【摘要】 目的:探究通脉汤对下肢闭合骨折深静脉血栓及其血栓弹力图影响性,以期选择最佳治疗方法,提高疗效。方法:选取2016年12月至2018年5月川北医学院附属医院收治下肢闭合骨折深静脉血栓患者92例作为研究对象,按照就诊顺序随机分为对照组和观察组,每组46例。对照组予常规西医治疗,观察组加用通脉汤治疗,均治疗10 d。观察并比较2组治疗前后血小板内皮细胞黏附因子-1(PECAM-1)、血管细胞黏附分子-1(VCAM-1)、D二聚体(D-D)、P-选择素、纤维蛋白原(FIB)的含量;观察并比较2组治疗前、治疗后全血比高切黏度、全血比低切黏度、血浆比黏度、凝血因子Ⅰ含量;观察并比较2组治疗前、完成治疗后在水肿、疼痛、皮色异常、皮温异常积分变化;观察并比较2组治疗前后血栓弹力图的变化;统计治疗过程中2组不良反应。结果:1) 2组患者治疗前PECAM-1、VCAM-1、D-D、P-选择素、FIB比较,差异无统计学意义(P> 0. 05),治疗后2组以上指标较治疗前均显著下降(均P <0. 05),治疗后观察组以上指标均显著低于对照组(均P <0. 05)。2) 2组患者治疗前全血比高切黏度、全血比低切黏度、血浆比黏度、凝血因子Ⅰ比较,差异无统计学意义(P>0. 05),治疗后以上指标2组较治疗前均显著下降(均P <0. 05),治疗后观察组以上指标均显著低于对照组(均P <0. 05)。3) 2组患者治疗前水肿、疼痛、皮色异常、皮温异常比较,差异无统计学意义(P> 0. 05),治疗后以上指标2组较治疗前均显著下降(均P <0. 05),完成治疗后以上指标观察组显著低于对照组(均P <0. 05)。4) 2组患者治疗前R值、K值、MA值、a角比较,差异无统计学意义(P> 0. 05),治疗后2组R值、K值较治疗前显著升高,MA值、a角较治疗前显著下降(均P <0. 05),治疗后以上指标观察组疗效显著优于对照组(P <0. 05)。5) 2组胃肠道反应、过敏反应、肝肾功能异常、出血发生率比较,差异无统计学意义(P <0. 05)。结论:通脉汤能促进下肢闭合骨折深静脉血栓血栓血液循环,改善血液黏稠度,改善症状,提高疗效。更多还原

【Abstract】 Objective: To explore the effects of Tongmai Decoction on deep venous thrombosis and its thromboelastogram in closed fracture of lower extremity,so as to select the best treatment method and improve the curative effect. Methods: A total of 92 patients with deep venous thrombosis( DVT) of closed limb fractures admitted to Affiliated Hospital of North Sichuan Medical College from December 2016 to May 2018 were randomly divided into a control group( 46 cases) and an observation group( 46 cases) according to the order of treatment. The control group was treated with conventional western medicine,while the observation group was treated with Tongmai Decoction. All patients were treated with 10 d. The levels of PECAM-1,VCAM-1,D-dimer,P-selectin and fibrinogen( FIB) were observed before and after treatment in the 2 groups. The whole blood high shear viscosity,whole blood low viscosity plasma specific viscosity,and blood coagulation factor I before and after treatment were compared. The edema,pain,skin color abnormalities,skin temperature abnormal integral changes before and after treatment were observed. The thrombus elasto graph before and after treatment was compared. The adverse reactions were observed and calculated during the treatment. Results: There was no significant difference in PECAM-1,VCAM-1,D-D,P-selectin and FIB between the 2 groups before treatment( P > 0. 05). After treatment,the above indexes in both groups were significantly decreased than those before treatment( P < 0. 05). After treatment,the above indexes in the observation group were significantly lower than those in the control group( P < 0. 05). 2) There was no significant difference between the 2 groups in the whole blood specific high shear viscosity,whole blood specific low shear viscosity,plasma specific viscosity and coagulation factor I before treatment( P > 0. 05). After treatment,the above indexes in both groups were significantly decreased than those before treatment( P < 0. 05). After treatment,the above indexes in the observation group were significantly lower than those in the control group( P < 0. 05). 3) There was no significant difference in edema,pain,skin color abnormality and skin temperature between the 2 groups before treatment( P > 0. 05). After treatment,the above indexes in both groups were significantly decreased than those before treatment( P < 0. 05). After treatment,the above indexes in the observation group were significantly lower than those in the control group( P < 0. 05). 4) There was no significant difference in R value,K value,MA value and a angle between the 2 groups before treatment( P > 0. 05). After treatment,R value and K value increased significantly,and MA value and a angle decreased significantly( P < 0. 05). After treatment,the above indexes in the observation group were significantly better than those in the control group( P < 0. 05). There was no significant difference in gastrointestinal reactions,allergic reactions,abnormal liver and kidney functions,and the incidence of bleeding between the 2 groups( P < 0. 05). Conclusion: Tongmai Decoction can promote the blood circulation of DVT in closed fracture of lower limbs,improve blood viscosity,improve symptoms and improve curative effect.更多还原