益气活血通脉汤预防妇科良性肿瘤腹腔镜术后深静脉血栓效果观察

Observation on the Effects of Yiqi Huoxue Tongmai Decoction on Preventing Deep Vein Thrombosis After Laparoscopic Surgery for Benign Gynecological Tumors

摘要:

目的：观察益气活血通脉汤在妇科良性肿瘤腹腔镜术后深静脉血栓（DVT） 中的预防效果。方法：采取前瞻性随机对照研究法。选取2024年3月—2025年3月嵊州市中医院妇科70例行腹腔镜下良性肿瘤手术患者，按随机数字表法分为对照组与观察组各35例。试验期间2组均剔除2例，最终2组各完成研究33例。对照组给予间断充气加压泵（IPC） 治疗，观察组给予益气活血通脉汤治疗。比较2组术后1天、术后7天凝血功能［活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）、纤维蛋白原（FIB）］、血液流变学指标值［血浆黏度（PV）、血小板计数（BPC）、红细胞压积（HCT）、全血高切黏度］、血清炎症因子［白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）］ 水平的变化。比较2组术前及术后7天股静脉血流速度的变化，术后3天比较2组腹部切口疼痛视觉模拟评定法（VAS） 评分，术后7 天DVT发生率及治疗期间评估药物安全性。结果：术后7天，2组APPT、PT水平均较术后1天提高（P＜0.05），FIB、D-D水平均较术后1天降低（P＜0.05）；观察组APTT、PT水平均高于对照组（P＜0.05），D-D水平低于对照组（P＜0.05），2组组间FIB比较，差异无统计学意义（P＞0.05）。术后7天，2组PV、BPC、HCT及全血高切黏度均较术后1天降低（P＜0.05），观察组PV、BPC、全血高切黏度均低于对照组（P＜0.05）。2组组间HCT比较，差异无统计学意义（P＞0.05）。术后7天，2组IL-6、TNF-α水平均较术后1天降低（P＜0.05），IL-10水平均较术后1天提高（P＜0.05）；观察组IL-6、TNF-α水平均低于对照组（P＜0.05）。2组组间IL-10水平比较，差异无统计学意义（P＞0.05）。治疗期间，2组均未出现下肢深静脉血栓。术后7天，2组股静脉血流速度均较术前减慢（P＜0.05），观察组股静脉血流速度快于对照组（P＜0.05）。术后第3天，观察组VAS评分低于对照组（P＜0.05）。2组治疗期间均无明显不良反应及异常。结论：口服益气活血通脉汤能预防妇科良性肿瘤腹腔镜手术后静脉血栓，有效改善凝血功能、血液流变学指标值，减轻机体炎症反应，改善股静脉血流速度，有效预防DVT的发生。

Abstract:

Abstract： Objective： To observe the preventive effect of Yiqi Huoxue Tongmai Decoction on deep vein thrombosis （DVT） after laparoscopic surgery for benign gynecological tumors. Methods： A prospective randomized controlled trial was conducted. A total of 70 patients undergoing laparoscopic surgery for benign tumors in the Department of Gynecology of Shengzhou Traditional Chinese Medicine Hospital from March 2024 to March 2025 were enrolled. They were randomly divided into a control group and an observation group using the random number table method，with 35 cases in each group. During the trial，2 cases were excluded from each group，resulting in 33 cases completing the study in each group. The control group received intermittent pneumatic compression （IPC） therapy， while the observation group received Yiqi Huoxue Tongmai Decoction. The changes in coagulation function [activated partial thromboplastin time （APTT）， prothrombin time （PT）， D-dimer （D-D）， fibrinogen （FIB）]， hemorheology [plasma viscosity （PV）， blood platelet count （BPC）， hematocrit （HCT）， whole blood high-shear viscosity]， and serum inflammatory factors [interleukin-6 （IL-6），interleukin-10 （IL-10），tumor necrosis factor-α （TNF-α）] were compared between the two groups at one day and seven day postoperatively. The changes in femoral vein blood flow velocity were compared between the two groups preoperatively and at seven day postoperatively. Abdominal incision pain was assessed using the Visual Analogue Scale （VAS） scores at three day postoperatively，the incidence of DVT at seven day postoperatively was recorded， and drug safety during treatment was evaluated. Results： At seven day postoperatively， the values of APTT and PT in both groups increased compared with those at one day postoperatively （P＜0.05）， while the levels of FIB and D-D decreased compared with those at one day postoperatively （P＜0.05）. The values of APTT and PT in the observation group were higher than those in the control group （P＜0.05）， and the D-D level in the observation group was lower than that in the control group （P＜0.05）， whereas there was no statistically significant difference in FIB between the two groups （P＞0.05）. At seven day postoperatively， the levels of PV， BPC， HCT， and whole blood high-shear viscosity in both groups decreased compared with those at one day postoperatively （P＜0.05）. The levels of PV， BPC， and whole blood high-shear viscosity in the observation group were lower than those in the control group （P＜0.05），while there was no statistically significant difference in HCT between the two groups （P＞0.05）. At seven day postoperatively，the levels of IL-6 and TNF-α in both groups decreased compared with those at one day postoperatively （P＜0.05）， and the level of IL-10 increased compared with that at one day postoperatively （P＜0.05）. The levels of IL-6 and TNF-α in the observation group were lower than those in the control group （P＜0.05），whereas there was no statistically significant difference in IL-10 between the two groups （P＞0.05）. During treatment， no DVT of lower extremity occurred in either group. At seven day postoperatively， the femoral vein blood flow velocity in both groups decreased compared with that preoperatively （P＜0.05），while the femoral vein blood flow velocity in the observation group was faster than that in the control group（ P＜0.05）. At three day postoperatively，the VAS score of the observation group was lower than that of the control group （P＜0.05）. No significant adverse reactions or abnormalities occurred in either group during treatment. Conclusion： Yiqi Huoxue Tongmai Decoction can prevent venous thrombosis after laparoscopic surgery for benign gynecological tumors， effectively improve coagulation function and hemorheological parameters， reduce the inflammatory response，improve femoral vein blood flow velocity，and effectively prevent DVT.