膝关节置换术后深静脉血栓形成的危险因素分析

A study on risk factors for deep venous thrombosis after knee arthroplasty

目的：研究膝关节置换术后深静脉血栓（ deep vein thrombosis，DVT ）发生的危险因素及 D-二聚体对 DVT 的诊断价值。方法回顾性分析我院2013年至2015年收治的136例膝关节置换患者，其中男40例，女96例，平均年龄（70.7±10.1）岁，均行彩色多普勒超声检查，以明确有无下肢 DVT 形成，并且将性别、年龄、术前制动时间、手术时间、术后卧床时间、血浆 D-二聚体浓度、FIB 浓度及基础疾病与 DVT 的发生进行统计学分析。结果 DVT 组 D-二聚体的值1.82（1.53～4.53） mg / L，非 DVT 组 D-二聚体值0.45（0.21～1.22） mg / L，P＜0.05，差异有统计学意义。Logistic 回归分析结果显示，血浆 D-二聚体、手术时间、基础疾病与下肢 DVT 形成相关，年龄、性别、术前制动时间、术后卧床时间及 FIB 的意义尚需进一步研究。根据 ROC 曲线，当 D-二聚体值为1.5 mg / L 时，预测静脉血栓形成的灵敏度为88.9%，特异性为84.7%。结论手术时间、基础疾病是下肢 DVT 形成的高危因素；D-二聚体＞1.5 mg / L 时认为有较高的 DVT 形成风险，早期干预，有助于 DVT 的发现和诊疗。

Objective To explore the risk factors for deep venous thrombosis （ DVT ） after knee arthroplasty and the diagnosis value of D-dimer for DVT.Methods A retrospective study was performed on 136 patients （ male 40, female 96 ） undergoing knee replacement surgery between January 2013 and December 2015, whose average age was （ 70.7 ± 10.1 ） years. Ultrasonography was used to assess the DVT occurrence in the lower limbs of the patients. Logistic regression was used to identify the association of DVT and the variables including the gender, age, preoperative braking time, duration of surgery, bed rest time after the surgery, plasma D-dimer concentration, ifbrinogen （ FIB ） concentration and chronic illness.Results The plasma D-dimer level was 1.82 mg / L （ range： 1.53 - 4.53 mg / L ） in the DVT group, which was 0.45 mg / L （ range： 0.21 - 1.22 mg / L ） in the control group. And the differences were statistically signiifcant （P 〈 0.05 ）. Logistic regression analysis showed that plasma D-dimer level, duration of surgery and chronic illness were risk factors for the development of DVT, but further studies should be performed on the association of DVT and the age, gender, preoperative braking time, bed rest time after the surgery and FIB concentration. Receiver operating characteristic （ ROC ） curves showed when the cut-off point of plasma D-dimer was 1.5 mg / L, the sensitivity was 88.9% and the speciifty was 84.7% in the prediction of DVT.Conclusions Duration of surgery and chronic illness are signiifcant risk factors for the development of DVT. When the plasma D-dimer is more than 1.5 mg / L, a higher occurrence rate of DVT should be noticed, and regular review of leg veins and clinical intervention may be necessary.