目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,...目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,根据术后是否发生下肢DVT分为发生组25例与未发生组175例。收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值。绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况。结果发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P<0.01);发生组术后3 d Vs、Vd低于未发生组,RI、D-二聚体高于未发生组(P<0.01);发生组Vs、Vd、RI及D-二聚体手术前后差值均大于未发生组(P<0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P<0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为0.88。构建下肢DVT预测模型,其AUC为0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10~0.90时具有更高的临床价值。结论手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高。展开更多
AIM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma. METHODS： The research included patients with a dia...AIM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma. METHODS： The research included patients with a diagnosis of Hodgkin＇s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index （HPI） estimated by HRA was calculated. was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins （P 〉 0.05）. A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave （r = 390, P 〈 0.01）. HPI was significantly lower in patients with lymphomas than in controls （P 〈 0.05）, pointing out increased arterial perfusion in comparison to portal perfusion. CONCLUSION： Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin＇s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.展开更多
文摘目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,根据术后是否发生下肢DVT分为发生组25例与未发生组175例。收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值。绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况。结果发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P<0.01);发生组术后3 d Vs、Vd低于未发生组,RI、D-二聚体高于未发生组(P<0.01);发生组Vs、Vd、RI及D-二聚体手术前后差值均大于未发生组(P<0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P<0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为0.88。构建下肢DVT预测模型,其AUC为0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10~0.90时具有更高的临床价值。结论手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高。
基金Supported by The grant of the Republic of Science of Serbia (M145033,Chief investigatior:Professor Vladimir Obradovic)
文摘AIM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma. METHODS： The research included patients with a diagnosis of Hodgkin＇s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index （HPI） estimated by HRA was calculated. was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins （P 〉 0.05）. A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave （r = 390, P 〈 0.01）. HPI was significantly lower in patients with lymphomas than in controls （P 〈 0.05）, pointing out increased arterial perfusion in comparison to portal perfusion. CONCLUSION： Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin＇s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.
