D-二聚体动态监测对预测神经脊柱修复术后下肢深静脉血栓形成的意义

Significance of dynamic monitoring of D-dimer levels in predicting deep vein thrombosis after spinal nerve repair

背景:神经脊柱术后深静脉血栓的发生是临床神经外科及骨科手术常见的术后并发症,多与静脉内膜的损伤,血流的瘀滞以及凝血因子的激活作用相关。早期进行预测可有效避免深静脉血栓的发生对患者疾病预后的不良影响。D-二聚体在深静脉血栓预测中的应用具有极高的灵敏度以及特异度,是深静脉血栓的敏感预测指标。目的:探讨神经脊柱修复术后D-二聚体的血浆质量浓度与深静脉血栓发生的关系。方法:回顾性分析新疆医科大学第一附属医院神经外科2014年4月至2015年8月收治的神经脊柱手术患者83例,根据术后血浆D-二聚体的质量浓度分为2组,其中D-二聚体阳性组48例,D-二聚体阴性组35例。分别监测2组患者术前及术后1,3,5,9,14 d的D-二聚体血浆质量浓度,分析D-二聚体质量浓度与深静脉血栓发生的关系。结果与结论:12组患者术前D-二聚体的质量浓度比较差异无显著性意义(P>0.05);D-二聚体阳性组术后1,3,5,9,14 d的D-二聚体质量浓度均显著高于D-二聚体阴性组(P<0.05);2术后2组患者中D-二聚体呈阳性且浓度持续性增高的共有28例,经双下肢深静脉彩色多普勒超声检查后,D-二聚体阳性组出现深静脉血栓的患者有7例,肺栓塞的患者有4例;D-二聚体阴性组患者未出现深静脉血栓及肺栓塞;3结果提示,神经脊柱修复术后D-二聚体血浆浓度阳性提示有深静脉血栓发生的可能,若D-二聚体质量浓度持续增高,应高度警惕深静脉血栓的发生。

BACKGROUND：Deep vein thrombosis is a common postoperative complication after spinal surgery in clinical department of neurosurgery and department of orthopedics.Deep vein thrombosis is mostly related to vein intima injury,stasis and activation of blood coagulation factor.Early effective prediction can effectively avoid the adverse effects on the prognosis of patients with deep vein thrombosis.D-dimer used in the prediction of deep venous thrombosis has high sensitivity and specificity,and can be used as a sensitive predictor for deep vein thrombosis.OBJECTIVE：To explore the relationship between plasma D-dimer mass concentration and deep vein thrombosis after spinal surgery.METHODS：A total of 83 patients treated with spinal surgery collected from Department of Neurosurgery,First Affiliated Hospital of Xinjiang Medical University from April 2014 to August 2015 were retrospectively analyzed.They were divided into two groups according to postoperative plasma D-dimer mass concentration：D-dimer positive group（n=48） and D-dimer negative group（n=35）.We monitored D-dimer mass concentration in both groups preoperatively and postoperatively 1,3,5,9 and 14 days,and analyzed the relationship between D-dimer mass concentration and deep vein thrombosis.RESULTS AND CONCLUSION：（1） No significant difference in D-dimer mass concentration was determined between the two groups（P〉 0.05）.D-dimer mass concentration was significantly higher in the D-dimer positive group than in the D-dimer negative group 1,3,5,9,and 14 days postoperatively（P〈 0.05）.（2） After operation,plasma D-dimer of 28 cases was positive,with persistent increasing.Double lower limb deep vein color Doppler ultrasound demonstrated that seven patients experienced deep vein thrombosis and four patients suffered from pulmonary embolism in D-dimer positive group.There was no deep vein thrombosis and pulmonary embolism in the D-dimer negative group.（3） These results indicate that positive D-dimer concentration of patients after spinal surgery suggests the possibility of deep vein thrombosis.If the concentration of D-dimer is persistently high,we should highly alert to the occurrence of deep vein thrombosis.