| Objective:Intertrochanteric fractures are common in elderly patients.According to the now advocated rapid recovery theory,early surgery is required to enable patients to get to the ground as soon as possible to prevent various complications caused by long-term bed rest.However,preoperative DVT is a risk factor for surgery,so it is very important to prevent DVT before surgery.Taohong siwu decoction is a classic prescription for promoting blood circulation and removing blood stasis,which can effectively prevent thrombosis.However,according to the constitution theory of traditional Chinese medicine,the same medicine has different curative effects for patients with different constitution types.Therefore,this study was divided into groups according to three common constitution types to observe whether there are differences in the clinical efficacy of taohong siwu decoction in preventing preoperative thrombosis in patients with intertrochanteric fracture.To explore the application value of taohong siwu decoction for patients with different constitution types,and to provide a new idea for prevention and treatment of lower limb deep venous thrombosis before surgery.Method:The subjects were diagnosed as intertrochanteric fracture in fuzhou no.2 hospital from December 2017 to December 2018.TCM is a syndrome of blood stasis,and it belongs to three types of constitution: placid,qi-deficient and yang-deficient.According to the standard of 90 cases into peaceful mass groups depending on the type of TCM constitution,qi deficiency,Yang deficiency group,30 cases in each group,were given peach siwu decoction(peach kernel 9 g,safflower 15 g,9 g,red paeony root,rehmannia glutinosa 15 g,rhizoma ligustici wallichii 15 g,angelica 15 g)treatment,uniform every day to 1 l water,boiled to 400 ml,divided into two,take 200 ml,respectively,in the morning and evening,take 5 days.VAS score,coagulation function(including prothrombin time,fibrinogen,activated partial thrombin time)and plasma d-dimer concentration were observed and recorded on the first day of treatment and the fifth day of treatment,respectively.The results of color doppler ultrasound examination of bilateral lower extremity vessels were recorded on the 5th day of treatment.The blood stasis symptoms and signs before and after treatment were scored.Result: 1.Comparison of the general conditions of subjects in the three groups(gender,age,and patients with intertrochanteric fracture of femur)showed no statistical significance(P > 0.05),indicating that the general conditions of subjects in the three groups were similar,which could be compared.2.VAS Scores Subjects in the three groups were compared within the group on the first day of treatment and the fifth day of treatment,all of which had statistical significance(P < 0.05),indicating that taohong siwu decoction had an obvious improvement effect on the pain of patients with intertrochanteric fracture of pingzhi,qi-deficiency and yang-deficiency.There was no statistical significance(P > 0.05)in the comparison between the three groups of subjects on the first day of treatment and the fifth day of treatment,indicating that taohong siwu decoction had no difference in improving the pain of patients with intertrochanteric fractures of three physique types.3.Prothrombin Time Subjects in the three groups were compared within the group on the first day of treatment and the fifth day of treatment,all of which had statistical significance(P < 0.05),indicating that taohong siwu decoction had a significant effect on prothrombin time reduction in patients with intertrochanteric fracture of pingzhi,qi-deficiency and yang-deficiency.There was no statistical significance(P > 0.05)in the comparison between the three groups of subjects on the first day of treatment and the fifth day of treatment,indicating that taohong siwu decoction had no difference in improving prothrombin time in patients with intertrochanteric fracture of three constitutions.4.Fibrinogen Subjects in the three groups were compared within the group on the first day of treatment and the fifth day of treatment,all of which had statistical significance(P < 0.05),indicating that taohong siwu decoction had obvious improvement effect on fibrin in patients with intertrochanteric fractures of pingzhi,qi-deficiency and yang-deficiency.There was no statistical significance(P > 0.05)in the comparison between the three groups of subjects on the first day of treatment and the fifth day of treatment,indicating that taohong siwu decoction had no difference in improving fibrinogen in patients with intertrochanteric fractures of three constitutions.5.Activated partial thromboplastin time The subjects in the three groups were compared within the group on the first day of treatment and the fifth day of treatment,all of which had statistical significance(P < 0.05),indicating that taohong siwu decoction had a significant effect on reducing the time of activated part of thrombin in patients with intertrochanteric fractures of pingzhi,qi-deficiency and yang-deficiency.There was no statistical significance(P > 0.05)in the comparison between the three groups of subjects on the first day of treatment and the fifth day of treatment,indicating that taohong siwu decoction had no difference in reducing the time of activated part of thrombin in patients with three types of constitution with intertrochanteric fracture.6.Plasma D-dimer concentration Subjects in the three groups were compared within the group on the first day of treatment and the fifth day of treatment,all of which had statistical significance(P < 0.05),indicating that taohong siwu decoction had a significant effect on reducing the plasma d-dimer concentration of patients with intertrochanteric fractures with three constitutions: pingzhi,qi-deficiency and yang-deficiency.There was no statistical significance(P > 0.05)in the comparison between the three groups of subjects on the first day of treatment and the fifth day of treatment,indicating that taohong siwu decoction had no difference in the reduction effect of plasma d-dimer concentration in patients with intertrochanteric fracture of three constitutions.7.Color doppler ultrasound of both lower limbs DVT formation was not found in bilateral lower extremity color doppler ultrasound and quality group,and the incidence was 0.00%.In qi-deficiency group,DVT was formed in 2 cases,including 1 on the affected side and 1 on the healthy side,with an incidence of 6.67%.The incidence of DVT in the three groups was similar to the results reported in many studies,indicating that taohong siwu decoction can effectively prevent the formation of DVT in patients with intertrochanteric fractures.8.All subjects were scored before and after treatment according to the symptom score chart of blood stasis syndrome.The total effective rate of the three groups was 100%,including 30 cases of obvious effect in pingping group,28 cases of obvious effect in qi-deficiency group,2 cases of effective effect,23 cases of yang-deficiency group,and 7 cases of effective effect.All the subjects in the three groups were effective after treatment with taohong siwu decoction,indicating that taohong siwu decoction has significant improvement effect on clinical symptoms and signs of blood stasis syndrome.Conclusion:Taohong siwu decoction can improve the pain and prevent the formation of thrombosis in patients with intertrochanteric fracture of femur who have three types of constitution: pinghezhi,qi-deficient and yang-deficient.There is no obvious evidence that taohong siwu decoction has better efficacy in preventing thrombus formation before surgery in patients with intertrochanteric fractures with three types of constitution: pingzhi,qi-deficiency and yang-deficiency. |
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