D-二聚体动态监测对预测骨科手术后卧床患者发生深静脉血栓的诊断价值

Value of Dynamic Monitoring of D-dimer in Predicting Deep Venous Thrombosisin Bedridden Patients After Orthopedic Surgery

目的探讨D-二聚体动态监测对预测骨科手术后卧床患者发生深静脉血栓(DVT)的诊断价值。方法选取2017年1月至2017年11月期间我院接受骨科手术治疗的患者659例,术后定期进行彩超检查,根据是否发生DVT分为DVT组124例、对照组535例。所有患者分别于术前、术后采血进行血浆D-二聚体测定,并制作受试者工作特征曲线(ROC)、以彩超诊断DVT的结果为"金标准"进行对比,分析D-二聚体对预测患者发生DVT的诊断价值。结果两组术前1d血浆D-二聚体水平接近,差异无统计学意义(P>0. 05),术后均明显升高,术后3d达到最高值,对照组术后14d恢复正常水平,而DVT组未恢复至正常水平,且术后各时间点血浆D-二聚体水平显著高于对照组,差异有统计学意义(P<0.05)。以术后第3d D-二聚体水平制作诊断DVT的ROC曲线,显示诊断截断值为4.25mg/L FEU,ROC曲线下面积为0.94,95%CI:0.875～0.972。以血浆D-二聚体≥4.25mg/L FEU为骨科手术后卧床患者DVT(+),<4.25mg/L FEU为DVT(-),显示D-二聚体诊断骨科手术后卧床患者DVT的灵敏度、特异性、准确率依次为84. 68%、92. 26%、94. 08%。结论骨科手术后患者血浆D-二聚体水平明显升高,动态监测D-二聚体水平对诊断和预测术后卧床患者发生DVT有重要意义。

Objective To investigate the value of dynamic monitoring of D-dimer in predicting deep venous thrombosis(DVT)in bedridden patients after orthopedic surgery. Methods 659 patients who underwent orthopedic surgery in our hospital during January ~November 2017 were selected.Color Doppler ultrasoundregularly were performed after surgery.According to the occurrence of DVT,they were divided into DVT group(124 cases)and control group(535 cases).Blood was collected before and after surgery for determining D-dimer in plasma,and the receiver operating characteristic(ROC)curve was drawn.With the results of color Doppler ultrasound diagnosis for DVT as the golden standard,the value of D-dimer in predicting the occurrence of DVT was analyzed. Results Plasma D-dimer levels in the two groups were similar on day 1 before surgery( P >0.05).After surgery,the levelwas increased significantly and reached the highest value on day 3 after surgery.The plasma D-dimer in the control group returned to normal level on day 14 after surgery,but it did not returned to normal in DVT group.Plasma D-dimer levels were significantly higher in DVT group than that in control group at different time points after surgery( P <0.05).The ROC curve for diagnosing DVT was made by the D-dimer level on day 3 after surgery,indicating that the diagnostic cut-off value was 4.25mg/L FEU,and the area under ROC curve was 0.94.95%CI was 0.875~0.972.With plasma D-dimer level ≥4.25mg/L FEU as DVT(+)and<4.25 mg/L FEUas DVT(-),it was found that the sensitivity,specificity and accuracy of D-dimer in diagnosing DVT in bedridden patients after orthopedic surgery were 84.68%, 92.26% and 94.08%,respectively. Conclusion The plasma level of D-dimer significantly increases in patients after orthopedic surgery.Dynamic monitoring of D -dimer is of great significance for diagnosis and prediction of DVT in bedridden patients after surgery.