骨科围术期抗凝治疗预防深静脉血栓行血栓弹力图检测的临床应用价值  

Clinical application value of thrombela-stogram for anticoagulant therapy to prevent deep venous thrombosis in perioperative period of Orthopedics Department

作　　者：汪弢[1] 杨宏宇[2] 张辉[1] 赵国平[1] 

机构地区：[1]江苏省南京市江宁医院血管外科,211100 [2]江苏省人民医院血管外科

出　　处：《中国综合临床》2017年第3期246-250,共5页Clinical Medicine of China

摘　　要：目的 探究血栓弹力图（TEG）检测在骨科围手术期行抗凝治疗预防深静脉血栓（DVT）上的临床应用效果.方法 将68例在我院进行骨科手术的骨折患者作为研究对象,并选择同期在我院进行体检的42名健康志愿者作为对照.所有骨折患者均于术后接受抗凝治疗,按抗凝药物使用的不同将骨折患者均分为低分子肝素（LWMH）组和利伐沙班组两个亚组.于查体当天对对照组进行TEG检测,并于围手术期间对所有骨折患者进行TEG检测.结果 患者组术前的各项TEG检测结果与对照组比较差异均无统计学意义（P均〉0.05）,各项TEG检测结果均正常,血液并未处于高凝状态.抗凝治疗第7d和抗凝治疗结束后,在LWMH组和利伐沙班组中凝血反应时间（R值）的检出率最高,均〉50%.且在抗凝治疗结束后,利伐沙班组患者的凝固角度（α角）、血栓最大幅度（MA）及综合凝血指数（CI）的异常检出率分别为35.29%、32.35%、41.76%,均显著高于LWMH组（8.82%、17.65%、11.76%）,差异均有统计学意义（χ^2值分别为6.9283、5.7566、7.5556,P均〈0.05）.抗凝治疗结束后经多普勒超声检查,确诊9例DVT者,病发率为14.06%.对比发现,在抗凝治疗终点预测DVT发生上,诊断价值较好的指标有α角、MA和CI,其敏感度分别为64.71%、76.47%、73.53%,特异度分别为79.41%、73.53%、82.35%.结论 骨折手术后,患者的凝血功能均有所变化,采用TEG动态检测能够实时准确地了解其血液状态变化,对于患者凝血功能评价具有重要参考价值.以MA为68.35 mm作为临床诊断临界点.Objective To research the clinical application effect of thrombela-stogram（TEG） for anticoagulant therapy to prevent deep venous thrombosis（DVT） in perioperative period of Orthopedics Department.Methods Sixty-eight cases of fracture patients treated with surgery in the Orthopedicsin Department of Jiangning Hospital of Nanjing were selected as the research subjects,and 42 healthy volunteers for a physical examination at the same period were selected as the control group.All fracture patients were treated with anticoagulant therapy after surgery,according to the different anticoagulants,the fracture patients were divided into the low molecular weight heparin（LWMH） group and the rivaroxaban group.On the day of the investigation,the control group was detected by TEG,and the TEG test was performed on all the patients during the perioperative period.Results There was no significant difference on the TEG test results between fracture patients and the control group（P〉0.05）,the TEG test results of fracture patients were normal,and the blood was not in the high coagulation state.On the 7th d of anticoagulant therapy and the end of anticoagulant therapy,the R value in the LWMH group and in the rivaroxaban group were the highest positive rate,were all more than 50%.At the end of the anticoagulant therapy,the abnormal detection rate of α angle,maximum thrombus（MA） and integrated coagulation index（CI） in the rivaroxaban group were 35.29%,32.35%,41.76%,respectively,were significantly higher than those in the LWMH group（8.82%,17.65%,11.76%）,the differences were statistically significant（χ^2=6.9283,5.7566,7.5556,P〈0.05）.After the end of the anticoagulant therapy for Doppler ultrasound,9 cases were diagnosed as DVT,and the incidence rate was 14.06%.Compared and founded,at the end of the anti coagulation therapy,the great value of the diagnostic indicators were α angle,MA and CI,the sensitivity was 64.71%,76.47%,73.53% respectively,and the specificity was 79.41%,73.53%,82.35% respectively.Conc

关 键 词：血栓弹力图 骨科围术期 抗凝治疗 深静脉血栓 

分 类 号：R687.3[医药卫生—骨科学]