摘要
目的探讨早期诊断关节置换患者围手术期静脉血栓栓塞症的指标及其相关危险因素。方法行全膝、全髋和全踝关节置换术患者148例,分别于术前及术后第1,3,7天检测血浆D-二聚体(D-dimer,D-D)、血浆纤维蛋白原(plasma fibrinogen,FIB)、纤维蛋白降解产物(fibrin degradation product,FDP)、血栓前体蛋白(thrombus precursor protein,TpP)、凝血酶原片段F1+2(prothrombin fragment 1+2,F1+2)及凝血酶-抗凝血酶(thrombin antithrombin,TAT)水平,并评价其对深静脉血栓形成(deep venous thrombosis,DVT)的诊断价值;分别于术前及术后第3,7天应用彩色多普勒超声血流检测仪检测双下肢DVT形成情况,依结果分为DVT阳性组和阴性组,分析DVT形成的危险因素。结果术后发生DVT 44例(29.7%);免疫比浊法检测D-D和FDP的AUC分别为0.798和0.679(P<0.05),FIB的AUC为0.570(P>0.05);ELISA检测D-D,TpP和TAT的AUC分别为0.875,0.723和0.783(P<0.05),F1+2的AUC为0.632(P>0.05);多因素Logistic回归分析结果显示,年龄≥65岁、体质量指数≥25kg/m2、全身麻醉、行全膝关节置换术是关节置换术后DVT发生的危险因素(P<0.05)。结论 D-D,TpP,TAT及FDP对关节置换术后假体周围感染有诊断价值;年龄高、体质量指数大、膝关节置换、全身麻醉是术后发生DVT的危险因素。
Objective To explore the early diagnosis of lower limb deep vein thrombosis （DVT） in perioperative period and analyze the risk factors after total joint arthroplasty. Methods The plasma D dimer （D-D）, fibrinogen （FIB）, fibrin degradation product （FDP）, thrombus precursor protein （TpP）, prothrombin fragment 1 ＋ 2 （F1 ＋ 2） and thrombin antithrombin （TAT） levels were examined in 148 cases undergoing total knee arthroplastic （TKA）, total hip arthroplastic （THA） and total ankle arthroplastic （TAA） before operation and 1, 3 and 7 days after operation, and were assessed the value to the diagnosis of DVT. The patient＇s medical history, symptoms, and relevant clinical factors were recorded. DVT was detected with color Doppler flow imaging technique before operation and 3 and 7 days after operation, and the patients were divided into positive DVT group and negative DVT group according to the results to analyze the risk factors for DVT formation after surgery. Results DVT occurred in 44 cases （29.7 % ） after operation. The immunoturbidimetry results showed AUC was 0.798 for D-D, 0. 679 for FDP （P〈0.05）, and 0. 570 for FIB （P〉0.05）. ELISA results showed AUC was 0. 875 forD-D, 0.723 forTpP, 0.783 for TAT（P〈0.05）, and0.632 forF1＋-2 （P〉0.05）. Logistic regression analysis indicated that the aged （65 years or older）, body mass index 25 kg/m2 or more, general anesthesia and TKA were the risk factors for the occurrence for DVT after total joint arthroplasty （P〈0.05）. Conclusion D-D, TpP, TAT and FDP are sensitive indexes to evaluate DVT. The aged, obesity, general anesthesia and TKA are the risk factors for the occurrence for DVT after total joint arthroplasty.
出处
《中华实用诊断与治疗杂志》
2013年第5期460-462,共3页
Journal of Chinese Practical Diagnosis and Therapy
