CAJ | 학술논문

目的探讨下肢深静脉血栓形成风险因素、临床表现和血浆D-二聚体水平在彩色多普勒超声诊断下肢深静脉血栓中的协助作用,以提高彩色多普勒超声诊断下肢深静脉血栓的效率.方法解放军总医院2010年1月至2012年1月怀疑下肢深静脉血栓疾病患者2821例,住院患者1602例,门诊患者1219例;所有患者中,确诊为下肢深静脉血栓者1233例.记录所有患者病史、下肢症状和体征且均行下肢静脉超声检查;对住院患者每周行D-二聚体检测,每2周行下肢静脉超声检查,如下肢出现肿胀、疼痛等症状或D-二聚体测值大于标准值(0.5 mg/L),即随时行下肢静脉超声检查.结果1233例下肢深静脉血栓患者中,1097例为第1次超声检查即发现;699例为门诊超声检查时发现,534例为住院后超声检查发现;明确发病因素者954例,未能明确发病因素者279例.住院患者中,403例80岁以下血浆D-二聚体测值小于0.5 mg/L者均无血栓,115例80岁及以上血浆D-二聚体测值1.98μg/ml以下者均无血栓.435例有明确发病因素和99例无明确发病因素患者之间的血浆D-二聚体水平差异无统计学意义[2.58(1.23,5.76) mg/L vs 1.86(0.98,5.23) mg/L,U=1.786,P=0.642].结论了解细致的病史和临床表现有助于提高超声检查的效率;提供确切的下肢深静脉血栓超声表现有利于临床选择治疗方案;不同年龄段D-二聚体水平临界值需作调整,可作为重要的排除诊断下肢深静脉血栓形成的筛选手段,优化超声诊断流程.
목적탐토하지심정맥혈전형성풍험인소、림상표현화혈장D-이취체수평재채색다보륵초성진단하지심정맥혈전중적협조작용,이제고채색다보륵초성진단하지심정맥혈전적효솔.방법해방군총의원2010년1월지2012년1월부의하지심정맥혈전질병환자2821례,주원환자1602례,문진환자1219례;소유환자중,학진위하지심정맥혈전자1233례.기록소유환자병사、하지증상화체정차균행하지정맥초성검사;대주원환자매주행D-이취체검측,매2주행하지정맥초성검사,여하지출현종창、동통등증상혹D-이취체측치대우표준치(0.5 mg/L),즉수시행하지정맥초성검사.결과1233례하지심정맥혈전환자중,1097례위제1차초성검사즉발현;699례위문진초성검사시발현,534례위주원후초성검사발현;명학발병인소자954례,미능명학발병인소자279례.주원환자중,403례80세이하혈장D-이취체측치소우0.5 mg/L자균무혈전,115례80세급이상혈장D-이취체측치1.98μg/ml이하자균무혈전.435례유명학발병인소화99례무명학발병인소환자지간적혈장D-이취체수평차이무통계학의의[2.58(1.23,5.76) mg/L vs 1.86(0.98,5.23) mg/L,U=1.786,P=0.642].결론료해세치적병사화림상표현유조우제고초성검사적효솔;제공학절적하지심정맥혈전초성표현유리우림상선택치료방안;불동년령단D-이취체수평림계치수작조정,가작위중요적배제진단하지심정맥혈전형성적사선수단,우화초성진단류정.
Objective To discuss the role of risk factors,clinical manifestation and plasma D-dimer in the diagnosis of lower limb deep vein thrombosis (LLDVT)by color Doppler ultrasound,and then enhance the color Doppler ultrasound diagnosis efficiency in LLDVT .Methods Totally 2821 suspected LLDVT patients which contained 1602 inpatients and 1219 outpatients from January 2010 to January 2012 in General Hospital of the People′s Liberation Army were included.Among all patients,1233 patients were confirmed to have LLDVT.All patients were asked about medical history ,obtained clinical manifestation of lower limbs and scanning lower limb deep vein.In addition, for inpatients, D-dimer detection and lower limb deep vein ultrasonography were carried out weekly and every two weeks , respectively.Furthermore, ultrasonography should be performed immediately if the symptoms such as swelling or pain appeared in lower limbs or the D-dimer level was greater than the standard value (0.5 mg/L).Results Among 1233 LLDTV patients,1097 cases were discovered in the first ultrasonography;699 cases of outpatients and 534 cases were detected after being admitted;954 cases had clear epidemic factors while 279 cases had not.LLDVT were ruled out in 403 patients less than 80 years old with D-dimer level below 0.5 mg/L and 115 patients more than or equal to 80 years old with D-dimer level below 1.98 mg/L.There was no significant difference in D-dimer level between patients with clear epidemic factors and those without [2.58(1.23,5.76)mg/L vs 1.86(0.98,5.23)mg/L, U=1.786,P=0.642].Conclusions Detailed information of medical history and clinical manifestation is helpful for improving ultrasonography efficiency .Definite ultrasonography appearance of LLDVT favors better clinical treatment decision.D-dimer critical value should be adjusted for different age groups,and D-dimer detection can be used as an important screening method for excluding LLDVT and optimize ultrasonography diagnosis flow.