血栓弹力图联合D-二聚体检测对PICC血栓风险早期预警的意义  

The significance of thromboelastogram combined with D-dimer as early warning index for PICC thrombosis risk

作　　者：李祖媚[1] 李民[1] 蔡美霞 孙洁群[1] 梁素芳[1] 陈嘉荣[1] 陈桃 Li Zumei;Li Min;Cai Meixia;Sun Jiequn;Liang Sufang;Chen Jiarong;Chen Tao(Jiangmen Central Hospital,529030,China)

机构地区：[1]江门市中心医院,529030

出　　处：《国际护理学杂志》2021年第18期3336-3339,共4页international journal of nursing

基　　金：江门市科学技术局2019年医疗卫生领域科技计划项目(2019A025)。

摘　　要：目的探讨血栓弹力图(TEG)联合D-二聚体(D-D)检测在经外周静脉置入中心静脉导管(PICC)血栓风险早期预警的意义。方法选择2019年3月至2021年2月江门市中心医院PICC置管患者180例,所有患者均予置管后1 w、2 w时间点完成血管彩超血栓筛查,根据筛查结果分为血栓组、无血栓组。两组均在PICC置管前T0(0~1 d)、置管后T1(4~7 d)两个时间点检测TEG和D-D;绘制ROC曲线,分析血栓弹力图联合D-D在PICC血栓风险早期中的预警效能(诊断敏感性、特异性)。结果血栓组血栓弹力图中凝血反应时间(R)、血细胞凝块形成时间(K)低于无血栓组,差异有统计学意义(P<0.05);血栓组血栓弹力图中K、CI、最大振幅(MA)、血细胞凝块形成速率(ε)及D-D水平均高于无血栓组,差异有统计学意义(P<0.05);ROC曲线结果表明:血栓弹力图联合D-D在PICC血栓风险早期中预警敏感性、特异性均高于单一血栓弹力图和D-D,差异有统计学意义(P<0.05)。结论血栓弹力图联合D-D检测用于PICC血栓风险中效果理想,能实现早期预警,获得较高的预测敏感性、特异性,值得推广应用。Objective To explore the significance of early detection of thromboelastogram(TEG)combined with D-dimer(D-D)as risk index of thrombosis in Peripherally Inserted Central Catheter(PICC).Methods A total of 180 patients with PICC catheterization in this hospital from March 2019 to February 2021 were selected.All patients were screened for vascular color doppler thrombosis at 1 week,2 weeks after catheterization,and were divided into thrombus group and non-thrombus group according to the screening results.The TEG and D-dimer levels were detected at two time points T0(0~1 d)before and T1(4~7 d)after PICC placement in both groups.ROC curves were drawn,and thromboelastograms were analyzed together with D-D for early warning efficacy in terms of diagnostic sensitivity and specificity as early thrombotic risk in PICC.Results The R and K of thrombus elasticity diagram in the thrombus group were lower than those in the non-thrombus group,and the difference was statistically significant(P<0.05).The levels of K,CI,MA,ε,and D-D of the thrombosis group were higher than those of the non-thrombus group,and the difference was statistically significant(P<0.05).The results of the ROC curve showed that the sensitivity and specificity of combination of thromboelastogram and D-D were higher than of the separated data,and the difference was statistically significant(P<0.05).Conclusions Thromboelastogram combined with D-D test is ideal to predict the risk of PICC thrombosis,with higher predictive sensitivity and specificity to show an early warning,and is worthy of popularization and application.

关 键 词：血栓弹力图 D-二聚体 PICC 血栓风险 早期预警 

分 类 号：R472[医药卫生—护理学]