[1]刘昕岩,程 韶,王吉利,等.加味补气养血汤联合氨甲环酸对全膝关节置换术后气虚血瘀型患者隐性失血的影响[J].陕西中医,2026,(5):625-629.[doi:DOI:10.3969/j.issn.1000-7369.2026.05.008]
　LIU Xinyan,CHENG Shao,WANG Jili,et al.Modified Buqi Yangxue decoction combined with tranexamic acid reduces occult blood loss after total knee arthroplasty in patients with Qi-deficiency and blood-stasis pattern[J].,2026,(5):625-629.[doi:DOI:10.3969/j.issn.1000-7369.2026.05.008]
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加味补气养血汤联合氨甲环酸对全膝关节置换术后气虚血瘀型患者隐性失血的影响

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2026年5期
页码:
625-629
栏目:
临床研究
出版日期:
2026-05-05

文章信息/Info

Title:
Modified Buqi Yangxue decoction combined with tranexamic acid reduces occult blood loss after total knee arthroplasty in patients with Qi-deficiency and blood-stasis pattern
作者:
刘昕岩1; 程 韶1; 王吉利1; 李基威2; 班赛博1; 郑博文1; 许文龙1; 王上增2
（1.河南中医药大学，河南 郑州 450000；2.河南省中医院，河南 郑州 450000）
Author(s):
LIU Xinyan1; CHENG Shao1; WANG Jili1; LI Jiwei2; BAN Saibo1; ZHENG Bowen1; XU Wenlong1; WANG Shangzeng2
（1.Henan University of Chinese Medicine,Zhengzhou 450000,China；2.Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou 450000,China）
关键词:
膝骨性关节炎; 全膝关节置换术; 加味补气养血汤; 氨甲环酸; 隐性失血量; 膝关节功能
Keywords:
Knee osteoarthritis; Total knee arthroplasty; Modified Buqi Yangxue decoction; Tranexamic acid; Hidden blood loss; Knee function
分类号:
R68
DOI:
DOI:10.3969/j.issn.1000-7369.2026.05.008
文献标志码:
A
摘要:
目的：探讨加味补气养血汤联合氨甲环酸对全膝关节置换术（TKA）后气虚血瘀型患者隐性失血的影响。方法：将56例行单侧TKA的膝骨关节炎患者随机分为两组（n=28）。对照组术中静脉滴注氨甲环酸；治疗组在此基础上围手术期加服加味补气养血汤。比较两组中医症状积分、视觉模拟疼痛评分（VAS）、膝关节HSS评分及血红蛋白（Hb）、红细胞压积（Hct）变化，计算失血量并观察并发症。结果：治疗组术后引流量、隐性失血量及总失血量均低于对照组（P＜0.05）。两组术中失血量比较，差异无统计学意义（P＞0.05）。术后1 d两组中医证候积分比较，差异无统计学意义（P＞0.05）。术后7、14 d治疗组中医证候积分均低于对照组（P＜0.05）。术后两组HSS评分均较术前升高，且治疗组高于对照组（P＜0.05）。术前及术后各时间点两组VAS评分比较，差异无统计学意义（P＞0.05）。术后7、14 d，治疗组Hb及Hct水平高于对照组（P＜0.05），术后3 d两组比较，差异无统计学意义（P＞0.05）。两组均未接受异体输血及发生严重并发症。结论：加味补气养血汤联合氨甲环酸可减少TKA术后隐性失血，稳定Hb和Hct水平，改善中医证候并促进膝关节功能恢复，是围术期安全有效的辅助治疗方案。
Abstract:
Objective:To explore effect of Modified Buqi Yangxue decoction combined with tranexamic acid on hidden blood loss in patients with Qi deficiency and blood stasis syndrome after total knee arthroplasty (TKA).Methods:Fifty-six patients with knee osteoarthritis undergoing unilateral TKA were randomly divided into two groups (n=28).The control group were intravenously infused with tranexamic acid during the operation.The treatment group were given modified Buqi Yangxue decoction in addition to the control group during the perioperative period.The TCM symptom scores,visual analogue scale (VAS) for pain,HSS score of the knee joint,and changes in hemoglobin (Hb) and hematocrit (Hct) were compared between the two groups.The blood loss was calculated and complications were observed.Results:The postoperative drainage volume,hidden blood loss volume and total blood loss volume in the treatment group were all lower than those in the control group(P＜0.05).There was no statistically significant difference in intraoperative blood loss between the two groups(P＞0.05).There was no statistically significant difference in TCM syndrome scores between the two groups on the first day after surgery(P＞0.05).The TCM syndrome scores in the treatment group were lower than those in the control group on the 7th and 14th days after surgery (P＜0.05).The HSS scores of both groups were higher than those before surgery after surgery,and the treatment group was higher than the control group(P＜0.05).There was no statistically significant difference in VAS scores between the two groups at each time point before and after surgery (P＞0.05).The levels of Hb and Hct in the treatment group were higher than those in the control group on the 7th and 14th days after surgery (P＜0.05),and there was no statistically significant difference on the 3rd day after surgery (P＞0.05).Neither group received allogeneic blood transfusion or had serious complications.Conclusion:Modified Buqi Yangxue decoction combined with tranexamic acid can reduce hidden blood loss after TKA,stabilize Hb and Hct levels,improve TCM syndrome and promote the recovery of knee joint function,and is a safe and effective perioperative adjuvant treatment plan.

