监测D-二聚体对老年退变性腰椎疾病手术患者发生静脉血栓栓塞的意义

Importance of D-dimer determination for diagnosis of venous thromboembolism for elderly patients with degenerative lumbar disease who undergo operation

目的评价监测D-二聚体对老年退变性腰椎疾病手术患者发生静脉血栓栓塞(VTE)的意义。方法对220例老年退变性腰椎疾病手术患者术后予以低分子肝素钠抗凝及下肢血液循环驱动预防VTE,术后每2~4天监测D-二聚体1次,共监测2~5次。按术后VTE诊断明确与否分为血栓组(18例)和血栓不确定组(202例)。结果术后D-二聚体平均值:血栓不确定组为(1 982.6±328.1)μg/L,血栓组术后血栓发生前为(2 168.5±311.9)μg/L,血栓时为(5 076.4±521.4)μg/L;血栓不确定组术后与血栓组血栓发生前的D-二聚体值差异无统计学意义(P>0.05),血栓组血栓发生前与发生时的D-二聚体值差异有统计学意义(P<0.05)。D-二聚体值≥4 500μg/L的36例中有16例发生VTE,<4 500μg/L的184例中有2例发生VTE,发生时间为术后1~2周,两组发生血栓的相对危险度RR为42∶1;当D-二聚体值≥4 500μg/L时,发生血栓的风险增加(P<0.01)。结论 D-二聚体水平监测有助于早期发现老年退变性腰椎疾病手术患者的VTE,这对早期治疗及防治病情进展有重要意义。

Objective To evaluate the importance of D-dimer determination for diagnosis of venous thromboembolism(VTE)for patients with degenerative lumbar disease who undergo operation.Methods The 220 elderly patients with degenerative lumbar disease underwent surgery.After surgery,all patients were treated with low molecular heparin sodium and lower limb blood circulation therapy for thromboprophylaxis,and D-dimer were detected per 2~4 d,a total of 2~5 times.All patients were divided into the uncertain-thrombus group(202 cases)and the thrombus group(18 cases)according to whether the VTE was clear or not.Results The mean D-dimer score of the uncertain-thrombus group after surgery was(1 982.6±328.1)μg/L.The pre-thrombus and the instant D-dimer score of the thrombus group were respectively(2 168.5±311.9)μg/L and(5 076.4±521.4)μg/L after surgery.There was no significant difference for D-dimer level between uncertain-thrombus group after surgery and pre-thrombus of thrombus group(P>0.05).In the thrombus group,there was significant difference between the pre-thrombus D-dimer and the instant D-dimer(P<0.05).During 1~2 week after surgery,16 patients suffered VTE in 36 cases of D-dimer≥4 500μg/L and 2 VTE in 184 cases of D-dimer<4 500μg/L.The relative risk of the thrombosis was 42∶1.That the patients of D-dimer score≥4 500μg/L had higher risk of VTE was significant(P<0.01).Conclusions Postoperative D-dimer assay can help early predict VTE occurrence for patients with degenerative lumbar disease who undergo operation,and that is important for the early treatment and prevention of further progress of VTE.