骨科大手术术前Autar评分联合D-二聚体值在深静脉血栓形成风险评估中的应用研究

Application of Autar Score Combined with D-dimer in DVT Risk Assessment before Major Orthopedic Surgery

目的探讨术前Autar评分联合D-二聚体值在评估骨科大手术患者下肢深静脉血栓形成中的应用。方法回顾性分析2015年8月—2016年2月于10家三级甲等综合医院行骨科大手术患者的一般资料、术前Autar评分、术前D-二聚体值、深静脉血栓形成诊断。根据术前Autar量表评分将患者分为低风险组(≤10分)、中风险组(10～14分)和高风险组(≥15分)。术前分别采用单独Autar评分、Autar评分联合D-二聚体值评估患者深静脉血栓形成风险,统计分析2种方法的深静脉血栓形成预测符合率和假阳性率。结果 198例患者中,确诊下肢深静脉血栓形成19例(9.6%)。术前单独使用Autar评分评估低风险组患者深静脉血栓形成预测符合率为8.5%,假阳性率为91.5%;术前Autar评分联合D-二聚体值评估低风险组患者深静脉血栓形成预测符合率为13.7%,假阳性率为86.3%,P<0.05。结论相对于术前单独使用Autar评分对骨科大手术患者进行深静脉血栓形成风险评估,术前Autar评分联合D-二聚体值可显著提高低风险组深静脉血栓形成预测符合率,降低假阳性率;提示术前Autar评分联合D-二聚体值评估患者深静脉血栓形成风险,有助于提高对术前低风险患者评估的准确性。

Objective To investigate the application of preoperative Autar score combined with D-dimer test in the assessment of deep vein thrombosis(DVT)of lower limb.Methods We retrospectively analyzed the general data of patients undergoing major orthopaedic surgery in 10 classⅢgradeⅠgeneral hospitals from August 2015 to February 2016.Preoperative Autar scores,preoperative D-dimer values,and deep vein thrombosis were diagnosed.Patients were divided into high risk group(Autar score≥15),medium risk group(Autar score 10-14)and low risk group(Autar score≤10).The risk of DVT was evaluated by Autar score or Autar score combined with D-dimer value before the operation.The predictive coincidence rate and false positive rate of DVT through the two methods were statistically analyzed.Results Among the 198 cases,19(9.6%)cases of DVT of lower limb were confirmed.We evaluated patients’DVT risk in low risk group by Autar score.DVT predictive coincidence rate and false positive rate of patients were 8.5%and 91.5%respectively.Then we evaluated patients’DVT risk in low risk group by Autar score combined with D-dimer value.DVT predictive coincidence rate and false positive rate of patients were 13.7%and 86.3%respectively(P<0.05). Conclusion In assessing preoperative DVT risk,compared with Autar score alone,preoperative Autar score combined with D-dimer can significantly increase the predictive coincidence rate while reduce false positive rate of DVT in low risk patients and it can improve the accuracy of preoperative assessment of patients with DVT risk.