老年卧床患者凝血功能变化及对DVT形成的预测价值

Changes of Coagulation Function in Elderly Bedridden Patients and Its Predictive Value for DVT Formation

目的 分析老年卧床患者凝血功能变化及对深静脉血栓形成(DVT)的预测价值。方法 选取接受下肢骨折手术并于术后发生DVT的患者58例作为DVT组,另选取同期接受下肢骨折手术并于术后未发生DVT的患者65例作为非DVT组。观察术前及术后3d卧床期间的凝血功能五项指标变化;采用二元Logistic回归分析凝血功能指标与DVT的相关性;采用ROC曲线评估凝血功能指标对DVT的预测效能。结果 DVT组的凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)水平较术前上升,且高于非DVT组(P<0.05);Logistic分析结果显示FIB(OR=2.363,95%,CI为1.462~3.820)和D-D(OR=1.013,95%,CI为1.007~1.019)是DVT的独立危险因素(P<0.05);ROC曲线分析显示FIB的AUC为0.694,最佳截点值为4.23g/L,D-D的AUC为0.797,最佳截点值为501.95μg/L,联合预测的AUC为0.918。结论 老年下肢骨折患者在术后卧床期间各项凝血功能均有所上升,其中的FIB和D-D为DVT的独立危险因素,对于DVT发生具有一定的预测价值。

Objective To analyze the changes of coagulation function in elderly bedridden patients and its predictive value for deep vein thrombosis(DVT).Methods 58 patients who underwent lower limb fracture surgery and developed DVT after surgery were selected as DVT group,and 65 patients who underwent lower extremity fracture surgery at the same time and did not have DVT after surgery were selected as non DVT group.The changes of five indexes of coagulation function before operation and 3 days after operation during bed rest were observed.Binary Logistic regression was used to analyze the correlation between coagulation function indexes and DVT.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of coagulation function indexes for DVT.Results The levels of PT,APTT,TT,FIB and D-D in the DVT group were significantly higher than those in the non-DVT group(P<0.05).Logistic analysis showed that FIB(OR=2.363,95%,CI:1.462-3.820)and D-D(OR=1.013,95%,CI:1.007-1.019)were independent risk factors for DVT(P<0.05).ROC curve analysis showed that the AUC of FIB was 0.694,the best cut-off value was 4.23g/L,the AUC of D-D was 0.797,the best cut-off value was 501.95μg/L,and the AUC of combined prediction was 0.918.Conclusions The coagulation function of elderly patients with lower extremity fracture increased during postoperative bed rest.FIB and D-D are independent risk factors for DVT,which have certain predictive value for DVT.