髋关节、膝关节置换术后静脉栓塞的风险因素分析  

Risk Factors for Postoperative Venous Thromboembolism in Hip Arthroplasty and Knee Arthroplasty Patients

作　　者：王华[1] 周天健[1] 罗奇[1] 吕猛[1] 林博文[1] 

机构地区：[1]深圳市人民医院暨南大学第二临床医学院骨关节科,广东深圳518020

出　　处：《中南医学科学杂志》2017年第3期288-291,共4页Medical Science Journal of Central South China

摘　　要：目的分析髋关节、膝关节置换术后出现静脉血栓栓塞(VTE)的主要危险因素及D二聚体(DDimer)对VTE的诊断价值。方法回顾性分析本院收治实施单侧髋关节置换和膝关节置换手术的患者共954例,其中术后发生肺栓塞(PE)或深静脉血栓(DVT)的患者47例为VTE组,其余907例为对照组。分析两组病例资料和术后48 h的D-Dimer。结果 VTE组患者吸烟史比例、手术时间、术后48 h的D-Dimer显著高于对照组,在VTE组使用硬膜外麻醉的比例显著低于对照组,吸烟史、全身麻醉、手术时间和术后48 h D-Dimer是髋膝关节置换术后发生VTE的风险因素,术后48 h D-Dimer水平的ROC曲线下面积为0.847,当D-Dimer水平为2.175 mg/L时,其灵敏度为88.8%,特异度为84.6%。结论吸烟、全身麻醉、手术时间和术后的48 h D-Dimer水平是髋膝关节置换术后VTE发生的高危因素的风险因素,术后的48 h D-Dimer水平对术后VTE的发生有良好的预测作用。Objective To analyze the major risk factors for venous thromboembolism（ VTE） after hip and knee arthroplasty,and the diagnosis value of D-Dimer value to the VTE. Methods A total of 954 cases with hip or knee replacement were retrospectively analyzed. There were 47 cases of patients（ VTE group） with postoperative pulmonary embolism（ PE） or deep vein thrombosis（ DVT）,the data of cases and D-Dimer of postoperative 48 h were analyzed. Results The proportion of VTE patients’ smoking history,operation time,postoperative 48 h D-Dimer was significantly higher than the control group,the proportion of the use of epidural anesthesia in VTE group was significantly lower than that of the control group,smoking history and general anesthesia,operation time,postoperative 48 h D-Dimer are risk factors for VTE after hip or knee replacement.The postoperative 48 h D-Dimer level has the under area of the ROC curve that is 0.847,when D-Dimer level was 2.175 mg/L,the sensitivity was 88.8%,and the specificity was 84.6%. Conclusion Smoking,general anesthesia,operation time and postoperative 48 h D-Dimer level are the high risk factors for VTE after the hip or knee arthroplasty,postoperative 48 h D-Dimer level has good prediction effect on the occurrence of postoperative VTE.

关 键 词：髋关节置换术 膝关节置换术 静脉血栓栓塞 肺栓塞 D-二聚体 

分 类 号：R684[医药卫生—骨科学]