骨科围手术期监测D-二聚体和同型半胱氨酸的临床意义

The clinical value of D-dimer and homocysteine during peri-operative orthopedic surgery

[目的]探讨骨科围手术期D-二聚体及同型半胱氨酸的变化对监测深静脉血栓形成的临床意义。[方法]选择55例骨科大手术患者,分别于术前24 h,术后24、48、72 h静脉血检测其D-二聚体及同型半胱氨酸的水平,将并发深静脉血栓组与未发生组比较及分别与正常对照组比较,分析它们对监测深静脉血栓形成的早期诊断价值。[结果]手术前24 h患者D-二聚体和同型半胱氨酸的浓度,并发深静脉血栓组与未发生组比较结果无显著性差异(P>0.05),且分别与正常对照组比较差异无显著性(P>0.05);手术后24、48、72 h,同时间两组比较,并发深静脉血栓组D-二聚体和同型半胱氨酸的浓度明显高于未并发深静脉血栓组,有显著性差异(P<0.05);并发深静脉血栓组手术后24、48、72 h D-二聚体和同型半胱氨酸的浓度与正常组比较,有显著性差异(P<0.05);未并发深静脉血栓组手术后24 h D-二聚体与正常组比较,有显著性差异(P<0.05),而手术后48、72 h与正常组比较,无显著性差异(P>0.05);未并发深静脉血栓组手术后24、48、72 h同型半胱氨酸浓度与正常组比较,无显著性差异(P>0.05);且D-二聚体和同型半胱氨酸血浆浓度升高与手术后深静脉血栓的发生呈显著正相关(P<0.05);[结论]动态联合监测D-二聚体及同型半胱氨酸的水平对早期诊断骨科大手术后并发深静脉血栓具有重要意义。

[Objective]To study the clinical effects of D-dimer（DD） and homocysteine（HCY） on deep vein thrombosis（DVT） during peri-operative orthopedic surgery.[Method]Fifty-five patients with major orthopedic surgery were selected for this study and the serum were collected 24 hours before operation and 24,48 and 72 hours after operation and the serum levels of DD and HCY were determined.The results were compared between concurrent DVT group and non-concurrent DVT group,and between the two groups with normal controls,respectively.[Result]The concentrations of DD and HCY 24 hours before operation showed no significant differences between the concurrent DVT,the non-concurrent DVT groups（P〉0.05） and normal controls,respectively（P〉0.05）.The concentrations of DD and HCY in concurrent DVT group were significantly higher than those in non-concurrent DVT group 24,48 and 72 hours after operation（P〈0.05）.There were significant differences in the concentrations of DD and HCY 24,48 and 72 hours after operation between the concurrent DVT group and the normal controls（P〈0.05）.There were significant differences in concentrations of DD 24 hours after operation between the non-concurrent DVT group and the normal controls（P〈0.05）.However,there were no significant differences in the concentrations of DD 48 and 72 hours after operation between the non-concurrent DVT group and the normal controls（P〉0.05）.The concentrations of HCY 24,48 and 72 hours after operation showed no significant differences between non-concurrent DVD group and the normal controls（P〉0.05）.The increase of the serum concentrations of DD and HCY was positively correlated with the occurrence rate of DVT after operation（P〈0.05）.[Conclusion]The detection of serum levels of DD and HCY plays an important role in the early diagnosis of concurrent deep vein thrombosis after major orthopedic surgery.