血栓弹力图联合D-二聚体在肺部手术后下肢深静脉血栓形成的预测价值  

The value of thromboelastography combined with D-dimer in predicting deep vein thrombosis of lower extremities after lung surgery

作　　者：虞亚菲 张海平[1] 居来提·艾尼瓦尔[1] 朱辉[1] Yu Yafei;Zhang Haiping;Julaiti Ainiwaer;Zhu Hui(Department of Thoracic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院胸外科,乌鲁木齐830054

出　　处：《中国血管外科杂志（电子版）》2021年第1期38-41,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨血栓弹力图(thrombelastography,TEG)联合D-二聚体在预测患者肺部手术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的临床价值。方法选取2019年6~12月新疆医科大学第一附属医院行胸腔镜下肺部手术98例患者作为研究对象,根据发生DVT情况分为DVT组(15例)和非DVT组(83例)。比较两组的TEG指标和D-二聚体水平,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并计算TEG指标及D-二聚体在DVT的诊断效能。结果TEG MA值是患者发生DVT的独立预测因素(OR=4.660,95%CI=1.578~13.758,P=0.005)。ROC曲线显示,TEG R值、K值、α角、MA值和D-二聚体在预测DVT形成的曲线下面积分别为0.831(95%CI=0.067~0.271)、0.878(95%CI=0.792~0.964)、0.847(95%CI=0.739~0.954)、0.983(95%CI=0.963~1.000)和0.823(95%CI=0.699~0.947),最佳截断值分别为5.05 min、1.25 min、70.5°、70.1 mm和0.66 mg/L。TEG联合D-二聚体诊断的准确率、灵敏度、阳性预测值明显高于TEG和D-二聚体单独诊断。结论TEG能有效预测肺部术后发生DVT的风险,TEG联合D-二聚体在预测DVT发生具有较高诊断价值。Objective To explore the clinical value of thromboelastography(TEG)combined with D-dimer in predicting deep vein thrombosis(DVT)of lower extremities in patients undergoing lung surgery.Methods A total of 98 patients underwent thoracoscopic lung surgery in the First Affiliated Hospital of Xinjiang Medical University from June to December 2019 were selected.According to the occurrence of DVT,they were divided into DVT group(15 cases)and non-DVT group(83 cases).The TEG indicators and D-dimer levels of the two groups were compared,the receiver operating characteristic(ROC)curve was drawn and the TEG indicators and D-dimer's diagnostic efficacy in DVT were calculated.Results TEG MA value was an independent predictor of DVT(OR=4.660,95%CI=1.578~13.758,P=0.005).The ROC curve shows that the area under curve of TEG R value,K value,αangle,MA value and D-dimer in predicting DVT were 0.831(95%CI=0.067~0.271),0.878(95%CI=0.792~0.964),0.847(95%CI=0.739~0.954),0.983(95%CI=0.963~1.000)and 0.823(95%CI=0.699~0.947),respectively.And the best cut-off values are 5.05 min,1.25 min,70.5°,70.1 mm and 0.66 mg/L,respectively.The accuracy,sensitivity and positive predictive value of TEG combined with D-dimer diagnosis are significantly higher than TEG and D-dimer alone.Conclusion TEG can predict the risk of DVT after lung surgery effectively.TEG combined with D-dimer has a high diagnostic value in predicting the occurrence of DVT.

关 键 词：血栓弹力图 D-二聚体 肺部手术 深静脉血栓形成 诊断 

分 类 号：R654.4[医药卫生—外科学]