超声血流参数联合血清生物化学指标对骨科患者围术期下肢静脉血栓形成的预测效果

Prediction effect of ultrasound blood flow parameters combined with serum biochemical indexes on the formation of lower extremity venous thrombosis in orthopaedic patients during perioperative period

目的分析超声血流参数、血清生物化学指标对骨科患者围术期下肢静脉血栓(DVT)形成的预测效果。方法选取2019年10月至2022年12月在河北省沧州中西医结合医院进行骨科手术的146例患者作为研究对象,根据DVT诊断结果,将患者分为血栓组和非血栓组,比较两组基线资料、超声血流参数[舒张期血流速度(Vd)、收缩期血流速度(Vs)、阻力指数(RI)]、血清生物化学指标[D-二聚体(D-D)、同型半胱氨酸(Hcy)、白细胞介素-18(IL-18)]。采用多因素Logistic回归分析骨科患者围术期DVT形成的危险因素。采用Pearson相关分析骨科围术期DVT形成患者超声血流参数与血清生物化学指标的相关性。采用受试者工作特征(ROC)曲线分析超声血流参数联合血清生物化学指标对骨科患者围术期DVT形成的预测价值。结果经DVT诊断,血栓组有36例患者,非血栓组有110例患者。两组性别、年龄等基线资料比较,差异均无统计学意义(P>0.05)。血栓组Vs、Vd低于非血栓组,RI、D-D、Hcy、IL-18水平高于非血栓组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,骨科围术期DVT形成患者Vs、Vd与D-D、Hcy、IL-18水平均呈负相关(P<0.05),RI与D-D、Hcy、IL-18水平均呈正相关(P<0.05)。ROC曲线分析结果显示,6项指标联合预测骨科患者围术期DVT形成的曲线下面积(AUC)为0.951,大于Vs、Vd、RI、D-D、Hcy、IL-18单独预测的AUC(Z=6.055、5.725、5.583、5.014、4.479、5.318,P<0.05)。结论骨科患者围术期Vs、Vd、RI、D-D、Hcy、IL-18水平异常,且与DVT形成密切相关,6项指标联合对骨科患者围术期DVT形成具有良好的预测价值,为临床评估提供参考。

Objective To analyze the prediction effect of ultrasonic blood flow parameters and serum biochemical indexes on the formation of lower extremity venous thrombosis(DVT)in orthopaedic patients during perioperative period.Methods A total of 146 patients who underwent orthopedic surgery in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from October 2019 to December 2022 were selected as the study objects.According to the diagnosis results of DVT,patients were divided into thrombotic group and non-thrombotic group.Baseline data,ultrasonic blood flow parameters[diastolic blood flow velocity(Vd),systolic blood flow velocity(Vs),resistance index(RI)],serum biochemical indexes[D-dimer(D-D),homocysteine(Hcy),interleukin-18(IL-18)]of the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of DVT formation in orthopedics patients during perioperative period.Pearson correlation was used to analyze the correlation between ultrasound blood flow parameters and serum biochemical indexes of DVT formation in orthopedics patients during perioperative period.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of ultrasound blood flow parameters combined with serum biochemical indexes on perioperative DVT formation in orthopedic patients.Results There were 36 patients in the thrombus group and 110 patients in the non-thrombus group diagnosed by DVT.There was no significant difference in gender,age and other baseline data between the two groups(P>0.05).The Vs and Vd in thrombus group were lower than those in non-thrombus group,and the levels of RI,D-D,Hcy and IL-18 in thrombus group were higher than those in non-thrombus group,with statistical significance(P<0.05).The results of Pearson correlation analysis showed that Vs and Vd were negatively correlated with D-D,Hcy and IL-18 levels in patients with perioperative DVT formation(P<0.05),while RI was positively correlated with D-D,Hcy and IL-18 levels(P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of perioperative DVT formation in orthopaedic patients predicted by the combination of 6 indexes was 0.951,which was higher than that predicted by Vs,Vd,RI,D-D,Hcy and IL-18 alone(Z=6.055,5.725,5.583,5.014,4.479,5.318,P<0.05).Conclusion The Vs,Vd,RI,D-D,Hcy and IL-18 levels are abnormal in orthopaedic patients during perioperative period and are closely related to the formation of DVT.The combination of these 6 indexes has a good predictive value for the formation of perioperative DVT in orthopaedic patients and provides a reference for clinical evaluation.