D-二聚体监测预防急性深静脉血栓的意义  

Significance of dynamically monitoring D-dimer on prevention of acute deep vein thrombosis of lower limbs

作　　者：曾伟[1] 蔡安烈 刘荆陵[1] 袁朝晖[1] 郑学文[1] 刘银[1] 

机构地区：[1]中南大学湘雅医学院附属株洲医院暨株洲市中心医院,湖南株洲412007

出　　处：《中国现代医学杂志》2017年第14期58-62,共5页China Journal of Modern Medicine

基　　金：湖南省卫计委资助项目(No:B2014-158)

摘　　要：目的探讨D-二聚体及血栓弹力图(TEG)在预测全髋关节置换术后急性下肢深静脉血栓(DVT)中的意义。方法纳入2015年12月-2016年5月在该院关节外科行全髋关节置换的患者93例,动态监测置换前及置换后1、3、5、7和12 d的D-二聚体,并定期检测TEG各项指标,置换后12 d行双下肢静脉彩超,根据彩超结果有无血栓形成分为血栓组与对照组。对比两组患者D-二聚体及TEG各项指标的水平。结果患者术后定期行患侧肢体血管彩超检查,术后1周内行彩超检查未发现血栓形成,术后第12天彩超检查提示11例患者存在小腿肌间静脉血栓,纳入血栓组;其余82例患者未发现血栓,纳入对照组。两组患者在年龄、吸烟史,体重、手术时长及术中失血量比较,差异无统计学意义(P>0.05)。血栓组与对照组术前及术后1、3、5、7和12 d D-二聚体水平比较,差异有统计学意义(P<0.05),所有患者术后较术前凝血反应时间(R)缩短,血栓最大幅度(MA)升高,伴α角升高。术后第12天血栓组TEG的R时间、凝固时间、a角、MA、凝血块强度值及D-二聚体与对照组比较,差异有统计学意义(P<0.05)。结论提示髋关节置换术后D-二聚体的动态监测及TEG、小腿肌间静脉丛彩超检查有助于早期发现血栓。Objective To study the ef fect of D -dimer and thrombelastography on predict ing acute deep vein thrombosis of lower l imbs af ter total hip arthroplasty. Methods Ninety-three pat ients who received total hip arthroplasty at Depar tment of Joint Surgery in our hospi tal from December 2015 to May 2016 were taken as subjects. The D-dimer was dynamical ly moni tored before operat ion and 1, 3, 5, 7 and 12 d af ter operat ion, and the indicators of thrombelastography were regularly tested as wel l . All the pat ients were divided into thrombus group and cont rol group according to the results of color ult rasonography of the lower l imbs taken 12 d af ter ar throplasty. The levels of indicators of thrombelastography and D-dimer were compared between the two groups. Resul ts After operat ion, the pat ients received regular ult rasonography on lower l imb veins and thrombosis was not found wi thin 1 w. On the 12th d af ter operat ion, 11 pat ients were found to have cal f intermuscular vein thrombosis and enrol led into thrombus group; the remaining 82 pat ients wi thout thrombosis were included into cont rol group. The two groups of pat ients showed no signi f icant dif ference on age, history of smoking, body weight , t ime of operat ion or int raoperat ive blood loss. There were signi f icant dif ferences in the D-dimer levels before operat ion and 1, 3, 5, 7 and 12d af ter surgery between the two groups 0.05） .The coagulation response time （R） was shortened, the maximum thrombus amplitude （MA） increased and the alpha angle was enlarged after operation in all the patients 0.05）. On the 12th d after surgery, the values of R, coagulation time,琢 angle, MA, clot strength and D -dimer in the thrombus group were significantly different from those in the control group （P 〈 0.05）. Conclusions Dynamically monitoring D -dimer, thrombelastography and calf venous plexus ultrasonography after total hip arthroplasty are useful for early detection of thrombus.

关 键 词：D-二聚体 血栓弹力图 深静脉血栓 全关节置换 小腿肌间静脉丛 高频超声 

分 类 号：R654.4[医药卫生—外科学]