Abstract:

Objective　To investigate the application effect of Jiawei Taohong Siwu Decoction combined with rivaroxaban after hip replacement surgery, and to evaluate its impact on postoperative thrombosis prevention, inflammation factor level, and complications. Methods　This study was a randomized controlled trial. A total of 120 patients undergoing hip replacement surgery in Baoji Hospital of Traditional Chinese Medicine from November 2019 to November 2023 were prospectively selected and were divided into an observation group (60 cases) and a control group (60 cases) by the random number table method. In the observation group, there were 30 males and 30 females, aged (65.25±10.33) years, and the course of disease was (4.72±1.15) years. In the control group, there were 28 males and 32 females, aged (63.96±10.87) years, and the course of disease was (4.68±1.13) years. The control group received rivaroxaban treatment, and the observation group was treated with a combination of Jiawei Taohong Siwu Decoction and rivaroxaban. The differences in coagulation function indexes [plasma prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (D-D)], hemorheological indexes (whole blood viscosity, plasma viscosity, hematocrit, erythrocyte rigidity index, and erythrocyte deformability index), pro-inflammatory cytokine [C-reactive protein (CRP)], complications, and deep vein thrombosis (DVT) were compared between the two groups before and 14 days after treatment. Independent sample t test, paired sample t test, and χ² test were used. Results　Before treatment, there were no statistically significant differences in various indexes between the two groups (all P>0.05). After 14 days of treatment, the PT [(15.79±2.33) s], TT [(19.05±3.12) s], and APTT [(30.21±4.07) s] in the observation group were all longer than those in the control group [(14.01±2.67) s, (15.52±2.79) s, and (27.33±3.49) s] (all P<0.05); the levels of FIB [(3.52±1.08) g/L] and D-D [(0.22±0.04) mg/L] in the observation group were lower than those in the control group [(4.09±1.06) g/L and (0.33±0.06) mg/L] (both P<0.05). After 14 days of treatment, the whole blood viscosity [(4.07±1.28) mPa·S], plasma viscosity [(1.48±0.43) mPa·S], hematocrit [(37.56±2.79)%], and erythrocyte rigidity index [(5.47±0.77)] in the observation group were lower than those in the control group [(4.65±0.27) mPa·S, (2.02±0.39) mPa·S, (42.06±2.17)%, and (6.23±0.84)] (all P<0.05); the erythrocyte deformability index in the observation group was higher than that in the control group [(0.84±0.03) vs. (0.74±0.07)] (P<0.05). After 14 days of treatment, the CRP level in the observation group [(4.25±1.09) mg/L] was lower than that in the control group [(7.97±2.14) mg/L] (P<0.05). Within 14 days after treatment, the total complication rate [13.33% (8/60)] and the positive rate of DVT [6.67% (4/60)] in the observation group were lower than those in the control group [25.00% (15/60) and 20.00% (12/60)] (both P<0.05). Conclusion　The combined application of Jiawei Taohong Siwu Decoction and rivaroxaban significantly prevents DVT after hip or knee replacement surgery, effectively improves the hemorheological parameters, inhibits the blood coagulation, and reduces the incidence of complications.

Key words:

Hip replacement surgery, Rivaroxaban, Jiawei Taohong Siwu Decoction, Deep vein thrombosis, Therapeutic efficacy

摘要：

目的　探讨加味桃红四物汤联合利伐沙班在髋关节置换术后应用的效果，旨在评估其对术后血栓预防、炎症因子水平及并发症的影响。方法　本研究为随机对照试验，前瞻性选取2019年11月至2023年11月在宝鸡市中医医院行髋关节置换手术的120例患者，采用随机数字表法将患者分为观察组（60例）和对照组（60例）。观察组男30例，女30例；年龄（65.25±10.33）岁；病程（4.72±1.15）年。对照组男28例，女32例；年龄（63.96±10.87）岁；病程（4.68±1.13）年。对照组采用利伐沙班治疗方案，观察组采用加味桃红四物汤与利伐沙班的联合治疗方案。比较两组在治疗前及治疗14 d后的凝血功能指标［血浆凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）及D-二聚体（D-D）］、血流变学指标（全血粘度、血浆粘度、红细胞比容、红细胞刚性指数及红细胞变形指数）、促炎性细胞因子指标［C反应蛋白（CRP）］、并发症及深静脉血栓（DVT）方面的差异。采用独立样本t检验、配对样本t检验和χ²检验。结果　治疗前，两组各项指标比较，差异均无统计学意义（均P>0.05）。治疗14 d后，观察组PT［（15.79±2.33）s］、TT［（19.05±3.12）s］和APTT［（30.21±4.07）s］均长于对照组［（14.01±2.67）s、（15.52±2.79）s、（27.33±3.49）s］（均P<0.05）；观察组FIB［（3.52±1.08）g/L］和D-D水平［（0.22±0.04）mg/L］均低于对照组［（4.09±1.06）g/L、（0.33±0.06）mg/L］（均P<0.05）。治疗14 d后，观察组全血粘度［（4.07±1.28）mPa·S］、血浆粘度［（1.48±0.43）mPa·S］、红细胞比容［（37.56±2.79）%］、红细胞刚性指数（5.47±0.77）均低于对照组［（4.65±0.27）mPa·S、（2.02±0.39）mPa·S、（42.06±2.17）%、（6.23±0.84）］（均P<0.05）；观察组红细胞变形指数（0.84±0.03）高于对照组（0.74±0.07）（P<0.05）。治疗14 d后，观察组CRP水平［（4.25±1.09）mg/L］低于对照组［（7.97±2.14）mg/L］（P<0.05）。治疗后14 d内，观察组并发症总发生率［13.33%（8/60）］和DVT阳性率［6.67%（4/60）］均低于对照组［25.00%（15/60）、20.00%（12/60）］（均P<0.05）。结论　加味桃红四物汤与利伐沙班的联合应用在预防髋关节或膝关节置换术后DVT的效果显著，能有效改善血流变学参数，抑制血液凝集，降低并发症发生率。

关键词:

髋关节置换术, 利伐沙班, 加味桃红四物汤, 深静脉血栓, 疗效