.05),内服组、外敷组以上血液流变学指标比较,差异均无统计学意义(P>0.05);内服外敷组视觉模拟评分法(VAS)评分明显低于内服组、外敷组,差异均有统计学意义(P<0.05);日常生活能力量表(ADL)以及髋关节功能 (Harris) 评分均明显高于内服组、外敷组,差异均有统计学意义 (P<0.05);内服组、外敷组下肢运动功能恢复情况各项评分比较,差异均无统计学意义 (P>0.05)。内服外敷组术后 DVT 发生率 2.44%,明显低于外敷组 19.51%,差异有统计学意义(P<0.05);与内服组 7.32%比较,差异无统计学意义(P>0.05),内服组、外敷组术后 DVT 发生率比较,差异无统计学意义(P>0.05);3 组术后不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:活血化瘀通络方内服外敷治疗高龄髋部骨折患者效果明显,可有效改善血液回流,促进患者下肢运动功能恢复,减少术后 DVT 发生。

    Abstract:

    Abstract: Objective: To observe the effect of oral administration and external application of Huoxue Huayu Tongluo prescription on deep vein thrombosis(DVT) in elderly patients after surgery of hip fracture. Methods:A total of 123 cases of elderly patients with hip fracture were randomly divided into the oral administration group,the external application group, and the oral administration and external application group,41 cases in each group. After surgery,patients were told to take bed rest and lift the affected limb. Heparin was used for anticoagulation and urokinase was used for thrombolysis. In addition, the oral administration group was given the oral administration of Huoxue Huayu Tongluo prescription;the external application group was treated with the external application of Huoxue Huayu Tongluo prescription;the oral administration and external application group was given the oral administration and external application of the prescription. The clinical effect, hemodynamic indexes,hemorheology indexes and the recovery of motor function of lower limbs were compared among the three groups. After surgery,the incidence of DVT and that of adverse reactions were observed. Results:The total clinical effective rate was 92.68% in the oral administration and external application group,significantly higher than that of 75.61% in the oral administration group and that of 53.66% in the external application group,the difference being significant(P<0.05); the rate in the oral administration group was significantly higher than that in the external application group,the difference being significant(P<0.05). After treatment, when compared with those in the oral administration group and those in the external application group,in the oral administration and external application group,the heart rate was significantly lower, the difference being significant(P<0.05),and the mean arterial pressure and central venous pressure were significantly higher (P<0.05). When compared the heart rate, mean arterial pressure and central venous pressure between the oral administration group and the external application group,there was no significance in differences(P>0.05). After treatment, capillary viscosity,whole blood high shear viscosity,whole blood low shear viscosity,index of erythrocyte aggregation, and hematocrit in the oral administration and external application group were significantly lower than those in the oral administration group and the external application groups(P<0.05);there was no significance difference being found in the comparison of the five hemorheology indexes above between the oral administration group and the external application group (P>0.05). The score of Visual Analogue Scale (VAS) in the oral administration and external application group was significantly lower than that of the oral administration group and that of the external application group,differences being significant(P< 0.05). The scores of Activities of Daily Living (ADL) and the Harris Hip Score in the oral administration and external application group were significantly higher than those in the oral administration group and the external application groups,differences being significant(P<0.05);when compared the scores for evaluating the recovery of lower limb motor function between the oral administration group and the external application group,there was no significance being found in differences(P>0.05). After surgery,the incidence of DVT was 2.44% in the oral administration and external application group,significantly lower than that of 19.51% in the external application group,the difference being significant (P<0.05). The incidence of DVT was 7.32% in the oral administration group, there being no significant difference when compared with that in the oral administration and external application group(P>0.05). The comparison of DVT incidence between the oral administration group and the external application group showed no significance in the difference(P>0.05). There was no significant difference being found when compared the total incidence of adverse reactions among the three groups(P>0.05). Conclusion:The oral administration and external application of Huoxue Huayu Tongluo prescription has significant curative effect on elderly patients with hip fracture,which can effectively improve blood backflow,promote the recovery of motor function of lower limbs,and reduce the incidence of postoperative DVT.

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李煜,唐洪涛,郑付杨.活血化瘀通络方内服外敷对高龄髋部骨折患者术后深静脉血栓的影响[J].新中医,2021,53(4):114-119

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  • 在线发布日期: 2021-02-27
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