葛小刚　　蔡旗旗　　牟财国　　蔡杨阳

[摘要] 目的 觀察温针灸配合低分子肝素加利伐沙班治疗脊髓损伤后下肢静脉血栓的临床疗效。 方法 选取2019年1—12月我院收治的脊髓损伤后下肢静脉血栓患者60例，随机分为观察组和对照组，每组各30例。观察组采用温针灸配合低分子肝素加利伐沙班治疗，对照组采用低分子肝素加利伐沙班治疗。比较两组患者治疗前后D-二聚体、血红蛋白及下肢静脉血流速度变化情况，检测HIF-1α及TNF-α水平，并评估治疗效果。 结果 治疗后，两组患者D-二聚体、血红蛋白水平均低于治疗前，下肢静脉血流速度高于治疗前，且观察组均优于对照组，差异有统计学意义（P<0.05）;治疗后，两组患者HIF-1α、TNF-α水平均低于治疗前，且观察组低于对照组，差异有统计学意义（P<0.05）;观察组治疗总有效率为93.33%，高于对照组的70.00%，差异有统计学意义（P<0.05）。 结论 温针灸配合低分子肝素加利伐沙班治疗脊髓损伤后下肢静脉血栓，对患者下肢静脉血流速度、细胞因子水平及临床指标改善显著，疗效可靠，可在临床广泛推广。

[关键词] 温针灸;低分子肝素;加利伐沙班;脊髓损伤;下肢静脉血栓;静脉血流速度

[中图分类号] R651.2          [文献标识码] B          [文章编号] 1673-9701（2021）09-0118-04

The clinical efficacy of warm acupuncture combined with low molecular weight heparin and rivaroxaban on venous thrombosis of lower extremity after spinal cord injury

GE Xiaogang   CAI Qiqi   MOU Caiguo   CAI Yangyang

Department of Vascular Surgery， Taizhou First People′s Hospital in Zhejiang Province， Taizhou   318020， China

[Abstract] Objective To observe the clinical efficacy of warm acupuncture combined with low molecular weight heparin and rivaroxaban on venous thrombosis of lower extremity after spinal cord injury. Methods A total of 60 patients with lower extremity venous thrombosis after spinal cord injury admitted to our hospital from January to December 2019 were selected and randomly divided into observation group and control group， 30 cases in each group. The observation group was treated with warm acupuncture combined with low molecular weight heparin and rivaroxaban， while the control group was treated with low molecular weight heparin and rivaroxaban. The changes of D-dimer， hemoglobin and velocity of venous blood flow of lower extremity were compared between the two groups before and after treatment， and the levels of HIF-1α and TNF-α were detected， and the therapeutic efficacy was evaluated. Results After treatment， the levels of D-dimer and hemoglobin in the two groups were lower than before treatment， and the lower extremity venous blood flow velocity was higher than before treatment， and the observation group was better than the control group， the differences were statistically significant（P<0.05）; After treatment， the levels of HIF-1α and TNF-α in the two groups were lower than those before treatment， and the levels in the observation group were lower than those in the control group（P<0.05）; The total effective rate of the observation group was 93.33%， which was higher than 70.00% of the control group， with statistically significant differences（P<0.05）. Conclusion Warm acupuncture combined with low molecular weight heparin and rivaroxaban in the treatment of venous thrombosis of lower extremity after spinal cord injury can significantly improve the velocity of venous blood flow of lower extremity， cytokine level and clinical indexes. It has reliable therapeutic efficacy， which can be widely promoted in clinical practice.

[Key words] Warm acupuncture; Low molecular weight heparin; Rivaroxaban; Spinal cord injury; Venous thrombosis of lower extremity; Velocity of venous blood flow

脊髓损伤是临床常见的骨科疾病，多由交通事故、高空坠落等创伤所致，患者会出现运动功能及感觉功能障碍，给社会及家庭带来沉重负担[1]。下肢静脉血栓是脊髓损伤后最为常见的并发症，以往研究报道，脊髓损伤后下肢静脉血栓发病率高达50%～80%[2]，一方面会对患者早期功能锻炼及临床康复产生影响;另一方面会降低患者预后，影响患者生存质量，严重者甚至会出现肺动脉栓塞，威胁患者生命安全，因此给予积极处理及治疗尤为重要。以往临床针对脊髓损伤后下肢静脉血栓多采用抗凝、溶栓及低分子肝素等治疗，尽管能缓解患者病情，但效果不理想[3]。近年来，中医在治疗脊髓损伤后下肢静脉血栓方面积累了丰富的经验，其中针灸疗法具有舒筋通络、消痛解瘀的作用，能抑制血栓形成。……