术前血管超声参数预测妇科恶性肿瘤患者术后下肢深静脉血栓形成的价值  

Value of preoperative vascular ultrasound parameters in predicting postoperative lower extremity deep venous thrombosis in patients with gynecological malignant tumors

作　　者：高文汇[1] 张玮玮[2] 王妮荣 张佳齐 戴靖华[1] 李欣微 卫建峰[2] 余淑珍[2] Gao Wenhui;Zhang Weiwei;Wang Nirong;Zhang Jiaqi;Dai Jinghua;Li Xinhui;Wei Jian-feng;Yu Shuzhen

机构地区：[1]山西省人民医院麻醉手术科,太原030012 [2]山西省人民医院麻醉科,太原030012 [3]山西医科大学麻醉学院,太原030001

出　　处：《中华麻醉学杂志》2024年第8期937-940,共4页Chinese Journal of Anesthesiology

基　　金：山西科技厅科研基金项目(201903D321171)。

摘　　要：目的评价术前血管超声参数预测妇科恶性肿瘤患者术后下肢深静脉血栓形成(DVT)的价值。方法选取全身麻醉下择期手术妇科恶性肿瘤患者99例,年龄>18岁,BMI<30 kg/m^(2),ASA分级Ⅱ或Ⅲ级。于术前行血管超声检查,记录股总静脉(CFV)、股深静脉(DFV)、腘静脉(POV)、小腿肌间静脉(IMV)流速和管径。于术后1~8 d每日超声检查下肢静脉(包括胫前静脉、胫后静脉、IMV、CFV、DFV、POV),判断是否发生DVT。采用受试者工作特征曲线评价各指标预测下肢DVT的准确性,根据约登指数最大原则确定截断值。结果下肢DVT发生率为13.1%。术前CFV流速和管径、DFV流速和管径、POV流速和管径、IMV流速和管径预测下肢DVT的曲线下面积(95%置信区间)分别为0.769(0.616~0.923)和0.800(0.644~0.950)、0.797(0.641~0.954)和0.771(0.596~0.945)、0.806(0.645~0.968)和0.754(0.606~0.903)、0.764(0.615~0.914)和0.818(0.645~0.990)(P<0.05),其预测截断值分别为27.13 cm/s和11.93 mm、19.31 cm/s和10.15 mm、16.04 cm/s和8.79 mm、14.39 cm/s和8.68 mm,灵敏度、特异度分别为90.0%、71.4%和90.0%、74.3%,90.0%、74.3%和90.0%、68.6%,90.0%、82.9%和90.0%、72.9%,90.0%、70.0%和80.0%、87.1%。结论术前血管超声参数可准确预测妇科恶性肿瘤患者术后下肢DVT的发生。ObjectiveTo evaluate the value of preoperative vascular ultrasound parameters in predicting the postoperative lower extremity deep venous thrombosis(DVT)in patients with gynecological malignant tumors.MethodsNinety-nine patients with gynecological malignant tumors,aged>18 yr,with body mass index<30 kg/m 2,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,scheduled for elective surgery under general anesthesia,were selected.Vascular ultrasound examination was performed before surgery.The flow velocity and diameter of common femoral vein(CFV),deep femoral vein(DFV),popliteal vein(POV),and intermuscular vein(IMV)were recorded.Ultrasound examination of lower limb veins(including anterior tibial vein,posterior tibial vein,IMV,CFV,DFV,POV)were conducted at 1-8 days after surgery to determine whether a DVT occurred.The receiver operating charcateristic curve was used to evaluate the accuracy of each indicator in predicting the lower extremity DVT,and the cut-off value was determined based on the maximum principle of Jorden index.ResultsThe incidence of lower extremity DVT was 13.1%.The area under the curve(95%confidence interval)of the preoperative CFV flow velocity and diameter,DFV flow velocity and diameter,POV flow velocity and diameter,IMV flow velocity and diameter in predicting the lower extremity DVT were 0.769(0.616-0.923)and 0.800(0.644-0.950),0.797(0.641-0.954)and 0.771(0.596-0.945),0.806(0.645-0.968)and 0.754(0.606-0.903),0.764(0.615-0.914)and 0.818(0.645-0.990),respectively(P<0.05),and the predicted cut-off values were 27.13 cm/s and 11.93 mm,19.31 cm/s and 10.15 mm,16.04 cm/s and 8.79 mm,14.39 cm/s and 8.68 mm,respectively,and the sensitivity and specificity were 90.0%,71.4%and 90.0%,74.3%;90.0%,74.3%and 90.0%,68.6%;90.0%,82.9%and 90.0%,72.9%;90.0%,70.0%and 80.0%,87.1%,respectively.ConclusionsPreoperative vascular vascular ultrasound parameters can accurately predict the occurrence of postoperative lower extremity DVT in patients with gynecological malignant tumors.

关 键 词：超声检查 下肢深静脉 静脉血栓形成 预测 

分 类 号：R737.3[医药卫生—肿瘤] R445.1[医药卫生—临床医学]