[1]张成波,阿欣雨,孙松涛,等.施氏芪桃化瘀方预防膝关节置换术后深静脉血栓的疗效观察[J].中国中医骨伤科杂志,2024,32(09):41-46.[doi:10.20085/j.cnki.issn1005-0205.240909]
　ZHANG Chengbo,A Xinyu,SUN Songtao,et al.Clinical Efficacy of Shi's Qi-Tao Huayu Decoction on Prevention of Deep Vein Thrombosis after Total Knee Arthroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(09):41-46.[doi:10.20085/j.cnki.issn1005-0205.240909]
点击复制

施氏芪桃化瘀方预防膝关节置换术后深静脉血栓的疗效观察()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年09期
页码:
41-46
栏目:
临床研究
出版日期:
2024-09-15

文章信息/Info

Title:
Clinical Efficacy of Shi's Qi-Tao Huayu Decoction on Prevention of Deep Vein Thrombosis after Total Knee Arthroplasty
文章编号:
1005-0205(2024)09-0041-06
作者:
张成波1; 阿欣雨1; 孙松涛1; 施杞2; 肖涟波1; 2△
1上海中医药大学附属光华医院(上海,200052)
2上海市中医药研究院中西医结合关节炎研究所
Author(s):
ZHANG Chengbo1; A Xinyu1; SUN Songtao1; SHI Qi2; XIAO Lianbo1; 2△
1Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;
2Arthritis Institute of Integrated Traditional Chinese and Western Medicine,Shanghai Institute of Traditional Chinese Medicine,Shanghai 200052,China.
关键词:
全膝关节置换术;  深静脉血栓;  气虚血瘀;  凝血功能
Keywords:
total knee arthroplasty;  deep vein thrombosis;  Qi deficiency and blood stasis;  coagulation function
分类号:
R654.4
DOI:
10.20085/j.cnki.issn1005-0205.240909
文献标志码:
A
摘要:
目的:探讨国医大师施杞教授芪桃化瘀方预防膝关节置换术后深静脉血栓的疗效,为该方的临床推广提供循证医学依据。方法:通过随机、对照、单盲试验,收集2023年5月至2023年12月就诊,需行全膝关节置换术的患者共计110例。根据干预方式分为观察组和对照组,每组各55例; 观察组芪桃化瘀方内服治疗,对照组口服利伐沙班。两组患者均进行术后14 d的随访,随访内容包括凝血功能、血常规、炎症指标、中医证候评分等。结果:110例患者均完成随访且无病例脱落。治疗14 d后观察组患者凝血功能指标(D-二聚体、纤维蛋白原、凝血酶原、活化部分凝血酶原时间)与对照组相比,差异无统计学意义(P>0.05); 凝血酶原时间与对照组相比,差异有统计学意义(P<0.05)。治疗14 d后观察组患者血常规指标(红细胞计数、血红蛋白、血小板计数、淋巴细胞计数)与对照组相比,差异无统计学意义(P>0.05); 中性粒细胞计数与对照组相比,差异有统计学意义(P<0.05)。治疗14 d后观察组患者的血沉、中性粒细胞与淋巴细胞比值改善程度优于对照组,差异有统计学意义(P<0.05); C反应蛋白与对照组相比,差异无统计学意义(P>0.05)。观察组中医证候评分整体有效率高于对照组,差异有统计学意义(P<0.05)。两组患者均未发生深静脉血栓,不良反应事件发生率差异无统计学意义(P>0.05)。结论:施氏芪桃化瘀方能够预防膝关节置换术后深静脉血栓,且不良反应发生率低,值得推广应用。
Abstract:
Objective:To analyze and evaluate the efficacy of Qi-Tao Huayu decoction by Professor Shi Qi on the prevention of deep vein thrombosis(DVT)after total knee arthroplasty(TKA),so as to provide evidence-based basis for the clinical promotion of this prescription.Methods:A total of 110 patients who needed TKA from May 2023 to December 2023 were enrolled in this randomized,controlled,single-blind trial.According to interventions,they are divided into observation group and control group,55 cases in each group.The observation group patients were treated with Qi-Tao Huayu decoction,the control group patients took Livashaban orally.Both groups were followed up 14 d,follow-up content including coagulation function,blood routine,inflammation index,traditional Chinese medicine(TCM)syndrome scores,etc.Results:All 110 patients completed the follow-up,and no case dropped out.After 14 d of treatment,there was no significant difference in coagulation function indexes(D-dimer,fibrinogen,prothrombin,activated partial thromboplastin time)between the observation group and the control group,but there was significant difference in prothrombin time between the two groups(P<0.05).After 14 d of treatment,the observation group patients with blood routine indexes(red blood cell count,hemoglobin,platelet count,lymphocyte count)compared with control group,there was no statistically significant difference,neutrophil count compared with control group,the difference was statistically significant(P<0.05).After 14 d of treatment,the observation group blood sedimentation,neutrophils and lymphocytes in patients with improved ratio is better than that of control group,the difference was statistically significant(P<0.05),C-reactive protein compared with control group,there was no statistically significant difference.The overall effective rate of TCM syndrome score in the observation group was higher than that in the control group(P<0.05).There was no DVT in the two groups,and there was no significant difference in the incidence of adverse events.Conclusion:Shi's Qi-Tao Huayu decoction can effectively prevent DVT after TKA,and the incidence of adverse reactions is low,which is worthy of promotion.

