动态监测D-二聚体及凝血-纤溶参数对深静脉血栓的意义

Dynamic monitoring the diagnosis value of D-Dimer and Coagulation-fibrinolysis parameter on deep venous thrombosis

目的:观察D-二聚体(DD)动态变化及凝血-纤溶参数对开胸术后深静脉血栓(DVT)的意义.方法:选择40例开胸手术(食管癌根治术和肺叶切除术)患者,于术前、关胸时、术后1d、术后3d行血浆DD、纤维蛋白原(FIB)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)及凝固启动时间(CST)、最大凝固程度(MCE)、凝血达峰值时间(MCT)、平衡时间(BLT)和全反应时间(WFT)等凝血-纤溶图参数进行检测.术前所有患者下肢深静脉彩超检测均阴性.根据术后4～7d下肢彩超检测结果将患者分为血栓(T)组(n=13)和非血栓(NT)组(n=27).结果:与NT组比较,T组DD关胸及术后各时点均明显升高(P<0.01～0.05),FIB术后3d明显增加(P<0.05);与基础值比较,两组DD,FIB,MCE,BLT,WFT术后各时点均明显升高(P<0.01～0.05),而PT,APTT均于术后1d明显缩短(P<0.01～0.05),TT于术后3d明显缩短(P<0.01).结论:血浆DD动态监测对开胸术后并发DVT具有早期诊断价值,而凝血-纤溶参数对预测DVT的形成无指导意义;且所有参数均提示术后血液呈高凝状态.

AIM： To observe the early diagnosis value of the dynamic change of D-Dimer （ DD ） and coagulation-fibrinolysis parameters on deep venous thrombosis（DVT） after an open chest operation. METHODS： Check and measure the blood plasma DD, fibrinogen （ FIB ）, prothrombin time （ PT）, activated partial thromboplastin time （ APTT）, thrombin time （TT） and concretion startup time （ CST ）, maximum extent of coagulation （ MCE ）, maximum coagulation time （ MCT）, the balance time （BLT） and the whole time of fibrinolysis reaction （WFT） of 40 patients undergoing thoracotomy （ esophageal cancer radical correction and lobectomia pulmonalis） in pre-operation, closing chest, the 1 st and 3rd days of post-operation. In pre-operation, the lower-limb deep venous color supersonic check results of all patients＇ were negative. According to the results of postoperative lower-limb color supersonic check from the 4th to the 7th day in postoperation, the patients were divided into Team Thrombosis （Team T）（n = 13） and team not thrombosis（Team NT） （n =27）. RESULTS ： Compared with team NT, the DD of Team T in each time points of closing the chest and after operation rised obviously （P 〈 0. 01-0. 05）, the FIB of the 3rd day in post-operation increased obviously（P 〈 0.05 ） ; Compared with the basic value, the DD, FIB, MCE, BLT and WFT of both team in each time points after operation rised obviously （P 〈 0.01-0.05 ）, the PT and APTT shortened obviously after the 1 st day in post-operation （ P 〈 0.01-0.05 ）, the TT shortened obviously after the 3rd day in post-operation（ P 〈 0.01 ）. CONCLUSION： Dynamic monitoring the blood plasma DD possess the early diagnose value of DVT after the thoracotomy, but coagulation-fibrinolysis parameters have no early diagnose value of DVT, furthermore, all the parameters indicate that hypercoagulabale state appears in the blood after the thoracotomy.