【目的】 探讨柴黄活血汤联合利伐沙班对髋关节置换术后下肢深静脉血栓（DVT）的防治效果及其对患者凝血功能、炎症 因子的影响。【方法】 选取2022年5月至2024年5月在山西省汾阳医院骨科行髋关节置换术的患者82例，采用随机数字表法 将患者随机分为西医组和联合组，每组各41例。2组患者均行髋关节置换术治疗，西医组术后给予利伐沙班治疗，联合组术 后给予柴黄活血汤联合利伐沙班治疗，2组疗程均为2周。观察2组患者治疗前后下肢周径（包括大腿周径和小腿周径）及凝 血功能指标、血管内皮功能指标、血清炎症因子水平的变化情况，比较 2 组患者的临床疗效和不良反应总发生率。【结果】 （1）疗效方面，治疗 2周后，联合组的总有效率为 87.80%（36/41），西医组为 68.29%（28/41），组间比较（χ2检验），联合组的 疗效明显优于西医组（P＜0.05）。（2）下肢周径方面，治疗7 d后，2组患者的大腿周径和小腿周径均较治疗前延长（P＜0.05）， 治疗 14 d后，2组患者的大腿周径和小腿周径均较治疗 7 d后缩短（P＜0.05）；组间比较，联合组治疗 7 d和 14 d后的大腿周 径和小腿周径均较西医组明显缩短（P＜0.01）。（3）凝血功能方面，治疗后，2组患者的凝血酶原时间（PT）、活化部分凝血活 酶时间（APTT）均较治疗前延长（P＜0.05），纤维蛋白原（FIB）水平均较治疗前下降（P＜0.05），且联合组对各项凝血功能指标 的改善幅度均明显优于西医组（P＜0.01）。（4）血管内皮功能方面，治疗后，2组患者的血清一氧化氮（NO）、内皮型一氧化氮 （eNOS）水平均较治疗前升高（P＜0.05），且联合组对血清NO、eNOS水平的升高幅度均明显优于西医组（P＜0.01）。（5）炎症因 子方面，治疗后，2 组患者的血清降钙素原（PCT）、白细胞介素 6（IL-6）水平均较治疗前下降（P＜0.05），且联合组对血清 PCT、IL-6水平的下降幅度均明显优于西医组（P＜0.01）。（6）不良反应方面，治疗期间，联合组的不良反应总发生率为7.32% （3/41），西医组为 19.51%（8/41），组间比较，差异无统计学意义（P＞0.05）。【结论】 髋关节置换术后患者接受柴黄活血汤与 利伐沙班联合干预，可有效促进下肢血液循环，调节机体凝血功能，减轻炎症反应，降低 DVT 发生风险，效果较为理想， 临床应用价值较高。

Objective To investigate the efficacy of Chaihuang Huoxue Decoction combined with rivaroxaban in preventing lower limb deep vein thrombosis （DVT） after hip replacement and to observe its effects on coagulation function and inflammatory cytokines of the patients. Methods A total of 82 patients who underwent hip replacement in the Department of Orthopedics，Fenyang Hospital，Shanxi Province from May 2022 to May 2024 were enrolled. The patients were randomly divided into a western medicine group and a combination group using a random number table，with 41 cases in each group. Both groups received hip replacement. Postoperatively，the western medicine group was treated with rivaroxaban，while the combination group received Chaihuang Huoxue Decoction combined with rivaroxaban. The treatment course for both groups was 2 weeks. Changes in lower limb circumference （including thigh and calf circumference）， coagulation function indicators， vascular endothelial function indicators，and serum inflammatory factor levels were observed before and after treatment. The clinical efficacy and total incidence of adverse reactions were compared between the two groups. Results （1） In terms of efficacy，after 2 weeks of treatment，the total effective rate in the combination group was 87.80% （36/41），while that in the western medicine group was 68.29%（28/41）. The intergroup comparison （by chi-square test） showed that the efficacy in the combination group was significantly superior to the western medicine group （P＜0.05）.（2）Regarding lower limb circumference，after 7 days of treatment，both groups showed increased thigh and calf circumferences compared with those before treatment（P＜0.05）. After 14 days of treatment，both groups showed decreased thigh and calf circumferences compared with those after 7 days （P＜0.05）. Intergroup comparison revealed that the thigh and calf circumferences in the combination group after 7 and 14 days of treatment were significantly shorter than those in the western medicine group （P＜0.01）.（3） In terms of coagulation function，after treatment，both groups showed prolonged prothrombin time （PT） and activated partial thromboplastin time （APTT）（P＜0.05） and decreased fibrinogen （FIB） levels （P＜0.05） compared with those before treatment. Moreover，the improvement in coagulation function indicators in the combination group was significantly greater than that in the western medicine group （P＜0.01）.（4） Regarding vascular endothelial function， after treatment， both groups showed increased serum levels of nitric oxide （NO） and endothelial nitric oxide synthase （eNOS） compared with those before treatment （P＜0.05）. The increase in serum NO and eNOS levels in the combination group was significantly greater than that in the western medicine group （P＜0.01）.（5） In terms of inflammatory factors，after treatment， both groups showed decreased serum levels of procalcitonin （PCT） and interleukin-6（IL-6） compared with those before treatment （P＜0.05）. The decrease in serum PCT and IL-6 levels in the combination group was significantly greater than that in the western medicine group （P＜0.01）.（6） Regarding adverse reactions，the total incidence of adverse reactions during treatment was 7.32%（3/41） in the combination group and 19.51% （8/41） in the western medicine group，with no statistically significant difference between the two groups （P＞0.05）. Conclusion The combined intervention of Chaihuang Huoxue Decoction and rivaroxaban in patients after hip replacement can effectively promote lower limb blood circulation， regulate coagulation function， reduce inflammatory response， and lower the risk of DVT. The treatment demonstrates favorable efficacy and high value of clinical application.

R274.9

国家卫生健康委“十四五”规划全国重点课题资助项目（编号：WSJK41048）