| BackgroundWith the popularization of artificial joint surgical, deep vein thrombosis (DVT) after artificial joint replacement as the main complication was given more and more attention. Arthroplasty pathogenesis of deep vein thrombosis after artificial joint replacement was mainly due to stagnant venous flow, vein wall damage and blood hypercoagulability. According to the reports:the incidence rate of DVT is about 40% if having not taken any preventive measures after total hip replacement(THR), the incidence rate of pulmonary embolism (PE) is about 0.5%～2.0%. Because of lack of specific symptoms and signs, Pulmonary embolism can easily be ignored, Rate of diagnosis is low and mortality is high, so anticoagulant drugs were used to improve postoperative hypercoagulability of blood, prevention of DVT in order to avoid pulmonary embolism after THR in the clinical. Application of Warfarin, low molecular weight heparin (LMWH), such as rivaroxaban effectively improved the blood hypercoagulability of patients after total hip replacement and reduced the probability of DVT. In recent years, modern pharmacological research confirmed that removing stasis mechanical herbs had the effects of improvement microcirculation, inhibition of platelet aggregation, clear clotting substances, change of blood hypercoagulability, with reliable results, good security and good clinical value. Chinese medicine can not only change the blood hypercoagulability, but also can improve the overall condition of patients,reduce the adverse reactions such as bleeding and the financial burden of patients.Objectives Investigate the feasible of building the blood stasis rat model by integration of multiple factors, and on this basis, observe the effect of Tao Hong Si Wu decoction in hypercoagulability of blood stasis rat model. Through clinical observation, discuss the efficacy and safety of Tao Hong Si Wu decoction in hypercoagulability improvement of patients after total hip replacement.Methods1 Experimental research1.1 Model40 aged SD rats were randomly divided into the blank group; the control group 1, the control group 2, the model group 1, the model group 2,8 rats in each group. Blank and control group were given normal diet, model group was given high fat diet, feeding 2 weeks. After 2 weeks, the control group was given the Epinephrine subcutaneous injection and ice bath, model group was given improvement "quantitative blow" to build the blood stasis rat model.1 day after modeling, the local symptoms and signs of rats were observed, and the rats in the blank group;control group 1, model group 1 were taken blood from abdominal aortic under anesthesia, and were tested D-dimer (D2D), fibrinogen (FIB), prothrombin time(PT), activated partial thromboplastin time (APTT), whole blood viscosity and plasma viscosity.7 days after modeling, control group 2, model group 2 were tested by the same method.1.2 Experimental study of Tao Hong Si Wu decoction60 aged SD rats were randomly divided into blank group, model group, fraxiparine group, Tao Hong Si Wu decoction high dose group, Tao Hong Si Wu decoction middle dose group and Tao Hong Si Wu decoction low dose group,10 rats in each group.All stasis models in 6 groups were builded by the method which studied in this paper. Blank group and model group was given normal saline,4ml/d;the Fraxiparine group was given Fraxiparine, Subcutaneous injection,25IU/100g·d; Tao Hong Si Wu decoction high dose group, Tao Hong Si Wu decoction middle dose group and Tao Hong Si Wu decoction low dose group were given the corresponding concentration of Tao Hong Si Wu decoction, 4ml/d. After ig 7 days, all model rats were taken blood from abdominal aortic under anesthesia, and the D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, whole blood viscosity and plasma viscosity of models were tested. 2 Clinical researchThe patients in our hospital needed to undergo total hip replacement from March 2009- April 2010, according to inclusion criteria and exclusion criteria, 86 cases were included and randomly divided into control group and treatment group.The opertations of patients in two groups were performed by the same team of doctors,using combined spinal-epidural anesthesia, posterolateral incision and imported cementless artificial arthroplasty in operations. Drainage tubes were placed and analgesia pumps were not used after the operations. The control group was given rivaroxaban 10mg, once a day; Treatment group was given Tao Hong Si Wu decoction 200ml each time, twice a day. The patients in two groups were treated for 2 weeks. Weight, age, gender and other general factors were compared before operations; the changes of Platelet count, red blood cell count, hemoglobin, prothrombin time, activated partial thromboplastin time, fibrinogen before and 7 days after the operations were tested. D-dimer levels before surgeries,3 days after surgeries and 7 days after surgeries were also tested. Drainage flow 2 days after operations and pain conditions of 1 day,7 days and 12 days after surgeries were also compared. Skin temperature, skin condition, ecchymosis, hematoma, Human sign and swelling condition were observed. All patients in two groups were tested the deep venous ultrasonography 10 days after surgeries.All datas were analyzed statistically using SPSS17.0, measurement data was expressed by mean±standard deviation(x±s), and the data was tested with normal distribution and homogeneity of variance test. If the data accorded with normal distribution and homogeneity of variance test, t-test was used when two groups were compared, but if not approximate t-test that t' test was used; One-Way ANOVA test was usd when the date compared among many groups; Count data was tested with chi square test, the results were considered statistically significant when