凝血系统相关指标改变对监测骨科大手术前后DVT发生的意义

THE COAGULATION SYSTEM RELATED INDEX CHANGES ON MONITORING DVT IN DEPARTMENT OF ORTHOPEDICS BEFORE AND AFTER OPERATION

目的观察骨科大手术患者术后深静脉血栓(deep venous thrombosis,DVT)发生与凝血相关指标改变的关系,为骨科术后DVT的防治提供依据。方法选取2010年6月—2011年12月骨科大手术患者43例。术后采用彩色多普勒超声及静脉造影检查患者是否存在DVT;术前1d及术后1d分别检测血小板计数(platelet count,PLC)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶时间(activated partial thrombin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,DD)。结果手术后1d发生DVT患者凝血各项指标有所变化,其中PLC、APTT水平低于未发生DVT组,FIB、DD及血管性血友病因子水平升高于未发生DVT组,与手术前差异均有统计学意义(P<0.05);未发生DVT患者凝血功能没有明显的变化,与手术前差异均无统计学意义(P>0.05)。结论骨科大手术后患者凝血相关指标异常可能是导致DVT发生的重要原因。

Objective To study the relationship between the incidence of postoperative deep venous thrombosis （DVT） and changes of blood coagulation indexes in orthopaedic surgery patients, and to provide the basis for the prevention of DVT after orthopedic surgery. Methods From June January 2010 to December 2011,43 candidated patients for orthopaedic surgery were selected. Color Doppler sonography and venography were used to examine whether the patient suffered from deep vein thrombosis （DVT） or not; One day before and one day after the surgery, platelet count （PLC）, prothrombin time （I^F） and activated partial thrombin time （ APTT）, thrombin time （ TI＇）, fibrinogen （ FIB ）, and D-dimer （ DD ） were detected. Results One day after operation, the coagulation indicators of patients with DVT changed The PLC, APTF levels were lower, while the FIB, DD and von willebrand factor （VWF） were higher than those of patients without DVT. There were significant differences between before and after surgery. The coagulation function of patients without DVT did not change obviously. There were no significant differences with before surgery. Conclusion Abnormal indicators of blood coagulation may be an important cause of DVT in patients after orthopedic surgery.