D-二聚体及抗心磷脂抗体与髋部骨折术后深静脉血栓形成的临床研究
|
摘要
目的本课题采用彩超结合实验室指标的方法,预测和早期诊断髋部骨折术后下肢深静脉血栓形成,找到一种对术后并发深静脉血栓形成(DVT)进行早期诊断和预测的简便并且有较高准确率的方法,从而提高手术的治愈率及降低死亡率。方法随机选取在连云港市第一人民医院急诊外科住院的老年髋部骨折需手术治疗的病例122例,其中包括股骨颈骨折55例和股骨粗隆间骨折67例,患者年龄均≥60岁。采取半髋或全髋关节置换手术治疗股骨颈骨折患者,采取PFNA内固定手术治疗股骨粗隆间骨折患者。入院后次晨,抽取静脉血,检测D-二聚体(D-D),空腹血糖(FBG),抗心磷脂抗体(ACA),抗β2糖蛋白Ⅰ抗体(anti-β2GPⅠ);术后第3 d晨,抽取静脉血,检测D-D,FBG,对DVT组和非DVT组中实验室指标进行比较,以彩超的结果为检验标准,评价实验室指标的测定对DVT的预测和早期诊断的可行性。结果 122例髋部骨折患者中,术后28例发生下肢DVT。术前通过彩色超声多普勒血流测试仪检查,结果为下肢深静脉管腔内没有异常的回声,静脉血流呈现正常的周期性变化,血流信号充盈良好;术后通过彩色超声多普勒血流测试仪检查,DVT组患者的股静脉或腘静脉出现不同程度闭塞,非DVT组无异常。DVT组与非DVT组相比,术前的D-D差异无统计学意义(P>0.05),DVT组与非DVT组相比,术前的FBG的差异有统计学意义(P<0.05);DVT组与非DVT组相比,术后的D-D及FBG的差异均具有统计学意义(P<0.05);发生DVT的患者,术前与术后的D-D浓度的差异有统计学意义(P<0.05),未发生DVT的患者,术前与术后的D-D浓度的差异无统计学意义(P>0.05);DVT组与非DVT组相比,术前ACA阳性率的差异有统计学意义(P<0.01),anti-β2GPⅠ阳性率的差异有统计学意义(P<0.05)。结论髋部骨折患者,运用彩色超声多普勒血流测试仪联合检测血浆D-D及抗心磷脂抗体有利于早期诊断和预测术后DVT。
Objective Through using colour ultrasound in combination with laboratory index method,to predict and do early diagnosis of hip fracture of postoperative deep vein thrombosis of lower limb,and to find a simple and high accuracy method of early diagnosis and prediction of postoperative concurrent DVT,so as to improve the cure rate and reduce mortality of operation. Methods Randomly selecting 122 elderly patients with hip fracture,who needed surgical treatment,in Emergency of Lianyungang City First People's Hospital,including 55 cases of femoral neck fracture and 67 cases of intertrochanteric fractures. The average age of patients was 60 years or more. A hip or total hip replacement surgery treatment was taken on femoral neck fracture patients. PFNA of intertrochanteric fractures treatment was taken on internal fixation surgery patients. After admission,through the extraction of venous blood,D-D,FBG,ACA and anti-β2 GPⅠwere tested. The morning after 3 days of surgery,through extraction of venous blood,D-D and FBG were detected. Feasibility of the determination of laboratory index on the prediction of DVT and early diagnosis was evaluated.Results Among 122 hip fracture patients,28 cases have lower limb DVT after surgery. Through preoperative color ultrasonic Doppler blood flow meter examination,there is no abnormal echo in lower extremity deep vein tube cavity,normal cyclical change appears venous blood flow,and blood flow signal is good. After postoperative color ultrasonic doppler blood flow examination,it is shown that DVT group have different degrees of femoral vein or popliteal vein,and there is no abnormality in non-DVT group. There is no statistically significant difference of preoperative D-D between DVT group and non-DVT group( P > 0. 05). Preoperative FBG difference is statistically significant between DVT group and non-DVT group( P < 0. 05). Differences of postoperative D-D and FBG between DVT group and non-DVT group are statistically significant( P < 0. 05). In patients with DVT,difference of preoperative and postoperative D-D concentration was statistically significant( P < 0. 05). In non-DVT patients,there is no statistically significant differences between preoperative and postoperative D-D concentration( P > 0. 05). Preoperative ACA positive difference is statistically significant between DVT group and non-DVT group( P < 0. 01). Anti-β2 GPⅠ positive difference is statistically significant( P < 0. 05). Conclusion In patients with hip fracture,plasma D-dimer and anti cardiolipin antibody through the use of color ultrasonic doppler blood flow joint detection has some effect on early diagnosis of postoperative DVT.
