血栓弹力图与D-二聚体检测在髋关节置换术围手术期患者中的应用

Application of thromboelastogram and D-dimer in perioperative patients with hip arthroplasty

目的探讨血栓弹力图(TEG)各参数与D-二聚体在髋关节置换术围手术期患者中的变化,并分析其临床意义。方法选择2020年6月—2021年10月在新疆医科大学第六附属医院行全髋关节置换术(THA)的68例患者作为观察组,另外选择同期本院35名健康体检者作为对照组。观察组分别在手术前以及术后1 d、3 d、7 d进行TEG检查〔包括凝血反应时间(R值)、凝固时间(K值)、凝固角(α角)、最大振幅(MA)、凝血指数(CI)〕并检测D-二聚体水平,对照组仅进行TEG检查。比较两组以及观察组不同时间点上述指标的变化,评估TEG参数和D-二聚体对术后深静脉血栓形成(DVT)的预测效果。结果观察组与对照组THA术前TEG各参数比较差异均无统计学意义。观察组术后1 d的α角、MA、CI、D-二聚体水平与术前比较均明显升高〔α角(°):68.1±5.13比61.0±2.9,MA(mm):75.7±7.3比64.4±4.1,CI:0.89±2.70比-0.18±1.67,D-二聚体(mg/L):5.06±3.82比0.49±0.45,均P<0.05〕;观察组术后3 d的α角、MA、CI、D-二聚体水平与术前比较均明显升高〔α角(°):66.9±6.2比61.0±2.9,MA(mm):76.2±7.3比64.4±4.1,CI:1.10±2.58比-0.18±1.67,D-二聚体(mg/L):5.52±3.98比0.49±0.45,均P<0.05〕;观察组术后7 d的MA、D-二聚体水平与术前比较均明显升高〔MA(mm):74.7±8.7比64.4±4.1,D-二聚体(mg/L):3.93±2.85比0.49±0.45,均P<0.05〕;观察组术后7 d的D-二聚体水平与术后1 d比较明显降低(mg/L:3.93±2.85比5.06±3.82,P<0.05)。观察组68例患者中有14例发生DVT,其中TEG与D-二聚体联合检出13例(检出率为93.9%),高于TEG单独检出11例(检出率为78.6%)或D-二聚体单独检出10例(检出率为71.4%),但比较差异均无统计学意义。结论关节置换术患者术后存在不同程度的高凝状态,TEG是预测患者术后出现高凝状态的良好指标,TEG检查与D-二聚体联合应用对血栓事件发生有一定的预测作用。

Objective To investigate the changes of thrombelastogram(TEG)indicators and D-dimer in the perioperative period of hip replacement,and analyze their clinical significance.Methods A total of 68 patients undergoing total hip arthroplasty(THA)in the Sixth Affiliated Hospital of Xinjiang Medical University from June 1,2020 to October 30,2021 were selected as observation group.Meanwhile,35 health examination participants at the same period were selected as control group.The observation group underwent TEG test[including reaction time(R value),kinetics time(K value),solidification angle(αangle),maximal amplitude(MA)and coagulation index(CI)]before and 1,3 and 7 days after operation,and the level of D-dimer was recorded,while the control group was only examined by TEG.The changes of above indexes between the two groups and at different time points of the observation group were compared,and the prediction effects of TEG indicators and D-dimer on postoperative deep vein thrombosis(DVT)were evaluated.Results There was no significant difference in TEG indicators between the observation group and control group.Theαangle,MA,CI and D-dimer of 1 day after operation were higher than those before operation[αangle(°):68.1±5.1 vs.61.0±2.9,MA(mm):75.7±7.3 vs.64.4±4.1,CI:0.89±2.70 vs.-0.18±1.67,D-dimer(mg/L):5.06±3.82 vs.0.49±0.45,all P<0.05].Theαangle,MA,CI and D-dimer of 3 days after operation were higher than those before operation[αangle(°):66.9±6.2 vs.61.0±2.9,MA(mm):76.2±7.3 vs.64.4±4.1,CI:1.10±2.58 vs.-0.18±1.67,D-dimer(mg/L):5.52±3.98 vs.0.49±0.45,all P<0.05].The MA and D-dimer of 7 days after operation were higher than those before operation[MA(mm):74.7±8.7 vs.64.4±4.1,D-dimer(mg/L):3.93±2.85 vs.0.49±0.45,both P<0.05].The D-dimer of 7 days after operation were lower than those 1 day after operation(mg/L:3.93±2.85 vs.5.06±3.82,P<0.05).There were 14 cases of DVT in 68 patients,and 13 cases(93.9%)were detected by TEG combined with D-dimer,which was higher than 11 cases(78.1%)detected by TEG or 10 cases(71.4%)detected by D-dimer.However,the difference was not statistically significant.Conclusions The patients with joint replacement have different degrees of hypercoagulability after operation,and TEG indicators are good indexes for predicting hypercoagulability after operation.The combined application of TEG test and D-dimer can predict the occurrence of thrombosis events to some extent.