血栓弹力图在骨科大手术围手术期抗凝治疗预防深静脉血栓中的动态监测作用  

Thrombelastography prevents deep venous thrombosis in the perioperative period of arthroplasty replacement

作　　者：杨军[1] 王毅[1] 张福江[2] 肖俞[2] 刘文彬[2] 董宝军[1] 

机构地区：[1]天津市天津医院检验科,300211 [2]天津市天津医院关节中心

出　　处：《中华检验医学杂志》2015年第5期333-336,共4页Chinese Journal of Laboratory Medicine

基　　金：天津市天津医院资助项目（08YJM004）;北京医学奖励基金（京医基项决字[2010]056）

摘　　要：目的：通过血栓弹力图（ TEG）动态检测，探讨TEG在骨科大手术围手术期抗凝治疗预防深静脉血栓（ DVT）中的监测作用。方法选择天津市天津医院2011年至2013年行膝关节置换术（ TKA）患者60例，男22例，女38例，年龄50～74岁。同期健康体检者42例，男24例，女18例，年龄45～75岁。患者按随机数字法分为低分子肝素（ LMWH）组，利伐沙班组，各30例。均采用常规剂量抗凝治疗，两组患者其余治疗均同常规治疗。 TEG（ R值、K值、Angle值、MA值、CI值）检测采用美国Haemoscope公司的TEG＠5000型血栓弹力图仪。应用美国GE LOGIQ 7型彩色多普勒超声诊断系统诊断有无DVT形成。使用SPSS17．0统计学软件分析实验数据，采用ROC曲线，敏感度、特异度、阳性预测值（ PPV）、阴性预测值（ NPV）评估TEG各参数对DVT的诊断价值。结果抗凝治疗终点利伐沙班组 TEG 的 Angle 值、 MA 值、 CI 值异常检出率（36．7％，46．7％，36．7％）均高于 LMWH 组（10．0％，20．0％，13．3％），差异均有统计学意义（χ2＝5．963，P＝0．015；χ2＝4．800，P＝0．028；χ2＝4．356，P＝0．037）。预测抗凝治疗终点发生DVT的临床诊断价值，CI、MA和Angle敏感度分别为75．0％、75．0％、62．5％，特异度分别为80．8％、76．9％、78．8％。以MA为68．35 mm作为抗凝治疗终点预测DVT发生的临床最佳诊断临界点。结论 TEG的R值可判断抗凝药物抗凝治疗后的有效性和安全性。（中华检验医学杂志，2015，38：333－336）Objective To investigate the effect of thrombelastography （ TEG ） monitoring on anticoagulation therapy in deep vein thrombosis （ DVT ） in the perioperative period of arthroplasty replacement through dynamic detecting of TEG.Methods 60 patients under went total knee arthroplasty （ TKA） were selected as the patient group from 2011 to 2013, Including 22 men and, 38 women, aging from 50 to 74 years old.These patients were divided into low molecular weight heparin （ LMWH ） group and rivaroxaban group according to random number table.Each group had 30 cases.Patients in both were all given routine dose anticoagulant drugs to prevent DVT.Other treatment were the same as conventional therapy for both group patients.Meannhile, 42 health examination participants were selected as the control group, 24 men and 18 women, aging from 45 to 75 years old.The parameters of TEG were measured by TEG@5000 thromboelastograph hemostasis system （ American Haemoscope Corporation）.DVT was diagnosed by LOGIQ 7 color Doppler ultrasonic diagnostic apparatus of American GE Corporation. Data were analyzed by SPSS17.0.The predictive value of TEG on DVT was evaluated by receiver operating characteristic cure （ROC）,sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV）. Results Abnormal detection rates of Angle,MA,CI in rivaroxaban group（36.7%,46.7%,36.7%） were higher than LMWH group （ 10.0%, 20.0%, 13.3%） , and the differences between both groups all had statistical significance between both group（χ2 =5.963,P=0.015;χ2 =4.800,P=0.028;χ2 =4.356,P=0.037）.CI , MA and Angle had better clinical diagnostic value on DVT.Their sensitivity was 75.0%, 75.0% and 62.5%, specificity respectively was 80.8%, 76.9%and 78.8%respectively.MA=68.35 mm 〈br〉 could be the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint.Conclusion TEG can monitor coagulation state of TKA patients, TEG′R can evaluate the safety and effectiveness of anticoagulat

关 键 词：血栓弹力描记术 关节成形术 置换 膝 静脉血栓形成 肝素 低分子量 

分 类 号：R687[医药卫生—骨科学] R446.1[医药卫生—外科学]