血栓弹力图和凝血实验对指导创伤骨折手术后DVT发生的价值

Value of Thromboelastography and Coagulation Tests in Guiding the Occurrence of DVT After Trauma Fracture Surgery

目的:明确血栓弹力图和凝血试验指导对预防创伤骨折手术术后DVT的应用价值。方法:根据临床检测结果将80例发生创伤骨折患者分为观察组(DVT组,n=41)与39例对照组(非DVT组,n=39),评估术前血栓弹力图与凝血指标对创伤性骨折术后DVT的预测效能。结果:对照组手术时间、术中出血量、切口大小分别为(85.34±12.33)min、(113.53±25.79)ml、(5.34±1.54)cm,手术相关指标改善情况较观察组更好;对照组骨折愈合时间为(11.18±1.37)d,较观察组(15.26±1.75)d更短(t=11.571,P=0.001);对照组凝血功能指标优于观察组(P<0.05);T2时间段内,观察组血液凝固时间(K)、凝血反应时间(R)、凝固角(α)及最大振幅(MA)均较对照组更高(P<0.05),观察组患者处在高凝状态;术后K、α角、MA、PT、TT及PLT的AUG在0.7~1.0间,预测价值较高。结论:血栓弹力图中的K、α角、MA三项参数与凝血实验中PT、TT、PLT能有效筛查创伤骨折患者中术后发生DVT的高危人群。

Objective:To clarify the application value of thromboelastography(TEG)and coagulation tests in guiding the prevention of deep vein thrombosis(DVT)following trauma fracture surgery.Methods:Eighty trauma fracture patients were divided into an observation group(DVT group,n=41)and a control group(non-DVT group,n=39)based on clinical test results,to evaluate the predictive efficacy of preoperative TEG and coagulation indices for DVT after trauma fracture surgery.Results:The control group had better surgical outcomes with operation time,intraoperative blood loss,and incision size averaging(85.34±12.33)min,(113.53±25.79)ml,and(5.34±1.54)cm,respectively.Fracture healing time was shorter in the control group at(11.18±1.37)days compared to(15.26±1.75)days in the observation group(t=11.571,P=0.001).The control group also had superior coagulation function indicators(P<0.05).At T2,the observation group showed higher values for clotting time(K),reaction time(R),angle of clot firmness(α),and maximum amplitude(MA)compared to the control group(P<0.05),indicating a hypercoagulable state.Postoperative K,αangle,MA,prothrombin time(PT),thrombin time(TT),and platelet count(PLT)values between 0.7 and 1.0 showed high predictive value.Conclusion:Three parameters from TEG(K,αangle,MA)and coagulation tests(PT,TT,PLT)can effectively screen high-risk populations for postoperative DVT among trauma fracture patients.