| Objective:To observe the clinical effect and safety of Xuesaitong Injection combined with low molecular weight heparin in the prevention of deep vein thrombosis after hip fracture surgery in elderly patients,to seek the combination of traditional Chinese and Western medicine methods in order to further decrease the incidence of deep vein thrombosis after hip fractures in elderly.Methods:The 60 elderly patients with hip fractures who accepted surgical treatment in the department of orthopedic trauma in Shiyan Taihe Hospital during the period from January 2016 to June 2017 were taken as the research objects,which were randomly divided into the treatment group and the control group,and 30 cases in each group.The two groups used the same basic and physical preventive measures to prevent DVT.In the control group,hypodermic injection of low molecular weight heparin calcium was given 12 hours after operation,based on which the treatment group was treated with 400mg of Xuesaitong Injection,plus 250ml of 0.9%Sodium Chloride Injection,intravenous drip,once a day.The observation period of all cases was 7 days.The changes in the indexes of HGB,PLT,PT,APTT and D-dimer of the day before operation,the first and the seventh day after operation respectively were observed and compared in two groups of patients,as well as the amount of intraoperative bleeding,postoperative wound flow rate and the results of color Doppler ultrasound examination of the venous vessels of the affected extremity after operation,in order to determine whether there was DVT formation or not.The incidences of DVT and PTE after operation in two groups of patients were also calculated.Results:1.Index of Hemostasis and Coagulation:Analytic results of grouping factors by repeated measurement analysis of variance:the overall level of HGB,PLT and APTT of the treatment group were about the same as that of the control group(P>0.05),while the overall level of PT was higher than that of the control group(P<0.05),and the overall level of D-dimer was lower than that of the control group(P<0.05).Analytic results of time factors:the indexes of HGB,PLT,PT,APTT,D-dimer of both groups had the tendency to change with time(P<0.05).The results of interaction analysis between the group and time factors are as follows:interaction between grouping and time of PT of the two groups had statistical significance(P<0.05),while that of HGB,PLT,APTT and D-dimer of the two groups had not statistical significance(P>0.05).Comparison results between two groups at each time point:there was no statistical significance in the comparisons of HGB,PLT,APTT between two groups on the day before operation,the first and the seventh day after operation respectively(P>0.05).The comparisons of PT and D-dimer between two groups on the day before operation had no statistical significance(P>0.05),however on the first and seventh day,the PT time of the treatment group was higher than the control group(P<0.05),and the D-dimer of the treatment group was lower than the control group(P<0.05).Comparison of paired t test results before and after each time point in the treatment group:compared with the pre-operative level,HGB significantly decreased on the first day after operation,PT and APTT obviously extended,D-dimer evidently increased(d<0.017),and PLT was almost equal to the preoperative level(P>0.017).Compared with the pre-operative level,on the seventh day after operation,PT and APTT obviously extended(P<0.017),and HGB,PLT,and D-dimer were almost the same(P>0.017).Compared with the first day after operation,on the seventh day,HGB and PLT obviously increased,PT time extended,while D-dimer declined(P<0.017),and APTT kept the same(P>0.017).On the first day after the operation,both HGB and PLT reached the lowest value,while D-dimer reached the peak.The results of paired t test before and after each time point in the control group was similar to that in the treatment group.Specific details see "3.2.4,3.3.4,3.4.4 " as followed.2.Comparison of Intraoperative and Postoperative BleedingThe average amount of intraoperative bleeding in the treatment group and the control group was 281.00ml and 304.17ml respectively,and that of postoperative bleeding was 260.67ml and 250ml respectively,neither of which has statistical significance(P<0.05).3.Incidence of DVT and Occurrence of Pulmonary EmbolismThe incidence of DVT in the treatment group was 16.7%(5/30),and that of the control group was 23.3%(7/30).There was no significant difference in the incidence of postoperative DVT in the two groups of patients(P>0.05).Therefore,it could not be considered that the prophylactic effect of DVT in the treatment group was better than that of the control group.There were no pulmonary embolism or death caused by pulmonary embolism in the two groups.Conclusion:The index of D-dimer of the two groups were higher than the normal value on the day before operation,rose to a peak on the first day after operation,and decreased to the preoperative level on the seventh days after operation.During this period,the risk of inducing DVT would significantly increase.So Prevention should be given in time.On the seventh day after operation,D-dimer was still higher than the normal value.Therefore,high attention is still needed within 1 week after the operation.It is suggested that the time of medication should be extended properly.PT and APTT of both groups extended on the first and seventh day after operation,but all were within the normal range,which indicated that the anticoagulant methods of both groups can effectively improve the coagulation function of the patients,and both anticoagulant methods have no significant risk of bleeding.The anticoagulant methods of the two groups have no obvious effect on HGB and PLT.Compared with simple use of low molecular weight heparin,although combining Xuesaitong with low molecular weight heparin has no obvious influence on preventing the occurrence of DVT in patients with hip fractures,but the treatment group overall effect of reducing D-dimer and prolonging the PT level is better than the control group,which indicates that combining Xuesaitong with low molecular weight heparin has a better effect on improving the hypercoagulability of blood than the simple use of low molecular weight heparin,and it does not increase the risk of intraoperative and postoperative bleeding.As a result,the combination of traditional Chinese and Western medicine can be used clinically to prevent postoperative DVT after hip fracture surgery,and reduce the risk factors of DVT more effectively. |
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