清脉饮联合利伐沙班对全膝关节置换术后股肿病的防治的临床观察

Clinical Observation on the Prevention and Treatment of Femoral Swelling after Total Knee Arthroplasty with Qingmai Decoction Combined with Rivaroxaban

摘要: 目的：探讨“清脉饮”联合利伐沙班对全膝关节置换术后深静脉血栓的防治效果；方法：纳入2023年7月至2024年3月在贵州中医药大学第一附属医院行全膝关节置换术，愿意配合且符合标准的60例患者作为研究对象，在护理条件、手术方式、假体厂家均一致的情况下，将其分为利伐沙班组与联合用药组，每组各30例。其中利伐沙班组仅予以利伐沙班抗凝治疗，联合用药组在利伐沙班组的基础上联合清脉饮口服治疗。比较两组患者的术后血栓发生率，对比两组术后第3天与第7天及第14天的D-二聚体、凝血酶原时间、纤维蛋白原，以及术后第15天HSS评分的优良率统计。试验结果：结合两组术后3天、术后7天、术后14天的凝血酶原时间、纤维蛋白原及D-二聚体分别比较，在同一指标、同一时间段内的差异值相比较，联合用药组与利伐沙班组的差异具有统计学意义(P < 0.05)，HSS评分优良率的统计中联合用药组优良率(93.33%)明显高于利伐沙班组(80.00%)。结论：对于人工全膝关节置换术后的患者，在相同的常规护理条件下，予以利伐沙班抗凝的基础上，联合清脉饮可有效降低术后下肢深静脉血栓的发生率，同时还可减少术后疼痛等不适，在一定程度上提高了患者的生活质量。

Abstract: Objective: To explore the prevention and treatment effect of “Qingmai Decoction” combined with rivaroxaban on deep venous thrombosis after total knee arthroplasty; Methods: Sixty patients who underwent total knee arthroplasty in the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from July 2023 to March 2024, who were willing to cooperate and met the standards, were selected as the research objects. Under the condition that the nursing conditions, operation methods and prosthesis manufacturers were consistent, they were divided into rivaroxa group and combined medication group, with 30 patients in each group. The rivaroxaban group was only treated with rivaroxaban anticoagulation, and the combined medication group was treated with Qingmaiyin orally on the basis of the rivaroxaban group. The incidence of postoperative thrombosis was compared between the two groups. The D-dime, prothrombin time and fibrinogen were compared between the two groups on the 3rd, 7th and 14th day after operation, and the excellent and good rate of HSS score on the 15th day after operation was compared. Results: Combined with the prothrombin time, fibrinogen and D-dimer of the two groups at 3 days, 7 days and 14 days after operation, the difference between the combined group and the rivaroxaban group was statistically significant (P < 0.05). The excellent and good rate of HSS score in the combined group (93.33%) was significantly higher than that in the rivaroxaban group (80.00%). Conclusion: For patients after total knee arthroplasty, under the same routine nursing conditions, on the basis of rivaroxaban anticoagulation, combined with Qingmai Decoction can effectively reduce the incidence of postoperative deep venous thrombosis of lower limbs, and also reduce postoperative pain and other discomfort, to a certain extent, improve the quality of life of patients.