a=0.05, P<0.05.Results1 Experimental research1.1 After modeling, there were "swelling", "petechiae", "pain" and other manifestations of blood stasis syndrome in the rats in model group.1 day after modeling, D-dimer, FIB, PT, APTT, whole blood viscosity and plasma viscosity of the rats in model group and control group occurred significant change (P<0.05) compared with the blank group, and there were not significant differences (P>0.05) between the model group and control group; 7 days after modeling, there were significant differences (P<0.05) in D-dimer, FIB, PT, APTT, whole blood viscosity and plasma viscosity between the blank group and the control group, and the D-dimer, FIB, PT, APTT, whole blood viscosity and plasma viscosity of the model group were significantly different from the blank group and the control group (P<0.05).1.2 The D-dimer levels of models in fraxiparine group and three dose groups of Tao Hong Si Wu decoction were reduced, and there were not significant differences between Tao Hong Si Wu decoction high dose group and fraxiparine group(P>0.05), the fibrinogen of models in Tao Hong Si Wu decoction high, middle dose groups and the fraxiparine group were significantly lower than model group (P<0.05). The PT of models in Tao Hong Si Wu decoction high dose group were prolonged, and there were statistical difference between Tao Hong Si Wu decoction high dose group and model group (P<0.05); however, there was not significant difference in APTT between two groups (P>0.05). The PT and APTT of models in Tao Hong Si Wu decoction middle and low dose groups were not statistically differences compared with the models in model group(P>0.05). The whole blood viscosity of models in Tao Hong Si Wu decoction high dose group and fraxiparine group in 200/s,30/s and 3/s shear rates and plasma viscosity were significantly lower than rats' in model group(P<0.05), however, there were not significant difference between the two groups(P>0.05). Tao Hong Si Wu decoction middle dose group compared with the model group significantly improved the whole blood viscosity in the high shear, low shear and also improved plasma viscosity (P<0.05), Tao Hong Si Wu decoction low dose group only significantly improved (P<0.05) the whole blood viscosity in low shear rate compared with the model group.2 Clinical researchThere were not significant differences (P>0.05) in sex, age, weight, platelet count, red blood cell count, hemoglobin, D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, whole blood viscosity and plasma viscosity before surgeries. After surgeries, the patients in treatment group were significantly better(P<0.05)than the patients in control group in swelling, pain, skin temperature, skin color, Human signs and other aspects of clinical signs and symptoms. But there were not significant differences (P>0.05) in postoperative drainage, hematoma, ecchymosis and other safety indicators.7 days after surgeries, red blood cell count of the treatment group was significantly higher(P<0.05)than the control group's,but there were not significant differences in treatment group between before and 7 days after operations in Platelet count, hemoglobin, red blood cell count (P>0.05).1 day and 12 days after surgeries, no significant differences were found in PT and APTT between two groups(P<0.05).3 days after operations, D-dimer levels of two groups were higher than those before the surgeries(P<0.05), and no significant difference was found between two groups(P>0.05).7 days after operations D-dimer levels of two groups were lower than those in 3 days after operations(P<0.05),but still higher than those before the surgeries (P<0.05).And there were not significant difference between two groups (P>0.05).7 days after operations, fibrinogen of the two groups were not significantly different (P>0.05), and compared with these before surgeries, were not statistically differnet (P>0.05). The whole blood viscosity and plasma viscosity of the two groups were significantly higherthan those before (P<0.05), and there were not statistically difference between the two groups in whole blood and plasma viscosity (P>0.05).The whole blood viscosity and plasma viscosity of the both groups in 12 days after operations were lower than these in 7 days after surgeries, and the differences were significant(P<0.05); the whole blood and plasma viscosity of treatment group were close to preoperative levels, the difference was not statistically significant(P>0.05),the whole blood viscosity of treatment group were lower than the control group's, and the difference was significant(P<0.05),but there was not significant difference in plasma viscosity between two groups (P>0.05). Color Doppler ultrasound examinations were given 10 days after the surgeries, the incidence of DVT of patients in two groups were 2.3%,7.0%, no significant difference (P>0.05).Conclusion1. Through Multi-factor composite method which the aged rats were given high fat diet and combined with modified "quantitative attack", blood stasis rats model can be successfully established.The success of this model is expected for providing experimental basis for the future study of blood stasis and screening of blood-activating and stasis-resolving medicinal.2. Tao Hong Si Wu decoction can improve fibrinolysis and blood rheology state of blood stasis rats model, thereby can improve hypercoagulability of blood stasis rat model.3. After 14 days of surgeries, Tao Hong Si Wu decoction can effectively improve the patient's blood hypercoagulability, prevent the occurrence of deep vein thrombosis, improve the state of hemorheology, recover the health, also can significantly ease the swelling, pain and other symptoms. The incidence of adverse reactions such as bleeding, hematoma and ecchymosis were not significant. |
PDF Full Text Request