老年骨折病人并发下肢深静脉血栓的血管内皮生长因子和血栓弹力图变化  

Changes of vascular endothelial growth factor and thromboelastogram in fracture patients with deep vein thrombosis of lower extremities

作　　者：朱瑜琪[1] 张帅 张韩瑜嘉 姚晖[1] 王智耀[1] ZHU Yuqi;ZHANG Shuai;ZHANG Hanyujia;YAO Hui;WANG Zhiyao(Department of Orthopedics,Eye Hospital China Academy of Chinese Medical Science,Beijing 100040,China)

机构地区：[1]中国中医科学院眼科医院骨科,北京100040

出　　处：《安徽医药》2021年第4期801-804,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨骨折病人围手术期下肢深静脉血栓病人的相关预测因子和临床价值。方法 2017年6—12月,根据术后是否发生下肢深静脉血栓,将70例老年骨折病人分为血栓组(n=28)与非血栓组(n=42)。比较两组病人围手术期血管内皮生长因子(VEGF)以及血栓弹力图指标变化情况。结果手术当日(T0d),两组病人D-二聚体含量比较,差异无统计学意义(P>0.05);术后第1天(T1d),两组病人D-二聚体含量呈升高趋势,并于第3天(T3d)[血栓组(1.78±0.21)mg/L;非血栓组(1.39±0.15)mg/L]逐渐下降;血栓组病人T3d、术后1周(T1w)、术后2周(T2w)D-二聚体含量高于非血栓组(P<0.05)。T0d,两组病人VEGF含量差异无统计学意义(P>0.05);T1d,两组病人VEGF含量呈升高趋势,并于T1w达到峰值[血栓组(588.67±70.19);非血栓组(495.20±68.14)],血栓组病人T3d、T1w、T2w时刻VEGF含量高于非血栓组(P<0.05)。T0d、T1d,两组病人凝血反应时间、凝固时间差异无统计学意义(P>0.05);T2w时刻,血栓组病人凝血反应时间、凝固时间低于非血栓组及T0d时刻(P<0.05)。两组病人凝固角在T0d、T1d时刻比较,差异无统计学意义(P>0.05),T2w时刻,血栓组大于非血栓组[血栓组(41.24±4.89)°;非血栓组(29.05±3.01)°,P<0.05]。T0d时刻,两组病人血栓最大幅度、凝血块强度值比较,差异无统计学意义(P>0.05);T1d时刻,血栓组病人血栓最大幅度[血栓组(63.36±3.60)mm;非血栓组(61.49±3.91)mm]、凝血块强度值[血栓组(9.29±0.63)d/s;非血栓组(8.68±0.57)d/s]均高于非血栓组(P<0.05);T2w时刻,血栓组病人血栓最大幅度[血栓组(63.28±4.84)mm;非血栓组(49.63±4.26)mm]、凝血块强度值[血栓组(9.28±1.02)d/s;非血栓组5.44±0.71 d/s]均高于非血栓组(P<0.05)。结论在老年骨折病人下肢深静脉血栓的形成过程中,血栓组病人术后2周时,凝血反应时间与凝固时间缩短,凝固角、血栓最大幅度值以及凝血块强度值增加,提示下肢深静脉血栓形成�Objective To explore the predictors and clinical value of perioperative deep venous thrombosis(DVT) in patients with fractures.Methods From June 2017 to December 2017,according to whether postoperative deep venous thrombosis occurred,70 elderly fracture patients were assigned into thrombus group(n=28) and non-thrombus group(n=42).The changes of vascular endothelial growth factor(VEGF) and thrombelastogram index in two groups during perioperative period were compared.Results On the day of operation(T0d),there was no significant difference in the D-dimer content between the two groups(P>0.05);on the first day after operation(T1d),the D-dimer content of the two groups showed an increasing trend,and then decreased gradually at the time of T3d [thrombus group:(1.78±0.21) mg/L;non thrombus group:(1.39±0.15) mg/L].The content of D-dimer in thrombus group was higher than that in non-thrombus group on the 3rd day(T3d),1st week(T1w) and 2nd week(T2w) after operation(P<0.05) with statistical significance.At T0 d,there was no significant difference in VEGF content between the two groups(P>0.05);at Tld,the VEGF contents of the two groups showed an increasing trend and reached its peak at T1 w [thrombus group:(588.67±70.19);non-thrombus group:(495.20±68.14)].The VEGF contents of the thrombus group was higher than those of the non-thrombus group at T3d,T1w and T2w(P<0.05).At T0d and Tld,there were no significant differences in coagulation reaction time and coagulation time between the two groups(P>0.05);at T2w,the coagulation reaction time and coagulation time of the thrombus group were shorter than those of the non-thrombus group and those at T0d with statistical significance(P<0.05).At T0d and T1d,there was no significant difference in coagulation angle between the two groups(P>0.05);at T2w,the coagulation angle of thrombus group was larger than that of non-thrombus group [thrombus group:(41.24±4.89)°;non-thrombus group:(29.05±3.01)°] with statistical significance(P<0.05).At T0d,there was no significant difference bet

关 键 词：静脉血栓形成 骨折 下肢 血管内皮生长因子 血栓弹力图 

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