Objective Through using colour ultrasound in combination with laboratory index method,to predict and do early diagnosis of hip fracture of postoperative deep vein thrombosis of lower limb,and to find a simple and high accuracy method of early diagnosis and prediction of postoperative concurrent DVT,so as to improve the cure rate and reduce mortality of operation. Methods Randomly selecting 122 elderly patients with hip fracture,who needed surgical treatment,in Emergency of Lianyungang City First People's Hospital,including 55 cases of femoral neck fracture and 67 cases of intertrochanteric fractures. The average age of patients was 60 years or more. A hip or total hip replacement surgery treatment was taken on femoral neck fracture patients. PFNA of intertrochanteric fractures treatment was taken on internal fixation surgery patients. After admission,through the extraction of venous blood,D-D,FBG,ACA and anti-β2 GPⅠwere tested. The morning after 3 days of surgery,through extraction of venous blood,D-D and FBG were detected. Feasibility of the determination of laboratory index on the prediction of DVT and early diagnosis was evaluated.Results Among 122 hip fracture patients,28 cases have lower limb DVT after surgery. Through preoperative color ultrasonic Doppler blood flow meter examination,there is no abnormal echo in lower extremity deep vein tube cavity,normal cyclical change appears venous blood flow,and blood flow signal is good. After postoperative color ultrasonic doppler blood flow examination,it is shown that DVT group have different degrees of femoral vein or popliteal vein,and there is no abnormality in non-DVT group. There is no statistically significant difference of preoperative D-D between DVT group and non-DVT group( P > 0. 05). Preoperative FBG difference is statistically significant between DVT group and non-DVT group( P < 0. 05). Differences of postoperative D-D and FBG between DVT group and non-DVT group are statistically significant( P < 0. 05). In patients with DVT,difference of preoperative and postoperative D-D concentration was statistically significant( P < 0. 05). In non-DVT patients,there is no statistically significant differences between preoperative and postoperative D-D concentration( P > 0. 05). Preoperative ACA positive difference is statistically significant between DVT group and non-DVT group( P < 0. 01). Anti-β2 GPⅠ positive difference is statistically significant( P < 0. 05). Conclusion In patients with hip fracture,plasma D-dimer and anti cardiolipin antibody through the use of color ultrasonic doppler blood flow joint detection has some effect on early diagnosis of postoperative DVT.
引文
[1]刘腾鸿.丹参川芎嗪注射液对预防人工膝关节置换术后深静脉血栓的临床研究[D].福州:福建中医药大学,2013.
[2]常春峰.利伐沙班用于人工全膝、髋关节置换术后抗凝及出血风险的研究[D].长春:吉林大学,2013.
[3]PAPALAMBROS E,SIGALA F,Travlou A,et al.P-Selectin and antibodies against heparin-Platelet Tactor4 in patients with venous or arterial dis-eases after a 7-day heparin treatment[J].J Am Coll Surg,2004(1):69.
[4]刘越.桃红四物汤加减预防腰椎术后下肢深静脉血栓的疗效观察[D].北京:北京中医药大学,2013.
[5]姚杰.麻醉手术期下肢深静脉血栓形成的危险因素分析[D].银川:宁夏医科大学,2013.
[6]ARNOUT J,VERMYLEN J.Mechanism of action of beta 2-glycoprotein I dependent lupus anticoaulants[J].Lupus,1998,7(Suppl 2):S23
[7]GALLI M,RUGGERI L,BARBUI T.Differential effects of anti-beta2-glycoprotein I and antiprothrombin antibodies on the anticoagulant activity of activated protein C[J].Blood,1998,91(6):1999.
[2]常春峰.利伐沙班用于人工全膝、髋关节置换术后抗凝及出血风险的研究[D].长春:吉林大学,2013.
[3]PAPALAMBROS E,SIGALA F,Travlou A,et al.P-Selectin and antibodies against heparin-Platelet Tactor4 in patients with venous or arterial dis-eases after a 7-day heparin treatment[J].J Am Coll Surg,2004(1):69.
[4]刘越.桃红四物汤加减预防腰椎术后下肢深静脉血栓的疗效观察[D].北京:北京中医药大学,2013.
[5]姚杰.麻醉手术期下肢深静脉血栓形成的危险因素分析[D].银川:宁夏医科大学,2013.
[6]ARNOUT J,VERMYLEN J.Mechanism of action of beta 2-glycoprotein I dependent lupus anticoaulants[J].Lupus,1998,7(Suppl 2):S23
[7]GALLI M,RUGGERI L,BARBUI T.Differential effects of anti-beta2-glycoprotein I and antiprothrombin antibodies on the anticoagulant activity of activated protein C[J].Blood,1998,91(6):1999.