标题：健脾益气汤预防膝关节置换术后深静脉血栓形成的疗效观察

      作者：许兴辉，侯凯，王世华，刘一飞    宝鸡市中医医院骨关节一科，陕西 宝鸡 721001

      卷次： 2023年34卷13期

      【摘要】 目的 观察健脾益气汤对膝关节置换术后患者下肢深静脉血栓(DVT)形成的预防效果。方法 前瞻性选取2021年3月至2022年3月宝鸡市中医医院收治的150例行膝关节置换术患者作为研究对象，按住院号分为对照组76例(采用常规方法治疗)和观察组74例(采用常规疗法联合健脾益气汤方治疗)。两组患者均治疗14 d，比较两组患者术前、术后2 d、术后14 d的凝血功能指标、患肢大小腿周径，治疗前、治疗14 d后的中医症状积分变化，治疗14 d后的患肢功能疗效及DVT和不良反应发生情况。结果 两组患者术后2 d的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)均较术前缩短，纤维蛋白原(FIB)水平较术前升高，术后14 d的PT、APTT均较术后2 d延长，FIB水平较术后2 d降低，且术后14 d，观察组患者的PT、APTT均较对照组长，FIB水平较对照组低，差异均有统计学意义(P<0.05)；两组患者术后2 d的大小腿周径较术前增加，术后14 d的大小腿周径较术后2 d缩小，且术后14 d时，观察组患者的上述大小腿周径均小于对照组，差异均有统计学意义(P<0.05)；治疗后，两组患者的患肢肿胀、胀痛及青筋曲张症状积分均降低，且观察组明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者的患肢功能临床有效率为95.95%，明显高于对照组的86.84%，DVT发生率为2.70%，明显低于对照组的11.84%，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的不良反应总发生率为2.70%；略低于对照组的7.89%，但差异无统计学意义(P>0.05)。结论 自拟健脾益气汤方用于治疗膝关节置换术可有效调节患者凝血功能，预防DVT的形成，促进下肢肿痛消退。
      【关键词】 健脾益气汤；膝关节置换术；下肢深静脉血栓；预防；疗效
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2023）13—1866—05

Clinical efficacy of Jianpi Yiqi decoction on preventing deep venous thrombosis formation after kneearthroplasty.
XU Xing-hui, HOU Kai, WANG Shi-hua, LIU Yi-fei. The First Department of Bone and Joint, Baoji Hospitalof Traditional Chinese Medicine, Baoji 721001, Shaanxi, CHINA
【Abstract】 Objective To observe the preventive effect of Jianpi Yiqi decoction on the formation of lower limbdeep venous thrombosis (DVT) in patients after knee arthroplasty. Methods A total of 150 patients undergoing knee ar-throplasty in Baoji Hospital of Traditional Chinese Medicine from March 2021 to March 2022 were prospectively select-ed and divided into a control group (76 cases, conventional therapy) and an observation group (74 cases, conventionaltherapy combined with Jianpi Yiqi decoction) according to the hospitalization number. Both groups were treated for 14days. The coagulation function indicators, thigh circumference, and shank circumference of the affected limbs before sur-gery and at 2 days and 14 days after surgery, TCM symptoms scores before treatment and after 14 days of treatment,functional efficacy of affected limb, occurrence of DVT, and adverse reactions were compared between the two groups.Results At 2 days after surgery, the prothrombin time (PT) and activated partial thromboplastin time (APTT) in thetwo groups were shortened compared with those before surgery, and the fibrinogen (FIB) was enhanced compared withthat before surgery; PT and APTT in the observation group at 14 days after surgery were longer than those in controlgroup, and FIB level was lower than that in control group; the differences were statistically significant (P<0.05). Thethigh circumference and shank circumference in both groups were lengthened at 2 days after surgery compared to thosebefore surgery, and were shortened at 14 days after surgery compared with those at 2 days after surgery; the circumfer-ences of thigh and shank in the observation group were shorter than those in control group at 14 days after surgery; thedifferences were statistically significant (P<0.05). After treatment, the scores of swelling of the affected limb, swellingpain, and varicose veins in the two groups were decreased, and the scores in the observation group were significantlylower than those in the control group (P<0.05). The clinical effective rate of affected limb function in the observationgroup was significantly higher compared with that in the control group (95.95% vs 86.84%), while the incidence rate ofDVT was significantly lower than that in the control group (2.70% vs 11.84%), with statistically significant differences(P<0.05). During treatment, the total incidence rate of adverse reactions was 2.70% in the observation group versus7.89% in the control group, with statistically significant differences (P>0.05). Conclusion Self-made Jianpi Yiqi decoc-tion in the treatment of patients with knee arthroplasty can effectively regulate the coagulation function, prevent the for-mation of DVT, and promote the subsidence of lower limb swelling pain.
      【Key words】 Jianpi Yiqi decoction; Knee arthroplasty; Lower limb deep venous thrombosis; Prevention; Efficacy