中西医结合治疗骨科大手术围手术期血液高凝状态60例临床观察

杜丽娟 林建华 宋璐

【摘 要】 目的：观察中西医结合对骨科大手术患者围手术期血浆D-二聚体、血栓前体蛋白水平的影响，探讨祛瘀消肿合剂外敷改善患者围手术期血液高凝状态及预防静脉血栓的作用。方法：选择骨科大手术围手术期患者60例，随机分为对照组30例与观察组30例。对照组为基础预防+物理预防;观察组为祛瘀消肿合剂外敷+基础预防+物理预防。比较两组D-二聚体、血栓前体蛋白水平变化。结果：术后第1天、第7天观察组D-二聚体均明显低于对照组（P<0.05），差异具统计学意义。对照组VTE发生率为6例（20%），观察组VTE发生率为4例（13.3%），两组患者术后VTE发生率有明显差异，差异具有统计学意义（P<0.05）。结论：中西医结合可以改善骨科大手术围手术期的高凝状态，降低VTE发生率。

【关键词】 祛瘀消肿合剂;骨科大手术;静脉血栓栓塞症;D-二聚体，血栓前体蛋白

【中图分类号】R687.3   【文献标志码】 A    【文章编号】1007-8517（2021）05-0081-03

Effect of Removing Blood Stasis and Swelling on Hypercoagulable State of Blood of Patients Undergoing Major Orthopaedic Surgery

DU Lijuan LIN Jianhua SONG Lu

Shenzhen pingle orthopedics hospital （shenzhen pingshan traditional Chinese medicine hospital），Shenzhen 518000， China

Abstract：Objective To observe the effects of integrated Traditional Chinese and western medicine on plasma D-dimer and thrombus precursor protein levels in patients undergoing major orthopedic surgery during perioperative period， and to explore the effect of quyu Xiaozhumu mixture applied outside to improve perioperative blood hypercoagulability and prevent venous thrombosis in patients. Methods ASixty patients in perioperative period of major orthopedic surgery were selected and randomly divided into control group and observation group. The control group was the basic prevention+physical prevention， and the observation group was the external application of The Quyu Xiaoquan mixture+basic prevention+physical prevention. The protein levels of d-dimer and thrombus precursor were compared between the two groups.Results The d-dimer of the observation group on day 1 and day 7 after surgery was significantly lower than that of the control group （P<0.05）， and the difference was statistically significant. The incidence of VTE in the control group was 6 cases （20%）， and that in the observation group was 4 cases （13.3%）. The incidence of VTE after operation was significantly different between the two groups （P<0.05）. Conclusion The combination of Chinese and western medicine can improve the perioperative hypercoagulability and reduce the incidence of VTE.

Keywords：Mixture for Removing Stasis and Removing Swelling; Major Orthopedic Surgery;Venous Thromboembolism（VTE）;D-dimer;Thrombogenic Precursor Protein

臨床上，静脉血栓栓塞症（Venous Thromboembolism，VTE）发生多由血液中物质在动脉或静脉内的凝积，使部分血管发生阻塞，引起血液高凝状态，从而导致VTE发生，其中主要包括深静脉血栓形成及肺栓塞[1-2]。骨科大手术[3]包括人工全髋置换（THA）、人工全膝关节置换（TKA）及髋部骨折手术（HFS），因手术及其他导致VTE高危因素使围手术期易发生静脉血栓栓塞症，而产生致死性的肺栓塞。因此，需要临床医师早诊断、早预防，达到有效改善骨科大手术患者临床结局[4]。

1 资料与方法

1.1 一般资料 选取符合纳入标准患者60例，按接诊顺序采用随机数字表分为对照组和观察组各30例，对照组年龄20～88岁，平均（62.35±16.26）岁，病程为3～90 d，平均（16.38±4.21）d;观察组年龄22～90岁，平均（63.05±15.98）岁，病程2～85 d，平均（18.26±3.45）d，两组资料比较差异无统计学意义（P>0.05），具有可比性。本研究通过医院医学伦理委员会审批通过。

1.2 诊断标准 西医诊断符合《实用骨科学》[5]，并经 X 线、CT 等检查确诊，且需行骨科大手术。骨……