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目的:观察肢伤一方联合利伐沙班片对股骨粗隆间骨折术后深静脉血栓形成(DVT)的预防作用。方法:选取60例气虚血瘀证股骨粗隆间骨折患者为研究对象,随机分为对照组与治疗组各30例。2组均给予骨科基础治疗,以及行切开复位内固定术治疗。对照组术后10 h给予口服利伐沙班片治疗,治疗组在对照组用药基础上联合肢伤一方治疗。观察2组术前及术后血小板计数(BPC)、D-二聚体、凝血功能、DVT发生率、切口引流量等指标的变化。结果:术前1天,2组BPC、D-二聚体水平、PT、APTT和FIB含量比较,差异均无统计学意义(P>0.05)。术后1、14天,2组BPC水平均较术前1天下降(P<0.05,P<0.01)。术后14天,治疗组的BPC水平低于同期对照组(P<0.01)。术后1天,2组D-二聚体水平均较术前1天上升(P<0.05)。术后14天,2组D-二聚体水平均较术后1天下降(P<0.01),PT、APTT均较术前1天延长(P<0.01),FIB含量均较术前1天减少(P<0.01);治疗组的D-二聚体水平低于对照组(P<0.01),PT、APTT长于对照组(P<0.01),FIB含量少于对照组(P<0.01)。2组术后14天DVT发生率和术后1天切口引流量比较,差异均无统计学意义(P>0.05)。结论:肢伤一方联合利伐沙班片治疗气虚血瘀证股骨粗隆间骨折,对改善患者的凝血功能、降低D-二聚体水平,预防DVT,具有良好的效果。
Objective: To observe the prophylactic effect of limbs associated with rivaroxaban on deep venous thrombosis (DVT) after intertrochanteric fractures. Methods: Sixty cases of intertrochanteric fractures with Qi-deficiency and blood-stasis syndrome were selected as study subjects and randomly divided into control group and treatment group with 30 cases each. 2 groups were given basic orthopedic treatment, and open reduction and internal fixation. The control group was treated with oral rivaroxaban 10 hours after operation, and the treatment group was treated on the basis of the control group with limb wound. The changes of preoperative and postoperative platelet count (BPC), D-dimer, coagulation function, incidence of DVT and incision drainage were observed. Results: There was no significant difference in the levels of BPC, D-dimer, PT, APTT and FIB between the two groups before surgery (P> 0.05). At 1 day and 14 days after operation, the levels of BPC in both groups were significantly lower than those in the first day (P <0.05, P <0.01). At 14 days after operation, the level of BPC in the treatment group was lower than that in the control group (P <0.01). One day after operation, the levels of D-dimer in two groups increased compared with the first day before operation (P <0.05). The levels of D-dimer in two groups decreased (P <0.01) on day 14 postoperatively compared with those on the first postoperative day (P <0.01), while the levels of PT and APTT both prolonged (P <0.01). The D-dimer level in the treatment group was lower than that in the control group (P <0.01). The PT and APTT lengths were longer than those in the control group (P <0.01). There was no significant difference in the incidence of DVT between the two groups 14 days after operation and the amount of incision drainage one day after operation (P> 0.05). Conclusion: One limb injury and rivaroxaban tablet treatment of intertrochanteric fractures with Qi-deficiency and blood-stasis syndrome has a good effect on improving coagulation function, lowering D-dimer level and preventing DVT.