补阳还五汤加减防治股骨粗隆间骨折术后早期下肢DVT形成

目的:观察补阳还五汤加减方对股骨粗隆间骨折术后早期下肢深静脉血栓(DVT)形成的防治效果及作用机制。方法:104例患者随机分为对照组和治疗组各52例。两组均采用低分子量肝素钙注射液预防DVT,术前1 h预防性用药1次,术后每天腹壁下注射4100 U,连续用药14 d。治疗组在此基础上于术后第1天开始加服补阳还五汤加减方,水煎服,日1剂,早晚分服,连续14 d。两组分别观察DVT发生率,观察记录患肢肿胀程度、股静脉血流速度和术后引流量,检测血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)及各项凝血指标水平。结果:治疗组DVT总发生率5.77%,低于对照组的19.23%(P<0.01);术后第7、14天,治疗组髌上和髌下肿胀程度均轻于对照组(P<0.01);术后第14天治疗组血清CRP、TNF-α、IL-1和IL-6水平均低于对照组(P<0.01);两组术后第14天血清D-二聚体(D-dimer)均下降,治疗组低于对照组(P<0.01)。结论:股骨粗隆间骨折术后使用补阳还五汤加减方可明显改善患者症状和体征,降低血清CRP、TNF-α、IL-1、IL-6和D-dimer水平,减轻炎症反应,预防DVT发生。

Prevention and Treatment of Early DVT Formation of Lower Extremity after Intertrochanteric Fracture with Modified Buyang Huanwu Decoction

Objective:To observe the preventive and therapeutic effects of modified Buyang Huanwu Decoction on the formation of deep venous thrombosis(DVT) of the lower extremity after intertrochanteric fracture of the femur in order to explore the mechanism of the decoction. Methods:A total of 104 patients were randomly divided into the normal control group and the treatment group,with 52 patients in each group.The two groups were treated with conventional low molecular weight heparin calcium injection to prevent DVT,1 hour before the operation and 4100 U abdominal wall injection per day after surgery for 14 days.The treatment group received modified Buyang Huanwu Decoction from the first day after surgery,twice a day,morning and night,lasted for 14 days. The incidence of DVT was calculated in the two groups. The swelling degree of the affected limbs,femoral venous blood flow velocity and postoperative drainage volume were observed and measured. The levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6)and coagulation indexes of the serum were measured. Results:The incidence rate of DVT of the treatment group was 5.77%,lower than that in the control group 19.23%(P< 0.01). The suprapatellar and infrapatellar swelling degree of the treatment group on the 7th,14th days after operation were lighter than that in the control group(P< 0.01). Serum CRP,IL-1,TNF-αand IL-6 of the treatment group were lower than those in the control group on the 14th day after surgery(P< 0.01). D-dimer decreased more in the treatment group than that in the control group on the 14th day after surgery(P< 0.01). Conclusions:Modified Buyang Huanwu Decoction can significantly improve the symptoms and signs of patients,decrease the levels of CRP,TNF-α,IL-1,IL-6 and D-dimer,reduce the inflammatory reaction and prevent the occurrence of DVT after the operation of femoral intertrochanteric fracture.