胫腓骨骨折患者围手术期深静脉血栓形成的发生规律  

Perioperative deep venous thrombosis in patients with tibiofibular fracture

作　　者：李杰 王谦[1] 王鹏飞[1] 路遥[1] 张斌飞[1] 李忠[1] 杨娜[1] 田丁[1] 张堃[1] Li Jie;Wang Qian;Wang Pengfei;Lu Yao;Zhang Binfei;Li Zhong;Yang Na;Tian Ding;Zhang Kun(Department of Orthopaedics and Trauma,Xi'an Honghui Hospital,Xi'an Jiao Tong University Health Science Center,Xi'an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,710054

出　　处：《中华创伤骨科杂志》2019年第11期952-958,共7页Chinese Journal of Orthopaedic Trauma

基　　金：陕西省自然科学基金(2014JM2-8183);陕西省重点项目(2017ZDXM-SF-009)。

摘　　要：目的探讨胫腓骨骨折患者围手术期深静脉血栓形成(DVT)的发生规律及其危险因素,并观察血浆D-二聚体的变化特点。方法回顾性分析2014年9月至2018年2月西安交通大学医学院附属红会医院创伤骨科收治的180例胫腓骨骨折患者资料。男114例,女66例;年龄16~83岁,平均47.6岁;分别于入院时、术前1 d、术后1 d、3 d、5 d测定患者血浆D-二聚体浓度,并在术前及术后行双下肢静脉超声检查。根据住院期间是否发生DVT将患者分为DVT组和非DVT组,比较两组不同时间点所测的血浆D-二聚体浓度的差别。先采用单因素分析筛选危险因素,再采用多因素logistic回归分析确定独立危险因素。结果共有54例(30%)患者出现DVT。术前出现DVT 39例(21.7%),DVT类型:混合1例,远端38例;14例术后消失;术后出现DVT 40例(22.2%),DVT类型:近端1例,混合1例,远端38例;15例为术后新发。多因素logistic回归分析显示:年龄、受伤至手术时间、术前及术后D-二聚体升高是患者发生DVT的独立危险因素(P<0.05)。DVT组血浆D-二聚体浓度在术前1 d、术后1 d、术后3 d、术后5 d都高于非DVT组,差异均有统计学意义(P<0.05),受试者工作特征曲线下面积为0.704。当D-二聚体临界值为1.4 mg/L时,其诊断DVT的敏感性为0.944,特异度为0.246,特异性较差;当D-二聚体的浓度为4.45 mg/L时,其诊断DVT的敏感性为0.574,特异度为0.817,此时特异性最高。结论胫腓骨骨折患者围手术期DVT有一定的发生率,以腘静脉以远的远端DVT为主。临床上对于高龄、入院及术后血浆D-二聚体升高、术前等待时间较长的患者要警惕DVT的发生。D-二聚体对于胫腓骨折患者有一定的诊断意义,推荐临界值设为4.45 mg/L。Objective To investigate the regularity in and risk factors for perioperative deep venous thrombosis(DVT)and the changes in plasma D-dimer in patients with tibiofibular fracture.Methods A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma,Xi'an Honghui Hospital from September 2014 to February 2018.They were 114 males and 66 females,aged from 16 to 83 years(average,47.6 years).The levels of plasma D-dimer were detected at admission,one day preoperation,and 1,3,5 days postoperation.B-ultrasound examination of both lower extremities was performed before and after surgery.According to the results of B-ultrasound,the patients were divided into a DVT group and a non-DVT group.The 2 groups were compared in the plasma D-dimer levels measured at different time points.DVT risk factors were screened by univariate analysis,and multivariate logistic regression analysis was used to determine independent risk factors.Results Of this cohort,54 cases(30%)developed DVT and 39 cases(21.7%)did preoperation.Of the 39 cases(mixed DVT in one and distal DVT in 38 ones),DVT disappeared in 14 postoperation.Of the 40 cases(22.2%)of postoperative DVT(proximal DVT in one,mixed DVT in one and distal DVT in 38 ones),15 developed newly postoperation.Multivariate logistic regression analysis showed that age,time from injury to operation,pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients.The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation,and 1,3,5 days postoperation(P<0.05).The area under the receiver operating characteristic curve was 0.704.When the critical value of D-dimer was 1.4 mg/L,its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246(poor).When the concentration of D-dimer was 4.45 mg/L,its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817(the highest).Conclusions Perioperative DVT may happen in patients wi

关 键 词：胫骨 腓骨 骨折 深静脉血栓形成 危险因素 D-二聚体 

分 类 号：R47[医药卫生—护理学]