CAJ | 학술논문

目的研究 D-二聚体(DD)与血浆纤维蛋白原(FIB)的动态变化对早期预测全髋关节置换术(THA)术后下肢深静脉血栓(DVT)的意义.方法选择2012年4月至9月,108例初次 THA 手术患者,术前所有患者下肢深静脉彩超检测均阴性,根据术后5天下肢彩超检测结果将患者分为血栓组(n=28)和非血栓组(n=80).所有患者于术前、术后1、3、5天对血浆 DD、FIB 进行检测,将检查结果进行统计学分析,并与B超检查结果对比,比较血浆 DD、FIB 两个检测指标及两个指标联合检测的敏感性和特异性.结果与非血栓组比较,血栓组 DD 术后各时间点均明显升高(P<0.01),FIB 术后3、5天明显增加(P<0.01).与基础值比较,两组 DD 术后各时间点均明显升高,于术后1天到峰值:非血栓组(4.94±1.27) mg/L,血栓组(8.96±1.67) mg/L (P<0.01);FIB 术后3、5天明显增加,且5天值较3天值增高明显:非血栓组(5.13±0.48) g/L,血栓组(7.24±1.23) g/L (P<0.01).术后3天,DD 结合 FIB 检测的敏感性和特异性分别达到94.7%和93.3%.结论本研究涉及参数均提示术后血液呈高凝状态,深静脉血栓风险增大.血浆 DD、FIB 的联合检测对 THA 术后并发下肢 DVT 具有早期预测价值,其在术后第3天的敏感性和特异性达到最优化.
목적연구 D-이취체(DD)여혈장섬유단백원(FIB)적동태변화대조기예측전관관절치환술(THA)술후하지심정맥혈전(DVT)적의의.방법선택2012년4월지9월,108례초차 THA 수술환자,술전소유환자하지심정맥채초검측균음성,근거술후5천하지채초검측결과장환자분위혈전조(n=28)화비혈전조(n=80).소유환자우술전、술후1、3、5천대혈장 DD、FIB 진행검측,장검사결과진행통계학분석,병여B초검사결과대비,비교혈장 DD、FIB 량개검측지표급량개지표연합검측적민감성화특이성.결과여비혈전조비교,혈전조 DD 술후각시간점균명현승고(P<0.01),FIB 술후3、5천명현증가(P<0.01).여기출치비교,량조 DD 술후각시간점균명현승고,우술후1천도봉치:비혈전조(4.94±1.27) mg/L,혈전조(8.96±1.67) mg/L (P<0.01);FIB 술후3、5천명현증가,차5천치교3천치증고명현:비혈전조(5.13±0.48) g/L,혈전조(7.24±1.23) g/L (P<0.01).술후3천,DD 결합 FIB 검측적민감성화특이성분별체도94.7%화93.3%.결론본연구섭급삼수균제시술후혈액정고응상태,심정맥혈전풍험증대.혈장 DD、FIB 적연합검측대 THA 술후병발하지 DVT 구유조기예측개치,기재술후제3천적민감성화특이성체도최우화.
Objective To determine the significance of dynamic testing D-Dimer (DD) and plasma fibrinogen (FIB) for the early prediction of lower limb deep vein thrombosis (DVT) after total hip arthroplasty (THA). Methods From April 2012 to September 2012, 108 patients underwent primary THA. Color duplex ultrasonography of lower limbs was performed preoperatively with negative results in all the patients. 5 days postoperatively color duplex ultrasonography was performed again. All patients were divided into thrombosis group (n=28) and non-thrombosis group (n=80) according to the results. Plasma DD and FIB were measured preoperatively, at the 1st, 3rd and 5th day postoperatively. All the results were statistically analyzed. Sensitivity and specificity of plasma DD, FIB and DD+FIB for thrombosis detection were evaluated. Results Compared with the non-thrombosis group, postoperative DD value of thrombosis group increased significantly at each time point (P<0.01), and FIB value increased significantly at postoperative 3rd and 5th day (P<0.01). Compared with preoperative value, the DD of both groups significantly increased at each time point postoperatively, the peak value was got at postoperatively 1st day: postoperatively the non-thrombosis group (4.94±1.27) mg/L, the thrombosis group (8.96±1.67) mg/L (P<0.01); FIB value significantly increased at postoperative 3rd and 5th day, and the value on the 5rd day is much higher than on the 3rd day. Non-thrombosis group (5.13±0.48) g/L. Thrombosis group (7.24 ±1.23) g/L (P<0.01). 3rd day postoperatively, the sensitivity and specificity of DD+FIB for thrombosis detection were 94.7% and 93.3%. Conclusions Parameters in this study indicated that the blood is in hypercoagulable state postoperatively, and the risk for DVT is increasing. Combined measurement of plasma DD and FIB could early predict lower limb DVT after the THA. The sensitivity and specificity for DVT detection optimize at the 3rd day postoperatively.