骨科围术期患者D-二聚体的动态变化及其影响因素研究  

Kinetics and Influencing Factors of D-dimer in Orthopaedic Surgery Preoperative Period

作　　者：胡萍[1] 王卓[1] 夏国光[1] 张运剑[1] 戴丽[1] 王艳霞[1] 黄野[2] 周一新[2] 

机构地区：[1]北京积水潭医院呼吸内科,北京市100035 [2]北京积水潭医院矫形骨科,北京市100035

出　　处：《中国全科医学》2010年第36期4100-4103,共4页Chinese General Practice

基　　金：北京市卫生局北京市管理局青年科学研究资助项目(QN2007-26)

摘　　要：目的探讨骨科围术期患者D-二聚体(D-dimer)水平的变化及其影响因素。方法对106例骨科围术期患者进行D-dimer水平的检测以及危险性评分量表(Wells)评估。结果对术前患者血D-dimer水平的多元线性回归分析,D-dimer水平与患者的性别、年龄、BMI、吸烟均无统计学意义(P>0.05);患者术前及术后1 d、3d、7 d血D-dimer水平比较,差异有统计学意义(P<0.05);其中术后1 d D-dimer水平达高峰,与术后3 d、7 d比较,差异均有统计学意义(P<0.05)。在术后1 d,预防性应用抗凝剂患者与未应用抗凝剂患者D-dimer水平比较,差异有统计学意义(P<0.05);术后输血患者与未输血患者D-dimer水平比较,差异无统计学意义(P>0.05);术中应用骨水泥患者在术后1 d、7 d与未应用骨水泥患者D-dimer水平比较,差异有统计学意义(P<0.05);在术后7d,膝关节置换与髋关节置换、非置换手术患者D-dimer水平比较,差异有统计学意义(P<0.05)。深静脉血栓形成患者的Wells评分与D-dimer水平呈正相关(r=0.166,P<0.05),肺动脉血栓栓塞症患者的Wells评分与D-dimer水平呈正相关(r=0.169,P<0.05)。结论骨科围术期患者D-dimer水平在术后有所增高,尤以术后1 d最高。术后预防性应用抗凝剂治疗、术中应用骨水泥以及不同的手术方式均可影响D-dimer水平,故D-dimer无法起到预警作用。Objective To investigate kinetics and influencing factors of D-dimer in orthopaedic surgery preoperative period.Methods The plasma concentration of D-dimer was measured and Wells clinical decision rule were applied in 106 patients following orthpaedic surgery.Results Multiple linear regression analysis showed that there were no statistical differences between preoperative plasma concentrations of D-dimer in patients with different sex,age,BMI and smoking condition（P〉0.05）;There were statistical differences between preoperative plasma concentrations of D-dimer and that of 1 day,3 days and 7 days after operation（P〈0.05）.The plasma concentrations of D-dimer reached peak 1 day after operation,and there were statistical differences between the level of peak and the level of 3 days and 7 days after operation（P〈0.05）;The plasma concentrations of D-dimer in patients treated by prophylaxis with low molecular weight heparin（LMWH） were significantly different from those without LMWH 1 day after operation（P〈0.05）;There were no statistical differences in the plasma concentrations of D-dimer between the patients with blood transfusion and those without blood transfusion after operation（P〉0.05）;The plasma concentrations of D-dimer in patients using acrylic bone cements during operation were significantly different from those not using acrylic bone cements 1 day and 7 days after operation（P〈0.05）;The plasma concentrations of D-dimer in patients with total knee arthroplasty were significantly different from those with total hip arthroplasty and other orthopaedic surgery 7 days after operation（P〈0.05）;There was positive correlation between Wells clinical decision rule of DVT and the plasma concentrations of D-dimer（r=0 166,P〈0.05）,and there was positive correlation between Wells clinical decision rule of PTE and the plasma concentrations of D-dimer（r=0 169,P〈0.05）.Conclusion The plasma concentrations of D-dimer are inceased after orthopaedic surgery,reaching peak 1 day afte

关 键 词：D-二聚体 血栓栓塞 手术期间 医院 骨科 

分 类 号：R687.3[医药卫生—骨科学]