柯宗明



TEG联合D-D评估骨科术后深静脉血栓的应用价值

柯宗明

目的分析血栓弹力图（TEG）联合D-二聚体（D-D）在动态监测骨科患者术后深静脉血栓形成（DVT）中的应用价值。方法将80例择期行手术治疗骨折患者作为研究对象，分别于术前（T0）、术后1 d（T1）、术后3 d（T2）、术后7 d（T3）采集静脉血液样本，监测D-D浓度与TEG指标变化，评估两者对术后DVT形成的监测效果。结果术后患者D-D水平升高（P＜0.05），T2时D-D达到最高水平，T3时开始下降，但仍高于T0时（P＜0.05）。术后TEG各指标中，T1～T2时，K、R均较T0缩短，α角、MA和CI增大，且随时间呈进行性加重表现；T3时，K、R继续升高，α角、MA和CI开始下降。本组80例中，术后发生DVT者24例，D-D检出20例（83.33%），TEG检出19例（79.17%），两者联合检出23例（95.83%），D-D联合TEG检测准确率均高于TEG或D-D单项检测。结论下肢骨折患者术后1～3 d血液高凝状态，且呈持续加重趋势，DVT发生率较高，采用TEG及D-D联合动态监测患者围手术期血液变化，对患者凝血功能评估有重要参考价值，对术后早期防治DVT有其重要指导价值，值得推广。

术后；下肢；深静脉血栓；D-二聚体；血栓弹力图

[Abstract]Objective To analyze the application value of dynamic monitoring by thrombelastogram(TEG)combined with D-dimer(D-D)in the assessmentof deep venous thrombosis(DVT)after orthopedic operations.Methods 80 patientswith fractureswho underwent selective operation were chosen as the research objects.Before the operation(T0),1 day(T1),3 days(T2),and 7 days(T3) after the operation,the venous blood samp les of the patients were collected.The D-D concentration and the changes of TEG indexes were monitored.The predictive effects of the two in DVT were assessed.Results A fter the operation,the patients'D-D levels increased(P＜0.05),reached to the top at T2,and began to decrease at T3,which were stillhigher than those at T0(P＜0.05).As to the postoperative TEG indexes,during T1 to T2,K and R both were shortened compared with those at T0.Angleα,MA,and CI increased and presented progressive aggravated performance along with the time.At T3,K and R continued to increase,while angleα,MA,and CIbegan to decrease.Among the 80 cases,there were 24 onesof DVT after the operation.20 caseswere detected by D-D(83.33%);19 oneswere detected by TEG(79.17%);and 23 oneswere detected by the combination of the two(95.83%).The detection accuracy of the combination was higher than that of TEG or D-D.Conclusion The blood presents hypercoagulabale state in patients with lower limb fractures 1 day to 3 days after the operation and has the tendency of continuous aggravation.The incidence of DVT is high.The combination dynamic monitoring by TEG and D-D for the perioperative blood changes is an important reference in the evaluation of patients'blood coagulation function and hasgreatguiding value in the early prevention and treatmentofDVTafter the operation.

[Key words]postoperative;lower limb;deep venous thrombosis;D-dimer;thrombelastogram

患者发生严重骨折时，骨结构遭受破坏性挤压，血管内膜损伤，大量炎性介质释放，激活凝血系统，血液长期处于高凝状态，易诱发深静脉血栓（DVT）与肺栓塞[1]。有统计资料显示，未作预防干预的骨折大手术后患者DVT发生率高达50%，尤其以髋关节置换术后DVT发生率更高，约占40%～70%[2]。血栓弹力图（TEG）是反映患者血液高凝动态变化的相关指标，其在骨科术后DVT监测中有重要的价值[3]。D-二聚体（D-D）则为凝血过程中交联纤维蛋白的纤溶酶降解产生的特异性产物，血浆内D-D水平的异常变化，是反映凝血及纤溶活性异常的标志[4-5]。……