摘要
目的 探讨D-二聚体(D-D)动态监测法对下肢骨折行切开复位内固定术患者发生围术期深静脉血栓形成(DVT)的预测效果。方法 60例下肢骨折行切开复位内固定术治疗的患者,于术前1 d和术后3 d行超声检查DVT,其中15例发生DVT患者纳入观察组,45例未发生DVT患者归为对照组。对比两组患者不同时间点血浆D-D、纤维蛋白(原)降解产物(FDP)水平变化情况,D-D单独检测、FDP单独检测、D-D与FDP联合检测诊断DVT的效能。结果 两组术后1、3 d的血浆D-D水平均显著高于术前,且观察组术后1、3 d的血浆D-D(1.63±0.38)、(2.87±0.45)mg/L显著高于对照组的(0.89±0.15)、(1.25±0.36)mg/L,差异具有统计学意义(P<0.05)。两组术后1、3 d的血浆FDP水平均显著高于术前,且观察组术后1、3 d的血浆FDP(6.78±1.23)、(9.25±2.03)mg/L显著高于对照组的(4.87±0.85)、(5.24±1.02)mg/L,差异具有统计学意义(P<0.05)。D-D与FDP联合检测的特异度高于D-D单独检测,灵敏度、阳性预测值、阴性预测值、符合率高于D-D及FDP单独检测,差异具有统计学意义(P<0.05)。结论 动态监测D-D及FDP水平变化有助于预判DVT的发生,能够在下肢骨折术后预防DVT发生中发挥重要的指导价值。
Objective To discuss the effect of D-dimer(D-D)dynamic monitoring on predicting perioperative deep venous thrombosis(DVT)in patients with lower limb fractures undergoing open reduction and internal fixation.Methods In 60 patients with lower limb fractures requiring open reduction and internal fixation,DVT was examined by ultrasound at 1 d preoperatively and 3 d postoperatively.15 patients with DVT were selected as the observation group,and 45 patients without DVT were selected as the control group.The changes of plasma D-D and fibrinogen degradation product(FDP)levels at different time points were compared between the two groups,and the efficacy of D-D,FDP alone and in combination in diagnosis of DVT was compared.Results The plasma D-D levels at 1 and 3 d postoperatively in both groups were significantly higher than those preoperatively in this group;the plasma D-D at 1 and 3 d postoperatively in the observation group were(1.63±0.38)and(2.87±0.45)mg/L,which were significantly higher than(0.89±0.15)and(1.25±0.36)mg/L in the control group;the differences were statistically significant(P<0.05).The plasma FDP levels at 1 and 3 d postoperatively in both groups were significantly higher than those before surgery in this group;the plasma FDP at 1 and 3 d postoperatively were(6.78±1.23)and(9.25±2.03)mg/L in the observation group,which were significantly higher than(4.87±0.85)and(5.24±1.02)mg/L in the control group;the differences were statistically significant(P<0.05).The specificity of D-D and FDP combined detection was higher than that of D-D alone;the sensitivity,positive predictive value,negative predictive value,and compliance rate of D-D and FDP combined detection were higher than those of D-D and FDP alone;the differences were statistically significant(P<0.05).Conclusion Dynamic monitoring of D-D and FDP levels is helpful to predict the occurrence of DVT,and can play an important guiding role in the prevention of DVT after surgery for lower limb fracture.
作者
陈霞
张韬
历文佳
潘皓
CHEN Xia;ZHANG Tao;LI Wen-jia(Department of Clinical Laboratory,Zhujiajiao People's Hospital,Shanghai 201700,China)
出处
《中国实用医药》
2023年第6期29-32,共4页
China Practical Medicine
