提高彩色多普勒超声诊断下肢深静脉血栓效率的策略研究  

The strategic research of improving the diagnosis of lower limbs deep vein thrombosis by Doppler ultrasound

作　　者：李俊来[1] 曹晓林[1] 余美琴[1] 李娟[1] 张舜欣[1] 高德伟[2] 白洁[3] 王节[1] 

机构地区：[1]解放军总医院南楼超声科,北京100853 [2]解放军总医院综合外科,北京100853 [3]解放军总医院检验科,北京100853

出　　处：《中华医学超声杂志（电子版）》2013年第2期134-138,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：全军医学科学技术研究"十一五"计划保健专项课题(09BJZ02)

摘　　要：目的探讨下肢深静脉血栓形成风险因素、临床表现和血浆D-二聚体水平在彩色多普勒超声诊断下肢深静脉血栓中的协助作用,以提高彩色多普勒超声诊断下肢深静脉血栓的效率。方法解放军总医院2010年1月至2012年1月怀疑下肢深静脉血栓疾病患者2821例,住院患者1602例,门诊患者1219例;所有患者中,确诊为下肢深静脉血栓者1233例。记录所有患者病史、下肢症状和体征且均行下肢静脉超声检查;对住院患者每周行D-二聚体检测,每2周行下肢静脉超声检查,如下肢出现肿胀、疼痛等症状或D-二聚体测值大于标准值(0.5mg/L),即随时行下肢静脉超声检查。结果 1233例下肢深静脉血栓患者中,1097例为第1次超声检查即发现;699例为门诊超声检查时发现,534例为住院后超声检查发现;明确发病因素者954例,未能明确发病因素者279例。住院患者中,403例80岁以下血浆D-二聚体测值小于0.5mg/L者均无血栓,115例80岁及以上血浆D-二聚体测值1.98μg/ml以下者均无血栓。435例有明确发病因素和99例无明确发病因素患者之间的血浆D-二聚体水平差异无统计学意义[2.58(1.23,5.76)mg/Lvs1.86(0.98,5.23)mg/L,U=1.786,P=0.642]。结论了解细致的病史和临床表现有助于提高超声检查的效率;提供确切的下肢深静脉血栓超声表现有利于临床选择治疗方案;不同年龄段D-二聚体水平临界值需作调整,可作为重要的排除诊断下肢深静脉血栓形成的筛选手段,优化超声诊断流程。Objective To discuss the role of risk factors,clinical manifestation and plasma D-dimer in the diagnosis of lower limb deep vein thrombosis(LLDVT)by color Doppler ultrasound,and then enhance the color Doppler ultrasound diagnosis efficiency in LLDVT.Methods Totally 2821 suspected LLDVT patients which contained 1602 inpatients and 1219 outpatients from January 2010 to January 2012 in General Hospital of the People's Liberation Army were included.Among all patients,1233 patients were confirmed to have LLDVT.All patients were asked about medical history,obtained clinical manifestation of lower limbs and scanning lower limb deep vein.In addition,for inpatients,D-dimer detection and lower limb deep vein ultrasonography were carried out weekly and every two weeks,respectively.Furthermore,ultrasonography should be performed immediately if the symptoms such as swelling or pain appeared in lower limbs or the D-dimer level was greater than the standard value(0.5 mg/L).Results Among 1233 LLDTV patients,1097 cases were discovered in the first ultrasonography;699 cases of outpatients and 534 cases were detected after being admitted;954 cases had clear epidemic factors while 279 cases had not.LLDVT were ruled out in 403 patients less than 80 years old with D-dimer level below 0.5 mg/L and 115 patients more than or equal to 80 years old with D-dimer level below 1.98 mg/L.There was no significant difference in D-dimer level between patients with clear epidemic factors and those without[2.58(1.23,5.76)mg/L vs 1.86(0.98,5.23)mg/L,U=1.786,P=0.642].Conclusions Detailed information of medical history and clinical manifestation is helpful for improving ultrasonography efficiency.Definite ultrasonography appearance of LLDVT favors better clinical treatment decision.D-dimer critical value should be adjusted for different age groups,and D-dimer detection can be used as an important screening method for excluding LLDVT and optimize ultrasonography diagnosis flow.

关 键 词：超声检查 多普勒 彩色 静脉血栓形成 下肢 

分 类 号：R445.1[医药卫生—影像医学与核医学]