| Research Background:Deep vein thrombosis(DVT)is one of the common complications after total hip arthroplasty(THA).The formation of severe DVT can result in the embolism of pulmonary artery and thus lead to the death of patients,so it is of great importance to prevent and cure DVT.However,there are still major limitations on the prevention and cure of DVT in modern Western medicine.Therefore,it needs to explore more effective and safer prevention and cure methods.Since DVT belongs to the category of"swollen thigh" and "vessel impediment" in traditional Chinese medicine(TCM),"qi stagnation and blood stasis" is the basic pathogenesis of DVT and "promoting blood circulation to remove blood stasis" is a general diagnosis and treatment principle for the prevention and cure of DVT.Chinese medicine therapy and acupuncture therapy are the most important two therapeutic approaches in TCM.Although the type of Chinese medicine formulae with the efficacy of promoting blood circulation to remove blood stasis has been widely applied in clinic for the prevention of DVT after THA,it still lacks evidence basis;and there are a few clinical reports on the use of acupuncture therapy to prevent the DVT caused by other diseases,but currently there is no report on the use of acupuncture therapy to prevent the DVT caused by THA.Hence,it is of great significance to provide evidence basis for the preventive and therapeutic effect of Chinese medicine on DVT after THA and explore the preventive and therapeutic effect of acupuncture on DVT after THA,so as to evaluate the therapeutic effect of TCM on DVT after THA and broaden the application of TCM in the prevention of DVT after THA.Evidence-based research:Objective:To make a systematic evaluation of the clinical research on the application of Chinese medicine formulae in the prevention and cure of leg DVT after THA by using the Cochrane systematic evaluation method,and discuss the efficacy of Chinese medicine formulae on the prevention and cure of DVT after THA compared with Western medicine by selecting and using the clinical research on Taohong Siwu decoction and Buyang Huanwu decoction,so as to provide evidence basis for the preventive and therapeutic effect of Chinese medicine on DVT after THA.Method:The clinical randomized controlled trials in which the incidence rate of DVT was taken as a main observational index and Huoxue recipe was taken as a main intervention measure for the prevention of DVT after THA were searched comprehensively.The included literature was screened and created according to inclusion criteria and processes.The basic information and the data on related observational indexes of the included literature were extracted,and meanwhile the methodological quality of the included literature was assessed according to the Cochrane standard.Meta-analysis was conducted for the curative effect indexes in the literature,the heterogeneity of each index was analyzed,and the publication bias was understood with the help of funnel plot.Results:Based on the systematic evaluation of the effect of Huoxue recipe on the prevention of DVT after THA,14 randomized controlled trials(1,147 patients)were included,and the quality of the included literature was generally poor.Compared with Western medicine,Huoxue recipe could prevent the incidence rate of DVT after THA more effectively(P<0.05),reduce the level of Fib in the blood of postoperative patients(P<0.05),and have better clinical safety.Through subgroup analysis,it was found that compared with Western medicine,Buyang Huanwu decoction could prevent the incidence rate of DVT after THA more effectively(P<0.05),and reduce the level of DDi in the blood of postoperative patients(P<0.05),while compared with Western medicine,Taohong Siwu decoction had a similar effect on the prevention of the incidence rate of DVT after THA(P>0.05),but it could reduce the level of Fib in the blood of postoperative patients more effectively(P<0.05).Conclusions:Based on taking the incidence rate of DVT as a main index,Huoxue recipe can prevent the development of leg DVT after THA safely and effectively.However,due to the limitations on methodological quality,heterogeneity,sample size,etc.,the preventive effect of Huoxue recipe still needs to be further verified by multicenter clinical research with larger sample and higher quality.Clinical research:ObjectiveTo explore the preventive and therapeutic effect of acupuncture on DVT after THA,and investigate the preventive effect and treatment mechanism of electroacupuncture on the development of DVT after THA through randomized controlled trials.Method:94 patients treated in Orthopedics Department,The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to December 2018 who met the inclusion criteria were selected,and they were divided into a control group and a treatment group by using block randomization,with 47 patients in