参考文献/References:

[1]廖婕,吴琼瑶,吴功华,等.1990—2023年中国膝骨关节炎疾病负担现状及趋势分析[J].中国修复重建外科杂志,2025,39(11):1381-1387.
[2]张茜玥,彭鹏.独活寄生汤治疗肝肾亏虚型膝关节骨性关节炎疗效研究[J].陕西中医,2025,46(3):354-358,363.
[3]ZENG L,ZHOU G,YANG W,et al.Guidelines for the diagnosis and treatment of knee osteoarthritis with integrative medicine based on traditional Chinese medicine[J].Front Med,2023,10:1260943.
[4]ZHANG Y,LIU H.Safety of total knee arthroplasty in the treatment of knee osteoarthritis and its effect on postoperative pain and quality of life of patients[J].Contrast Media Mol Imaging,2021:6951578.
[5]HOK K W,LAU L C M,CHAU W W,et al.End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty:A prospective cohort study[J].BMC Geriatr,2021,21(1):2.
[6]LI S,LA S.The hidden blood loss and its factors in patients undergoing minimally invasive knee arthroscopy[J].Front Surg,2022,9:944481.
[7]楼红侃,叶海,金甬,等.益气活血方联合氨甲环酸对全膝关节置换术术后隐性失血及功能恢复的影响[J].新中医,2020,52(21):41-44.
[8]中国骨关节炎诊疗指南专家组.中国骨关节炎诊疗指南(2024版)[R].中华疼痛学杂志,2024,20(3):323-338.
[9]国家中医药管理局.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002：29,329.
[10]国家中医药管理局.中医病证诊断疗效标准:ZY/T 001.1-1994[S].南京:南京大学出版社,1994：24.
[11]中华医学会骨科学分会关节外科学组,中国医师协会骨科医师分会骨关节炎学组,国家老年疾病临床医学研究中心(湘雅医院),等.中国骨关节炎诊疗指南(2021年版)[J].中华骨科杂志,2021,41(18):1291-1314.
[12]KOLIN D A,LYMAN S,DELLA-VALLE A G,et al.Predicting postoperative anemia and blood transfusion following total knee arthroplasty[J].J Arthroplasty,2023,38(7):1262-1266.
[13]ZHANG S,XIE J,CAO G,et al.Six-dose intravenous tranexamic acid regimen further inhibits postoperative fibrinolysis and reduces hidden blood loss following total knee arthroplasty[J].J Knee Surg,2021,34(14):1508-1515.
[14]LIU J,WANG H,WU X,et al.Not all patients benefit from the postoperative antifibrinolytic treatment:Clinical evidence against the universal use of tranexamic acid following total knee arthroplasty[J].J Orthop Surg Res,2022,17(1):59.
[15]JEON Y D,CHA J R,OH J M,et al.Comparison of blood loss between intra-articular microporous polysaccharide hemospheres powder and tranexamic acid following primary total knee arthroplasty[J].Sci Rep,2024,14(1):5188.
[16]冯陈,沈珠,陶宏,等.氨甲环酸不同使用方式在全膝关节置换术中的有效性与安全性[J].中国医院药学杂志,2025,45(4):439-443.
[17]何易祥,乔万佳,王文己.氨甲环酸与氨基己酸在全髋和全膝关节置换过程中有效性和安全性的Meta分析[J].中国组织工程研究,2026,30(9):2361-2369.
[18]ECKHOF M L,VON HERTZBERG-BOLCH S,EIDMANN A,et al.Total blood loss and early clinical outcomes under different tranexamic acid regimes in total knee arthroplasty[J].Arch Orthop Trauma Surg,2024,144(6):2795-2802.
[19]张丽娜,王江静.当归补血汤加味联合氨甲环酸序贯抗凝及蔗糖铁治疗全膝关节置换术后隐性失血临床研究[J].陕西中医,2024,45(1):71-74.
[20]孙培磊,杨玉宝,张晓艳.氨甲环酸不同给药方式对全膝关节置换术患者失血量、术后恢复情况的影响[J].现代医学与健康研究电子杂志,2024,8(9):76-78.
[21]吴杰,李润泽,张凯,等.初次全膝关节置换术中局部联合应用氨甲环酸与血凝酶的临床研究[J].中国骨与关节损伤杂志,2025,40(6):594-601.
[22]游昊明,郑派,窦文博,等.经皮穴位电刺激联合血流限制治疗全膝关节置换术后疗效研究[J].陕西中医,2026,47(2):248-254.
[23]刘利民,王迎彬,张猛,等.益气续骨汤联合加压冷疗法对全膝关节置换术后镇痛及隐性失血的影响[J].中国中西医结合外科杂志,2025,31(1):57-60.
[24]杜莹,邸晴,赵相轩.人参化学成分与药理作用研究进展[J].药学前沿,2025,29(9):1576-1592.
[25]LIANG Y,CHEN B,LIANG D,et al.Pharmacological effects of astragaloside Ⅳ:A review[J].Molecules,2023,28(16):6118.

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备注/Memo

备注/Memo:
河南省自然科学基金资助项目(232300420269,222300420486)；河南省科技攻关项目(252102310454)；河南省高校科技创新团队(24IRTSTHN040)；河南省中青年卫生健康科技创新领军人才培养项目(LJRC2024020)；河南省中医药科学研究专项课题(2021ZY2010,2019ZY2035)；郑州市科技惠民计划项目(2023KJHM0009)
更新日期/Last Update: 2026-05-05