髋关节置换术围术期FM动态检测在下肢DVT早期诊断中的意义

Significance of FM dynamic detection in early diagnosis of lower limb DVT during hip arthroplasty perioperative period

目的探讨髋关节置换术围术期纤维蛋白单体(FM)动态检测在下肢深静脉血栓(DVT)早期诊断中的意义。方法选取2017年3月至2018年6月在该院行髋关节置换术的患者120例,于入院第2天以及术后1、3、7d行下肢静脉彩超检查,根据多普勒彩色超声检查结果分为DVT组与非DVT组,统计入院第2天以及术后1、3、7dFM、D-二聚体(D-D)、纤维蛋白原(FIB)及纤维蛋白降解产物(FDP)水平,比较术后FM、D-D、FIB、FDP不同时点单独及联合诊断的灵敏度与特异度。结果 FM、D-D、FDP均在术后1d明显增高,术后3d短暂下降,术后7d又出现增高,均明显高于术前,且DVT组高于非DVT组(P<0.05),FIB术后处于较平稳状态,且DVT组高于非DVT组(P<0.05);FM在术后1、3、7d单独诊断DVT的灵敏度与特异度均高于DD、FIB、FDP;FM+D-D+FIB+FDP联合检测在术后1、3、7d的特异度均明显高于FM、D-D、FIB、FDP单独检测,且在术后3d检测时的灵敏度与特异度分别为93.55%、94.38%。结论与D-D、FIB、FDP相比,FM单独检测DVT具有更高的灵敏度与特异度,FM、D-D、FIB、FDP联合检测可提高术后DVT诊断的特异度,且在术后3d其灵敏度与特异度最为理想。

Objective To explore the significance of fibrin monomer(FM)dynamic detection in the early diagnosis of deep venous thrombosis(DVT)during hip arthroplasty perioperative period.Methods One hundred and twenty cases of hip arthroplasty in this hospital from March2017 to June2018 were selected and performed the lower extremity vein color ultrasound examination.The patients were divided into the DVT group and non-DVT group according to Doppler color ultrasound examination.The levels of FM,D-D,FIB and FDP on2 d after admission,postoperative 1,3,7 d conducted statistics.The sensitivity and specificity of FM,D-D,FIB and FDP for single diagnosis and combined diagnosiswere compared among different postoperative time points.Results FM,D-D and FDP were significantly increased on postoperative 1 d,transiently decreased on postoperative 3 d,and increased again on postoperative 7 d,which were significantly higher than those before operation,moreover the DVT group was higher than the non-DVT group(P<0.05).After operation,FIB was in a more stable state,moreover the DVT group was higher than the non-DVT group(P<0.05).The sensitivity and specificity of FM for single diagnosis of DVT on postoperative 1,3,7 d were higher than those of D-D,FIB and FDP.The specificity of FM+D-D+FIB+FDP combination on postoperative 1,3,7 d was significantly higher than that of FM,D-D,FIB and FDP single detection.The sensitivity and specificity of detection on postoperative 3 d were 93.55%and 94.38%respectively.Conclusion Compared with D-D,FIB and FDP,the FM single detection for DVT has higher sensitivity and specificity,the combination detection of FM,FIB and FDP can increase the sensitivity and specificity of postoperative DVT,moreover which on postoperative 3 d are most ideal.