参考文献/References:

[1] STONE J,HANGGE P,ALBADAWI H,et al.Deep vein thrombosis:pathogenesis,diagnosis,and medical management[J].Cardiovasc Diagn Ther,2017,7(3):S276-S284.
[2] LEIZOROVICZ A,SMART Venography Study Steering Committee.Epidemiology of post-operative venous thromboembolism in Asian patients.Results of the SMART venography study[J].Haematologica,2007,92(9):1194-1200.
[3] MONREAL M,FOLKERTS K,DIAMANTOPOULOS A,et al.Cost-effectiveness impact of rivaroxaban versus new and existing prophylaxis for the prevention of venous thromboembolism after total hip or knee replacement surgery in France,Italy and Spain[J].Thromb Haemost,2013,110(5):987-994.
[4] 凌坤,宋超,石秀霞.膝关节置换术后下肢深静脉血栓危险因素研究[J].中华实验外科杂志,2019,36(5):843.
[5] 马宇飞,洛佳坤,李涛,等.老年下肢创伤或关节置换术后住院患者血栓预防现状及抗凝方案疗效和安全性单中心分析[J].中国医学前沿杂志(电子版),2023,15(7):54-59.
[6] 鹿洪秀,吕文学,张建新,等.中药对全膝关节置换术后早期应激反应及DVT发生的影响[J].中国矫形外科杂志,2019,27(16):1467-1471.
[7] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[8] 国家食品药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[9] 俞秋纬,汤伟忠,邱德华,等.国医大师石仰山“以气为主、以血为先”理论在创伤骨科中的应用经验[J].上海中医药杂志,2016,50(1):5-8.
[10] 杨洋,张德宏,王巧巧,等.基于玄府理论探讨活血开玄药在深静脉血栓中的治疗[J].中医药临床杂志,2023,35(11):2075-2078.
[11] STUBBS M J,MOUYIS M,THOMAS M.Deep vein thrombosis[J].The British Medical Journal,2018,360:k1335.
[12] CARTER K T,PALEI A C,SPRADLEY F T,et al.A rat model of orthopedic injury-induced hypercoagulability and fibrinolytic shutdown[J].J Trauma Acute Care Surg,2020,89(5):926-931.
[13] BRANCHFORD B R,CARPENTER S L.The role of inflammation in venous thromboembolism[J].Front Pediatr,2018,6:142.
[14] 赵海建.血清生化炎症因子对老年骨科创伤患者术后感染及血栓发生的临床预测价值[J].中国老年学杂志,2023,43(20):5007-5009.
[15] QI Y,GAO F,HOU L,et al.Anti-inflammatory and immunostimulatory activities of astragalosides[J].Am J Chin Med,2017,45(6):1157-1167.
[16] 揭立士,时孝晴,刘子修,等.桃仁-红花通过抑制NF-κB信号通路改善IL-1β诱导的软骨炎症和降解[J].中药新药与临床药理,2023,34(7):936-947.
