摘要
目的探讨血栓弹力图(TEG)在评估全膝关节置换术(TKA)后下肢深静脉血栓形成(DVT)风险中的应用价值。方法根据纳入、排除及退出标准,选取2018年1月—2020年1月在我科因膝关节骨关节炎行单侧TKA的患者316例。随访时间为90天,根据随访期内,经下肢血管彩超诊断是否发生DVT分为非血栓组(非DVT组)305例,血栓组(DVT组)11例。于术前1 d,术后第14天,采用血栓弹力仪检测TEG,记录TEG指标数据R值,K值,MA值,CI值,Alpha角度及TDR值。结果非DVT组与DVT组在性别、年龄、吸烟情况、手术时间或止血带时间方面差异无统计学意义(P>0.05);DVT组的体质量指数(BMI)高于非DVT组(P<0.01)。术前非DVT组与DVT组R值、K值、Alpha角度、MA值、CI值及TDR值间差异无统计学意义。术后两组比较,DVT组术后R值、K值减小,Alpha角度、MA值和TDR值增加(P<0.01),差异均有统计学意义。ROC曲线分析R值,K值,Alpha值,MA值及TDR值对DVT诊断的曲线下面积(AUC)分别为0.95,0.77,0.91,0.97和0.99,约登指数分别为0.76,0.72,0.91,0.89和0.91。R值,K值,Alpha角度和MA值及TDR值的Cut-off分别为5.40 min,1.40 min,69.20°,67.10 mm和765.80。二元logistic回归在R值,K值,MA值,CI值,Alpha角度及TDR值中,TDR值是唯一有可能有临床价值的血栓弹力图指标(OR 1.01;95%CI1.00~1.02;P=0.021)。结论TEG在TKA后下肢DVT形成风险的评估中有一定应用价值,TDR值与下肢DVT形成有明显相关性,但在参数范围标准化方面尚需进一步研究。
Objective There remains a risk of deep vein thrombosis(DVT)following total knee arthroplasty(TKA)despite anticoagulation.Thromboelastography(TEG)is a technique for evaluating blood coagulability that might be useful in the prediction of DVT risk.Methods This prospective study enrolled 320 patients undergoing unilateral TKA for knee osteoarthritis.The final analysis included 316 patients.Patients received tranexamic acid and nadroparin calcium during the perioperative period.TEG was performed prior to surgery and on postoperative day 14.The TEG parameters calculated were reaction time(R),kinetic time(K),maximum amplitude(MA),alpha angle(Alpha),coagulation index(CI)and thrombodynamic ratio(TDR).Receiver operating characteristic(ROC)curve and binary logistic regression analyses were utilized to assess the ability of these TEG parameters to predict postoperative DVT risk.Results DVT incidence was 3.48%(95%confidence interval[95%CI]:1.4~5.4%).Pulmonary embolism incidence was 1.25%(95%CI:0~2.5%).ROC curve analysis of the ability of R,K,Alpha,MA and TDR to predict postoperative DVT yielded area under the curve values of 0.95,0.77,0.91,0.97 and 0.99,respectively,and Youden indexes of 0.76,0.72,0.91,0.89 and 0.91,respectively.Optimal cutoff values for R,K,Alpha,MA and TDR were 5.40 min,1.40 min,69.20°,67.10 mm and 765.80,respectively.Binary logistic regression analysis determined that the only significant predictor of postoperative DVT was TDR(OR:1.01;95%CI:1.00-1.02;P=0.021).Conclusion If refined,TEG may have potential as a screening tool to predict the risk of DVT after TKA.
作者
蔺超
刘涛
任强
石辉
刘明廷
李贤让
戚大春
孟涛
王雅宁
LIN Chao;LIU Tao;REN Qiang;SHI Hui;LIU Mingting;LI Xianrang;QI Dachun;MENG Tao;WANG Ya′ning(Department of Joint Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China;Urology Department,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)
出处
《滨州医学院学报》
2022年第3期190-194,共5页
Journal of Binzhou Medical University
