血栓弹力图相关参数对股骨粗隆间骨折术后深静脉血栓形成的预测价值研究  

Study on Predictive Value of Thromboelastography Related Parameters on Postoperative Deep Venous Thrombosis Formation of Intertrochanteric Fracture of Femur

作　　者：张彦[1] 王大城[1] 郭汉明[1] 康明[1] 张理选[1] ZHANG Yan;WANG Dacheng;GUO Hanming;KANG Ming;ZHANG Lixuan(Huizhou Central People’s Hospital,Huizhou 516000,China;不详)

机构地区：[1]广东省惠州市中心人民医院,广东惠州516000

出　　处：《中国医学创新》2020年第11期17-22,共6页Medical Innovation of China

基　　金：惠州市科技计划项目(技术开发类)(190418114573292)。

摘　　要：目的:探究血栓弹力图(thromboelastography,TEG)相关参数对股骨粗隆间骨折(intertrochanteric fracture of femur,IFF)术后深静脉血栓(deep venous thrombosis,DVT)形成的预测价值。方法:选取2018年6月-2019年10月本院收治的178例IFF患者为研究对象,所有患者均行闭合复位髓内钉内固定术,围手术期使用低分子肝素钙预防深静脉血栓,术前和术后1、7 d行凝血五项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)]及TEG[反应时间(R值)、血块形成时间(K值)、血块生成率(α角)、最大血栓幅度(MA)]检查,所有患者随访3周,以彩色多普勒超声检查明确DVT诊断,以DVT形成者为血栓组,从剩余无DVT形成者中选择同样例数患者为对照组,比较血栓组与对照组不同时间点凝血五项指标、TEG参数,分析术前血栓组凝血五项与TEG参数相关性,并绘制受试者工作特征(ROC)曲线探究术前凝血五项、TEG参数中相关指标对DVT形成的预测价值。结果:术前、术后1 d、术后7 d,血栓组的FIB、D-D均显著高于对照组(P<0.05),R值、K值均显著低于对照组(P<0.05),α角、MA值均显著高于对照组(P<0.05)。Pearson相关性分析显示,术前血栓组R值、K值与PT均呈正相关,与FIB、D-D均呈负相关(P<0.05);α角、MA值与PT均呈负相关,与FIB、D-D均呈正相关(P<0.05)。术前FIB、D-D预测DVT形成的ROC曲线下面积分别为0.795、0.840(P<0.05),血栓弹力图参数R值、K值、α角、MA值预测DVT形成的ROC曲线下面积分别为0.726、0.580、0.722、0.589(P<0.05)。结论:围术期行TEG检查可反映IFF术后患者凝血功能变化,可预测患者DVT形成风险,对DVT形成评估及预防有指导价值。Objective:To explore the predictive value of thromboelastography (TEG) related parameters on postoperative deep venous thrombosis (DVT) formation of intertrochanteric fracture of femur (IFF).Method:From June 2018 to October 2019,178 patients with IFF fractures were selected as the study subjects.All patients underwent closed reduction and intramedullary nail fixation,and were given low-molecular-weight heparin calcium during perioperative period to prevent deep venous thrombosis.The coagulation five items [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB),D-dimer (D-D)] and TEG [response time (R value),clot formation time (K value),clot generation rate (α angle),maximum thrombus amplitude (MA)] were examined before surgery,1 d and 7 d after surgery,all patients were followed up for3 weeks,and color Doppler ultrasound examination was performed to confirm DVT diagnosis.The patients with DVT formation were taken as thrombus group,and the same number of patients from the remaining patients without DVT were selected as control group.The coagulation five indexes and TEG parameters at different time points were compared between thrombus group and control group.The correlation between coagulation five indexes and TEG parameters was analyzed in thrombus group before surgery,and the receiver operating characteristic curve (ROC curve) was drawn to explore the predictive value of indicators with statistical significance among preoperative coagulation five indexes and TEG parameters on the formation of DVT.Result:Before surgery,1 d after surgery and 7 d after surgery,the FIB,D-D of the thrombus group were significantly higher than those of the control group (P<0.05),the R value and K value were significantly lower than those of the control group (P<0.05),and the MA value of the α angles were significantly higher than those of the control group (P<0.05).Pearson correlation analysis showed that preoperative R value and K value in the thrombus group were positively correlate

关 键 词：股骨粗隆间骨折 深静脉血栓 血栓弹力图 凝血功能 

分 类 号：R687.3[医药卫生—骨科学] R543.6[医药卫生—外科学]