[17] 以敏,徐君毅,郝二伟,等.桃仁提取物抗血瘀证大鼠血栓形成的机制[J].中国实验方剂学杂志,2016,22(1):125-128.
[18] ZHOU Y,GUO X,CHEN W,et al.Angelica polysaccharide mitigates lipopolysaccharide-evoked inflammatory injury by regulating microRNA-10a in neuronal cell line HT22[J].Artif Cells Nanomed Biotechnol,2019,47(1):3194-3201.
[19] LI Y,WANG N.Antithrombotic effects of danggui,honghua and potential drug interaction with clopidogrel[J].J Ethnopharmacol,2010,128(3):623-628.
[20] 彭熙炜,阎卉芳,黄娟,等.黄芪-当归配伍对大鼠血管内膜增生模型炎性反应的影响[J].中华中医药杂志,2019,34(2):580-584.
[21] 秦臻,黄水清,韦正新,等.剪切应力环境中当归补血汤对大鼠内皮祖细胞功能的影响[J].中国实验方剂学杂志,2021,27(2):1-7.
[22] 勾楠,王星晨,高建义,等.不同配比赤芍-桃仁乙醇提取物对急性血瘀模型大鼠血液流变学的影响[J].医药导报,2021,40(2):170-174.
[23] 华芳,赵玉玲,李莞,等.川芎及其中成药抗凝血作用测定方法的研究[J].中草药,2019,50(7):1698-1702.
[24] 马宁宁,范姗姗,李欣,等.川芎的抗炎物质筛选及其作用机制分析[J].中国实验方剂学杂志,2018,24(18):140-146.
[25] 赵继荣,杨涛,赵宁,等.赤芍抗血栓物质基础及相关机制研究进展[J].中国中医药信息杂志,2021,28(3):137-140.
[26] LI P,LIN B Q,TANG P,et al.Aqueous extract of Whit- mania pigra Whitman ameliorates ferric chloride-induced venous thrombosis in rats via antioxidation[J].J Thromb Thrombolysis,2021,52(1):59-68.
[27] 荆文光,符江,刘玉梅,等.水蛭的化学成分[J].中国实验方剂学杂志,2014,20(19):120-123.
[28] 胡宇驰,肖斯婷,杨文良,等.水蛭抗凝血活性的效价单位定义与对照药材赋值研究[J].药物分析杂志,2023,43(5):837-848.
[29] 韩倩倩,潘芸芸,温紫云,等.水蛭对ApoE-/-动脉粥样硬化小鼠自噬的影响[J].中国临床药理学杂志,2024,40(5):688-692.
[30] 邢娜,彭东辉,张志宏,等.炮制对三七化学成分及药理作用影响的研究进展[J].中国实验方剂学杂志,2020,26(16):210-217.
[31] 陶成龙,刘漩,袁可望,等.三七总皂苷微球胶囊活血化瘀药效的实验研究[J].中华中医药学刊,2023,41(4):64-68.
[32] HU S N,LIU T T,WU Y L,et al.Panax notoginseng saponins suppress lipopolysaccharide-induced barrier disruption and monocyte adhesion on bEnd.3 cells via the opposite modulation of Nrf2 antioxidant and NF-κB inflammatory pathways[J].Phytother Res,2019,33(12):3163-3176.

备注/Memo

备注/Memo:
基金项目:上海市卫健委上海市临床重点专科建设项目(shslczdzk04801)
上海市卫健委中医药三年行动计划项目(ZY(2021-2023)-0201-06)
△通信作者 E-mail:xiao_lianbo@163.com
更新日期/Last Update: 2024-09-05