骨科大手术围手术期血浆D-二聚体检测的临床意义  

Clinical significance of perioperative plasma D- dimer in patients undergoing orthopaedics major operation

作　　者：王少华[1] 连鸿凯[1] 宋树春[1] 邹士平[1] 白玉[1] 段智霞[1] 刘博[1] 

机构地区：[1]郑州市骨科医院关节病治疗中心450052

出　　处：《中华生物医学工程杂志》2012年第2期153-156,共4页Chinese Journal of Biomedical Engineering

基　　金：河南省2010年度医学科技攻关计划项目（201004013）

摘　　要：目的 探讨骨科大手术围手术期血浆D-二聚体动态检测对深静脉血栓（DVT）形成早期诊断中的临床意义。方法 2009年10月至2010年11月，采用紫外免疫比浊法于入院时、术后2h和术后1、2、3、4、6、8、10、15d动态测定本院92例骨科大手术患者（髋关节置换术28例、膝关节置换术40例、髋部周围骨折手术24例）血浆D-二聚体浓度，分析其动态变化特点。按照彩超检查结果将患者分为DVT组与非DVT组，比较两组各时间点的D-二聚体水平。结果 与术前相比，92例患者术后血浆D-二聚体浓度均升高，术后2h即达2000μg／L以上，其中有10例D-二聚体浓度呈持续性或进行性升高，术后1d达高峰（3588±512）μg／L，并呈持续升高状态，术后15d仍有（2494±394）μg／L，而其他82例患者D-二聚体值能较快地下降，其峰值仅持续3d，术后4d即降至500μg／L以下。双下肢深静脉彩超检查后确认10例持续升高患者发生DVT（DVT组），82例D-二聚体水平迅速下降患者未发生DVT（非DVT组），DVT的发生率为10．87％。与非DVT组比较，DVT组患者术前D-二聚体水平接近，术后2h和术后1、2、3、4、6、8、10、15dD-二聚体水平均升高（均P〈0．05）。结论 骨科大手术围手术期血浆D-二聚体浓度的动态监测对术后并发DVT早期诊断具有重要价值。Objective To determine the clinical significance of perioperative plasma D-dimer dynamic assays in predicting incidence of deep vein thrombosis （DVT） in patients undergoing major orthopedics operations. Methods A total of 92 patients undergoing major orthopedics operations （28 underwent total hip anthroplasty, 40 received total knee anthroplasty, 24 were treated with hip fracture surgery） were recruited from Zhengzhou Orthopedics Hospital between October 2009 and November 2010 and were subjected to ts of plasma D-dimer levels via immunochromatogram assay during admission, at 2 hours postoperatively, and on days 1, 2, 3, 4, 6, 8, 10 and 15 postoperatively, for analysis of dynamic variation. Subjects were assigned into DVT group and non-DVT group based on the deep venous ultrasonography. Results As compared with preoperative levels, 92 patients presented elevated plasma D- dimer levels postoperatively, which was over 2000 μg/L 2 h after operation. Ten patients were found to have continuous or progressive increase in plasma D-dimer, which peaked to （3588±512） μg/L on day 1, sustained at high levels and retained as high as （2494±394） μg/L at day 15 postoperatively. By contrast, 82 patients exhibited rapid fall in plasma D-dimer levels, with the peak concentration sustained for merely 3 days and average levels lower than 500 μg/L at day 4 postoperatively and thereafter. Above 10 patients （incidence rate： 10.87% ） were confirmed to have DVT （DVT group） and other 82 patients showed noevidence of DVT （non-DVT group）. Plasma D-dimer of DVT group increased significant at 2 hours, and on days 1, 2, 3, 4, 6, 8, 10 and 15 postoperatively （all P〈0.05） , but not preoperatively （P〉0.05） as compared with non- DVT group. Conclusion Dynamic plasma D- dimer monitoring is critical to timely diagnosis of DVT during perioperative period in patients undergoing major orthopedics operations.

关 键 词：骨科大手术 D-二聚体 深静脉血栓形成 围手术期 

分 类 号：R619[医药卫生—外科学]