CAJ | 학술논문

目的探讨骨科大手术围手术期血浆D-二聚体动态检测对深静脉血栓(DVT)形成早期诊断中的临床意义.方法 2009年10月至2010年11月,采用紫外免疫比浊法于入院时、术后2h和术后1、2、3、4、6、8、10、15 d动态测定本院92例骨科大手术患者(髋关节置换术28例、膝关节置换术40例、髋部周围骨折手术24例)血浆D－二聚体浓度,分析其动态变化特点.按照彩超检查结果将患者分为DVT组与非DVT组,比较两组各时间点的D-二聚体水平.结果与术前相比,92例患者术后血浆D-二聚体浓度均升高,术后2h即达2000 μg/L以上,其中有10例D-二聚体浓度呈持续性或进行性升高,术后1d达高峰(3588±512)μg/L,并呈持续升高状态,术后15 d仍有(2494±394)μg/L,而其他82例患者D-二聚体值能较快地下降,其峰值仅持续3d,术后4d即降至500 μg/L以下.双下肢深静脉彩超检查后确认10例持续升高患者发生DVT(DVT组),82例D-二聚体水平迅速下降患者未发生DVT(非DVT组),DVT的发生率为10.87％.与非DVT组比较,DVT组患者术前D－二聚体水平接近,术后2h和术后1、2、3、4、6、8、10、15 d D-二聚体水平均升高(均P＜0.05).结论骨科大手术围手术期血浆D-二聚体浓度的动态监测对术后并发DVT早期诊断具有重要价值.
목적 탐토골과대수술위수술기혈장D-이취체동태검측대심정맥혈전(DVT)형성조기진단중적림상의의.방법 2009년10월지2010년11월,채용자외면역비탁법우입원시、술후2h화술후1、2、3、4、6、8、10、15 d동태측정본원92례골과대수술환자(관관절치환술28례、슬관절치환술40례、관부주위골절수술24례)혈장D－이취체농도,분석기동태변화특점.안조채초검사결과장환자분위DVT조여비DVT조,비교량조각시간점적D-이취체수평.결과 여술전상비,92례환자술후혈장D-이취체농도균승고,술후2h즉체2000 μg/L이상,기중유10례D-이취체농도정지속성혹진행성승고,술후1d체고봉(3588±512)μg/L,병정지속승고상태,술후15 d잉유(2494±394)μg/L,이기타82례환자D-이취체치능교쾌지하강,기봉치부지속3d,술후4d즉강지500 μg/L이하.쌍하지심정맥채초검사후학인10례지속승고환자발생DVT(DVT조),82례D-이취체수평신속하강환자미발생DVT(비DVT조),DVT적발생솔위10.87％.여비DVT조비교,DVT조환자술전D－이취체수평접근,술후2h화술후1、2、3、4、6、8、10、15 d D-이취체수평균승고(균P＜0.05).결론 골과대수술위수술기혈장D-이취체농도적동태감측대술후병발DVT조기진단구유중요개치.
Objective To determine the clinical significance of perioperative plasma D- dimer dynamic assays in predicting incidence of deep vein thrombosis (DVT) in patients undergoing major orthopedics operations.Methods A total of 92 patients undergoing major orthopedics operations (28 underwent total hip anthroplasty,40 received total knee anthroplasty,24 were treated with hip fracture surgery) were recruited from Zhengzhou Orthopedics Hospital between October 2009 and November 2010 and were subjected to measurements of plasma D- dimer levels via immunochromatogram assay during admission,at 2 hours postoperatively,and on days 1,2,3,4,6,8,10 and 15 postoperatively,for analysis of dynamic variation.Subjects were assigned into DVT group and non-DVT group based on the deep venous ultrasonography.Results As compared with preoperative levels,92 patients presented elevated plasma D-dimer levels postoperatively,which was over 2000 μg/L 2 h after operation.Ten patients were found to have continuous or progressive increase in plasma D- dimer,which peaked to (3588 ± 512) μg/L on day 1,sustained at high levels and retained as high as (2494±394) μg/L at day 15 postoperatively.By contrast,82 patients exhibited rapid fall in plasma D-dimer levels,with the peak concentration sustained for merely 3 days and average levels lower than 500 μg/L at day 4 postoperatively and thereafter.Above 10 patients (incidence rate:10.87％ ) were confirmed to have DVT (DVT group) and other 82 patients showed no evidence of DVT (non-DVT group).Plasma D-dimer of DVT group increased significant at 2 hours,and on days 1,2,3,4,6,8,10 and 15 postoperatively (all P＜0.05),but not preoperatively (P＞0.05) as compared with non- DVT group.Conclusion Dynamic plasma D- dimer monitoring is critical to timely diagnosis of DVT during perioperative period in patients undergoing major orthopedics operations.