D-二聚体监测预防急性深静脉血栓的意义

Significance of dynamically monitoring D-dimer on prevention of acute deep vein thrombosis of lower limbs

摘要:

探讨D-二聚体及血栓弹力图（TEG）在预测全髋关节置换术后急性下肢深静脉血栓（DVT）中的意义。方法纳入2015 年12 月-2016 年5 月在该院关节外科行全髋关节置换的患者93 例，动态监测置换前及置换后1、3、5、7 和12 d的D- 二聚体，并定期检测TEG 各项指标，置换后12 d 行双下肢静脉彩超，根据彩超结果有无血栓形成分为血栓组与对照组。对比两组患者D- 二聚体及TEG 各项指标的水平。结果患者术后定期行患侧肢体血管彩超检查，术后1周内行彩超检查未发现血栓形成，术后第12 天彩超检查提示11 例患者存在小腿肌间静脉血栓，纳入血栓组；其余82 例患者未发现血栓，纳入对照组。两组患者在年龄、吸烟史，体重、手术时长及术中失血量比较，差异无统计学意义（p >0.05）。血栓组与对照组术前及术后1、3、5、7 和12 d D- 二聚体水平比较，差异有统计学意（p <0.05），所有患者术后较术前凝血反应时间（R）缩短，血栓最大幅度（MA）升高，伴α角升高。术后第12天血栓组TEG的R时间、凝固时间、a角、MA、凝血块强度值及D-二聚体与对照组比较，差异有统计学意义（p <0.05）。结论提示髋关节置换术后D- 二聚体的动态监测及TEG、小腿肌间静脉丛彩超检查有助于早期发现血栓。

Abstract:

To study the effect of D-dimer and thrombelastography on predicting acute deep vein thrombosis of lower limbs after total hip arthroplasty. Methods Ninety-three patients who received total hip arthroplasty at Department of Joint Surgery in our hospital from December 2015 to May 2016 were taken as subjects. The D-dimer was dynamically monitored before operation and 1, 3, 5, 7 and 12 d after operation,and the indicators of thrombelastography were regularly tested as well. All the patients were divided into thrombus group and control group according to the results of color ultrasonography of the lower limbs taken 12 d after arthroplasty. The levels of indicators of thrombelastography and D-dimer were compared between the two groups. Results After operation, the patients received regular ultrasonography on lower limb veins and thrombosis was not found within 1 w. On the 12th d after operation, 11 patients were found to have calf intermuscular vein thrombosis and enrolled into thrombus group; the remaining 82 patients without thrombosis were included into control group. The two groups of patients showed no significant difference on age, history of smoking, body weight, time of operation or intraoperative blood loss. There were significant differences in the D-dimer levels before operation and 1, 3, 5, 7 and 12d after surgery between the two groups (p < 0.05).The coagulation response time (R) was shortened, the maximum thrombus amplitude (MA) increased and the alpha angle was enlarged after operation in all the patients (p < 0.05). On the 12th d after surgery, the values of R, coagulation time, α angle, MA, clot strength and D-dimer in the thrombus group were significantly different from those in the control group (p < 0.05). Conclusions Dynamically monitoring D -dimer,thrombelastography and calf venous plexus ultrasonography after total hip arthroplasty are useful for early detection of thrombus.