each group.Since there were 2 dropouts in the treatment group,the final admitted case was 45 patients in the treatment group and 47 patients in the control group.Both groups received basic treatment,namely stretch socks were used after operation and patients were guided to perform the functional exercise of hip joint systematically and reasonably at the early stage.On this basis,patients in the treatment group received electroacupuncture on days 1-7 after operation.Through routine disinfection,the needle was inserted into Hegu acupoint and Taichong acupoint at the double sides and Liangqiu acupoint,Waiqiu acupoint and Jinmen acupoint at the affected side,with the depth of about 25mm.After getting the qi,electroacupuncture output wire was clipped on the acupuncture needle located at the acupoint of affected limbs,the dilatational wave with the frequency of 2/100Hz stimulated for 30 minutes,and the output intensity was set according to the tolerance of patients.Meanwhile,patients in the treatment group took rivaroxaban on days 1-7 after operation,with 10mg per day.However,based on the basic treatment,patients in the control group only took rivaroxaban on days 1-7 after operation,with 10mg per day.Color ultrasound examination was performed for lower extremity veins of patients in both groups before operation and on the 7 th day after operation.The PT,APTT,Fib,DDi,PLT,the whole blood viscosity at low,middle and high shear rates,and the plasma viscosity were examined before operation and on the 1st,3rd and 5th day after operation.The results of the color ultrasound of lower extremity veins,the incidence rates of leg DVT,the situations of hematoma and swelling in patients'affected limbs,and the changes of relevant blood indexes were observed in both groups on the 7th day after operation.SPSS12.0 software was used to analyze all the data statistically.Chi-square test was adopted to compare the distribution of categorical data between two groups.Independent sample T-test was adopted for the comparison of continuous data between two groups.The repeated measure of ANOVA was mainly used to compare clinical outcome indicators.Bonferroni method was used for pairwise comparison at different time points.The significant level was set as 0.05,and P<0.05 was considered statistically significant.Results:After operation,there were 7 patients with DVT and 40 patients without DVT in the control group,with the incidence rate of 14.9%,while there was 1 patient with DVT and 44 patients without DVT in the treatment group,with the incidence rate of 2.2%.According to the chi-square test,it could be considered that the difference of the incidence rate of DVT between the two groups was statistically significant(P<0.05).After operation,there were 5 patients with lower extremity hematoma and 42 patients without lower extremity hematoma in the control group,with the incidence rate of 7.6%,while there were 2 patients with lower extremity hematoma and 43 patients without lower extremity hematoma in the treatment group,with the incidence rate of 4.4%.According to the chi-square test,it could be considered that the difference of the incidence rate of lower extremity hematoma between the two groups was not statistically significant(P>0.05).After operation,there were 4 patients with lower extremity ecchymosis and 43 patients without lower extremity ecchymosis in the control group,with the incidence rate of 4.3%,while there were no patients with lower extremity ecchymosis in the treatment group,with the incidence rate of 0%.According to the chi-square test,it could be considered that the difference of the incidence rate of lower extremity ecchymosis between the two groups was statistically significant(P<0.05).The level of PLT in the treatment group on the 5th day after operation was lower than that in the control group,and the difference was statistically significant(P<0.01).The level of Fib in the treatment group on the 3rd and 5th day after operation was lower than that in the control group,and the difference was statistically significant(P<0.01).The level of DDi in the treatment group on the 5th day after operation was lower than that in the control group,and the difference was statistically significant(P<0.01).Conclusion:The clinical research shows that compared with simple Western medicine,electroacupuncture combined with Western medicine can significantly reduce the risk of leg DVT after THA and also have better safety.Through comparing some blood indexes,it is found that electroacupuncture can inhibit the aggregation of platelets and improve the blood hypercoagulable state,thus enhancing the blood fibrinolysis status and reducing the content of D-dimer.However,due to the limited sample size in this study,its conclusions still need to be further verified by more clinical and experimental research. |
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