【摘要】 目的 观察芪箭消栓通组方联合导管溶栓治疗老年急性中央型下肢深静脉血栓(气虚血瘀型)的临床疗效及安全性。方法 选取2020年1月至2021年1月在河北省沧州中西医结合医院住院治疗的老年急性中央型下肢深静脉血栓中医辨证为气虚血瘀证的病人70例，按照随机数字表法分为治疗组35例，对照组35例。对照组单纯给予导管溶栓治疗，治疗组在对照组基础上加服芪箭消栓通组方治疗。观察对比两组治疗前后凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)]与炎症因子[超敏C反应蛋白(CRP)、血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]的变化情况以及治疗后血栓清除率、患肢肿胀缓解情况与治疗期并发症，对比随访6个月后的后遗症发生率、复发率以及髂股静脉通畅率。结果两组治疗前后APTT比较，差异无统计学意义(P>0.05)。但治疗14 d后，两组D-D、FIB水平均显著降低(P<0.05)，治疗组D-D[(1.06±1.19)mg/L比(2.52±1.13)mg/L]、FIB[(2.21±0.67)g/L比(3.77±0.89)g/L]水平优于对照组(P<0.05)。治疗14 d后，两组血清CRP浓度、IL-6、TNF-α含量均显著下降(P<0.05)，治疗组CRP浓度[(2.14±2.37)mg/L比(5.73±4.14)mg/L]、IL-6[(1.09±0.65)ng/L比(2.15±0.91)ng/L]、TNF-α含量[(3.67±4.22)ng/L比(6.42±4.33)ng/L]优于对照组(P<0.05)。溶栓治疗14 d后，治疗组血栓Ⅲ级清除率达88.57%，对照组血栓Ⅲ级清除率达65.71%，两组差异有统计学意义(P<0.05)。治疗14 d后，治疗组膝上20 cm处、膝下15 cm处周径差均明显低于对照组(P<0.05)；此外两组治疗期间不良反应发生率差异无统计学意义(P>0.05)。随访6个月后，治疗组后遗症发生率显著低于对照组(P<0.05)；治疗组髂股静脉通畅率明显高于对照组(P<0.05)。结论 芪箭消栓通组方联合导管溶栓治疗老年急性中央型下肢深静脉血栓(气虚血瘀型)疗效确切，能明显改善凝血功能，抑制炎性反应，且预后良好，安全性高，具有一定的临床推广价值。更多还原

【Abstract】 Objective To observe the clinical effects and sefety of Qijian Xiaoshuantong recipe combined with catheter thrombolysis in treatment of the acute lower limbs’ deep venous thrombosis(DVT) in elderly patients with Qi deficiency and blood stasis type.Methods Seventy elderly patients with the acute lower limbs’ DVT who were diagnosed Qi deficiency and blood stasis type and hospitalized in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to January 2021 were selected and assigned into two groups according to the random number table method.35 cases in control group were treated only by catheter thrombolysis,and 35 cases in treatment group were treated by Qijian Xiaoshuantong recipe on the basis of the control group.The changes of coagulation function indexes [D-dimer(D-D),fibrinogen(FIB),activated partial thromboplastin time(APTT)] and inflammatory factors [high-sensitivity C-reactive protein(CRP),serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)] before and after treatment as well as the thrombus clearance rate,limb swelling relief and complications during treatment in the two groups were observed,and the incidence of sequelae,recurrence rate and iliofemoral vein patency rate were compared after 6 months of follow-up.Results There was no significant difference in activated partial thromboplastin time between the two groups before and after treatment(P>0.05).But,after treatment,the levels of D-D and FIB in the two groups were significantly decreased(P<0.05),and the levels of D-D [(1.06±1.19) mg/L vs.(2.52±1.13) mg/L] and FIB [(2.21±0.67) g/L vs.(3.77±0.89) g/L] in the treatment group were better than those in the control group(P<0.05).After treatment,the levels of serum high-sensitivity CRP,IL-6 and TNF-α in the two groups were significantly decreased(P<0.05),and the levels of serum high-sensitivity CRP [(2.14±2.37) mg/L vs.(5.73±4.14) mg/L],IL-6 [(1.09±0.65) ng/L vs.(2.15±0.91) ng/L] and TNF-α [(3.67±4.22) ng/L vs.(6.42±4.33) ng/L] in the treatment group were better than those in the control group(P<0.05).After thrombolytic therapy,the thrombus clearance rate of the treatment group was 88.57%,and that of the control group was65.71%,the difference was statistically significant(P<0.05).After treatment,the circumference difference of 20 cm above the knee and15 cm below the knee in the treatment group was significantly lower than that in the control group(P<0.05);in addition,there was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).After 6 months of followup,the incidence of sequelae in the treatment group was significantly lower than that in the control group(P<0.05);the patency rate of iliofemoral vein in the treatment group was significantly higher than that in the control group(P<0.05).Conclusion Qijian Xiaoshuantong recipe combined with catheter thrombolysis in treatment of the acute lower limbs’ DVT in elderly patients with Qi deficiency and blood stasis type has definite curative effect,can significantly improve coagulation function,inhibit inflammatory reaction,and has good prognosis and high safety.更多还原