补气活血通络汤对老年高凝状态髋部骨折手术患者的临床疗效观察及影响因素分析
Clinical Efficacy Observation and Influencing Factor Analysis of Buqi Huoxue Tongluo Tang on Elderly Patients With Hypercoagulable Hip Fracture Surgery
周跃辉 1马云 1赵育刚 1李国帅 1胡晓龙 1刘昌鹏1
作者信息
- 1. 成都军区八一骨科医院 中医骨科,四川成都 610031
- 折叠
摘要
目的 观察补气活血通络汤在老年高凝髋关节骨折手术中的临床疗效,同时构建下肢静脉血栓风险预测模型.方法 回顾性选取2019年6月至2021年6月于成都军区八一骨科医院行髋部关节置换术的老年高凝状态下髋部骨折患者.根据术后患者的治疗方式将患者分为对照组以及观察组.对照组予以依诺肝素钠40 mg皮下注射,观察组在对照组基础上予以补气活血通络汤口服治疗.记录两组患者的一般资料、治疗前和治疗后1周、2周、3周的凝血指标(D-D聚体、FIB、PT、APTT)以及VAS评分.记录两组患者治疗过程中下肢深静脉血栓的发生情况以及下床活动率、髋关节功能(HARRIS)评分及骨折愈合率.通过Logistic回归建立血栓发生的风险预测模型,分别通过内部验证和外部验证明确模型的具体预测效能.结果 观察组患者治疗后1周、2周、3周的VAS评分、FIB低于对照组(P＜0.05).PT、APTT高于对照组(P＜0.05).观察组患者治疗后2周、3周的D-D明显低于对照组(P＜0.05).观察组患者血栓发生率明显低于对照组,14个月后下床活动率、HARRIS评分及5个月后骨折愈合率明显高于对照组(P＜0.05).观察组患者的D-D聚体、FIB、PT、APTT较对照组早恢复至临床正常参考水平,且未偏离至正常水平之外.通过多因素回归分析明确补气活血通络汤的使用、糖尿病病史、基线APTT水平是DVT发生的独立风险因素.通过内部验证和外部验证证明模型具有较好的临床预测价值.结论 补气活血通络汤可以有效改善髋部关节置换术治疗的老年高凝状态下髋部骨折患者的凝血功能,降低患者疼痛以及下肢深静脉血栓的发生,且具有一定的安全性.此外,本研究所构建的下肢静脉血栓风险预测模型具有较好的预测价值.
Abstract
Objective To observe the application effect of Buqi Huoxue Tongluo decoction(BHTD)in elderly patients with hypercoagulable state undergoing hip fracture surgery.Methods A retrospective analysis was conducted on elderly patients with hypercoagulable state and hip fracture who underwent hip arthroplasty in our hospital from June 2019 to June 2021.Patients were divided into control group or BHTD group.General information,coagulation indicators and Visual Analog Scale(VAS)scores were recorded before treatment and at 1,2 and 3 weeks after treatment.Logistic regression was used to establish a risk prediction model for thrombosis,and the model's predictive performance was internally and externally validated.Results This study ultimately included 148 elderly patients with hip fractures in a hypercoagulable state who underwent surgical treatment,including 72 in the control group and 76 in the intervention group treated with BHTD.The VAS score and FIB of the intervention group patients were significantly lower than those of the control group at 1 week,2 weeks and 3 weeks after treatment(P＜0.05).PT and APTT were significantly higher than the control group(P＜0.05).The D-D aggregates in the intervention group were significantly lower than those in the control group at 2 and 3 weeks after treatment(P＜0.05).The incidence of thrombosis in the intervention group of BHTD was significantly lower than that in the control group,and the mobilization rate,HARRIS score,and fracture healing rate after 14 months were significantly higher than those in the control group(P＜0.05).The D-D aggregates,FIB,PT and APTT of the intervention group patients returned to clinical normal reference levels earlier than those of the control group,and did not deviate from normal levels.The use of BHTD,the history of diabetes,and the baseline APTT level were identified as independent risk factors for DVT by multiple factor regression analysis.The model had been proven to have good clinical predictive value through internal and external validation,respectively.Conclusion BHTD effectively improved the prognosis of elderly patients with hypercoagulable state undergoing hip arthroplasty.
关键词
老年髋部骨折/高凝状态/补气活血通络汤/下肢深静脉血栓/风险预测模型Key words
Elderly hip fracture/hypercoagulable state/Buqi Huoxue Tongluo decoction/lower limb deep vein thrombosis/risk prediction model引用本文复制引用
基金项目
四川省中医药科学技术研究专项项目(2016C055)
四川省中医药管理局科学技术研究专项项目(2018BY003)
出版年
2024
NETL
NSTL
万方数据