D-二聚体升高临界值与腹部手术术后下肢深静脉血栓进展的相关性研究  

Correlation between the elevation of D-dimer and of deep venous thrombosis progression of the lower extremities after abdominal surgery

作　　者：郜永顺[1] 闫西忠 黄晶晶[1] 陈鹏[1] 张云飞[1] 樊晓金 孙建刚[1] 王依明 

机构地区：[1]郑州大学第一附属医院胃肠外科,450000

出　　处：《中华普通外科杂志》2017年第12期1022-1025,共4页Chinese Journal of General Surgery

摘　　要：目的探讨D-二聚体（D-dimer）升高在预测围手术期下肢深静脉血栓（deep vein thrombosis，DVT）进展中的应用价值。方法应用彩色多普勒超声动态监测2014年11月至2016年8月间我科收治的239例患者围手术期下肢DVT形成及变化情况，监测围手术期血浆D-二聚体变化，收集恶性肿瘤、感染、年龄、体质量指数（body mass index，BMI）等相关临床资料，统计下肢DVT形成及进展发生率．并分析D-二聚体升高与下肢DVT进展的关系。结果术后出现下肢DVT患者97例，其中16．6％（16／97）出现血栓进展。单因素Logistic回归分析提示术后D-二聚体持续升高与血栓进展密切相关，多因素Logistic回归分析结果显术后D-二聚体持续升高是血栓进展的独立危险因素，受试者工作特征曲线（receiver operating characteristic curve，ROC）曲线分析术后第3天较术后第1天,血浆D-二聚体水平升高〉0．87mg／L时血栓进展风险明显增加。结论术后D-二聚体持续升高〉0．87mg／L对于预测下肢DVT进展具有一定临床价值。Objective To investigate the value of D-dimer in predicting the progression of lower extremity deep venous thrombosis （DVT） during perioperative period of gastrointestinal surgery. Methods Color Doppler ultrasound was used to dynamically monitor the formation and changes of perioperative deep venous thrombosis （DVT） in 239 patients receiving abdominal surgery in our department from Nov 2014 to Aug 2016. Changes of plasma D-dimer were measured, and clinical data of malignant tumor, infection, age, BMI were collected. The relationship between D-dimer elevation and DVT progression was analyzed. Results Lower extremity DVT after surgery developed in 97 patients, and thrombosis progression occurred in 16. 6% （ 16/97 ）. Univariate logistic regression analysis showed that continuous increase of postoperative D-dimer was closely related to the progression of thrombosiss. Multivariate Logistic regression analysis showed that the continuous rise of D-dimer was an independent risk factor for thrombosis. ROC curve analysis showed significantly increased risk of thrombosis progression, when plasma D-dimer polymerization increased 〉0. 87 mg/L on the 3rd day. Conclusion The continuous increase of D-dimer 〉 0. 87 mg/L predicts DVT progression of lower extremity DVT.

关 键 词：静脉血栓形成 围手术期 D-二聚体 肌间静脉血栓 

分 类 号：R656[医药卫生—外科学]