CAJ | 학술논문

目的：探讨血栓弹力图（thrombelastography，TEG）、D-二聚体（D?dimer，D?D）预测骨科大手术围手术期抗凝治疗终点并发深静脉血栓（deep vein thrombosis，DVT）的诊断价值。方法选择2011至2013年行全膝关节置换术（total knee arthroplasty，TKA）患者60例（患者组），再按随机数字法分为低分子肝素组和利伐沙班组（各30例）。对照组为同期健康体检者42例。TEG检测采用美国Hemoscope公司TEG 5000型血栓弹力图仪。结果低分子肝素组与利伐沙班组围手术期不同时间点各指标检测结果仅术后抗凝治疗前D?D最高，差异有统计学意义。低分子肝素组不同时间点TEG的R、K、Alpha、CI及D?D的差异均有统计学意义；利伐沙班组不同时间点TEG的Alpha、MA、CI及D?D的差异均有统计学意义。抗凝治疗终点发生肌间静脉血栓为7例，腘静脉血栓为1例。DVT组TEG的Alpha、MA、CI以及D?D检测结果高于非DVT组，差异均有统计学意义。预测抗凝治疗终点发生DVT临床诊断价值较好的指标依次为TEG的CI、MA、Alpha及D?D,受试者工作特征曲线下面积分别为0.746、0.733、0.707和0.644；敏感度分别为75%、75%、62.5%及62.5%；特异性分别为80.8%、76.9%、78.8%及71.1%；阳性预测值分别为37.5%、33.3%、31.3%及25.0%；阴性预测值分别为95.4%、95.2%、93.2%及93.1%。MA=68.35 mm为预测抗凝治疗终点DVT发生的最佳临床诊断临界点。结论 TEG的CI、MA、Alpha在骨科大手术围手术期抗凝治疗终点预测DVT发生的准确性高于D?D，其联合检测将提高排除DVT的诊断准确性。
목적：탐토혈전탄력도（thrombelastography，TEG）、D-이취체（D?dimer，D?D）예측골과대수술위수술기항응치료종점병발심정맥혈전（deep vein thrombosis，DVT）적진단개치。방법선택2011지2013년행전슬관절치환술（total knee arthroplasty，TKA）환자60례（환자조），재안수궤수자법분위저분자간소조화리벌사반조（각30례）。대조조위동기건강체검자42례。TEG검측채용미국Hemoscope공사TEG 5000형혈전탄력도의。결과저분자간소조여리벌사반조위수술기불동시간점각지표검측결과부술후항응치료전D?D최고，차이유통계학의의。저분자간소조불동시간점TEG적R、K、Alpha、CI급D?D적차이균유통계학의의；리벌사반조불동시간점TEG적Alpha、MA、CI급D?D적차이균유통계학의의。항응치료종점발생기간정맥혈전위7례，객정맥혈전위1례。DVT조TEG적Alpha、MA、CI이급D?D검측결과고우비DVT조，차이균유통계학의의。예측항응치료종점발생DVT림상진단개치교호적지표의차위TEG적CI、MA、Alpha급D?D,수시자공작특정곡선하면적분별위0.746、0.733、0.707화0.644；민감도분별위75%、75%、62.5%급62.5%；특이성분별위80.8%、76.9%、78.8%급71.1%；양성예측치분별위37.5%、33.3%、31.3%급25.0%；음성예측치분별위95.4%、95.2%、93.2%급93.1%。MA=68.35 mm위예측항응치료종점DVT발생적최가림상진단림계점。결론 TEG적CI、MA、Alpha재골과대수술위수술기항응치료종점예측DVT발생적준학성고우D?D，기연합검측장제고배제DVT적진단준학성。
Objective To investigate the predictive value and clinical significance of dynamic monitoring of thromboelas?tography (TEG) and D?dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replace?ment. Methods All of 60 patients of total knee arthroplasty (TKA) were selected as patient group from 2011 to 2013. They were divided into low molecular weight heparin (LMWH) group and rivaroxaban group according to random number table. LM?WH group was given LMWH (xi fu quan) 4250 IUAXa 12 h after knee replacement, im, qd for 7 days, then rivaroxaban 10 mg, qd for 7 days. Rivaroxaban group was given rivaroxaban 10 mg 6 h after knee replacement, qd for 14 days. Meanwhile, 42 health examination participants were selected as control group. The parameters of TEG were detected by TEG 5000 thrombo?elastograph hemostasis system (American Haemoscope Corporation). Results D?dimer levels of postoperative before anticoagu?lation therapy were highest and there was statistical difference, while other parameters had no statistical difference. Intra?group comparison:the levels of R, K, Alpha, CI of TEG and D?D in LMWH group and the levels of Alpha, MA, CI of TEG and D?D in ri?varoxaban group had statistical difference, while other parameters' levels showed no statistical difference. At anticoagulation treat?ment endpoint, DVT occurred in 8 cases with an incidence of 13.3%(8/60). 7 cases were intramuscular vein thrombosis, and 1 case was popliteal vein thrombosis. The levels of Alpha, MA, CI of TEG and D?D in DVT group were higher than no DVT group, and there was statistical difference. TEG's CI, MA, Alpha and D?dimer had better clinical diagnostic value on DVT, whose area un?der receiver operating characteristic cure (ROC) respectively was 0.746, 0.733, 0.707 and 0.644, with sensitivity of 75%, 75%, 62.5%and 62.5%, specificity of 80.8%, 76.9%, 78.8%and 71.1%, positive predictive value of 37.5%, 33.3%, 31.3%and 25.0%, and negative predictive value of 95.4%, 95.2%, 93.2%and 93.1%. MA=68.35 mm was the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint. Conclusion CI, MA, Alpha of TEG are better than D?dimer in predicting the inci?dence of DVT in the perioperative period of orthopaedics major operation. If these indexes are detected, the diagnosis value ’s ac?curacy of DVT will be improved.