[1]信鸿杰,申雅文,王琳,等.D-二聚体监测在髋关节置换术后DVT 诊治中的应用研究[J].中华老年骨科与康复电子杂志,2018,(06):327-330.[doi:10.3877/cma.j.issn.2096-0263.2018.06.002]
　Xin Hongjie,Shen Yawen,Wang Lin,et al.Effect of dynamic monitoring of D-dimer on prediction of deep venous thrombosis in lower extremity after hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(06):327-330.[doi:10.3877/cma.j.issn.2096-0263.2018.06.002]
点击复制

D-二聚体监测在髋关节置换术后DVT 诊治中的应用研究()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年06期
页码:
327-330
栏目:
关节置换
出版日期:
2018-11-23

文章信息/Info

Title:
Effect of dynamic monitoring of D-dimer on prediction of deep venous thrombosis in lower extremity after hip arthroplasty
作者:
信鸿杰; 申雅文; 王琳; 史俊霞
010030 呼和浩特市，内蒙古医科大学第二附属医院护理部
Author(s):
Xin Hongjie;  Shen Yawen;  Wang Lin;  Shi Junxia
Nursing department, the Second Affiliated Hospital of Inner Mongolia Medical University Hohhot City, Hohhot 010030, China
关键词:
D-二聚体;  关节成形术; 置换; 髋;  静脉血栓形成
Keywords:
D-dimer;  Arthroplasty;  replacement;  ; hip;  Venous thrombosis
DOI:
10.3877/cma.j.issn.2096-0263.2018.06.002
文献标志码:
A
摘要:
目的 验证D-二聚体质量浓度监测髋关节置换术后DVT发生的敏感性，确定行D-二聚体测量的最佳采血时间。方法 回顾性收集2017年3月至2018年8年在内蒙古医科大学第二附属医院行髋关节置换手术的患者60例，术前测定全部患者的D-二聚体质量浓度、双下肢彩色多普勒超声检查排除DVT，将D-二聚体质量浓度＞（年龄×10）?g/L者分为阳性组，其余为阴性组。术后监测D-二聚体质量浓度并行彩超检查。对两组的BMI指数、年龄、手术出血量、性别，以及术前、术后1 d、3 d、5 d、9 d、14 d的D-二聚体浓度进行统计分析。结果 术后1 d、3 d、5 d、9 d、14 d阳性组D-二聚体质量浓度分别为（1 700±124）?g/L、（2 318±246）?g/L、（1 985±435）?g/L、（1 752±221）?g/L、（1 322±158）?g/L，阴性组的D-二聚体质量浓度分别为（343±98）?g/L、（372±79）?g/L、（356±59）?g/L、（345±76）?g/L、（226±102）?g/L，不同时间点阳性组D-二聚体质量浓度均大于阴性组，差异均有统计学意义（均P＜0.05）。术后彩超检查发现阳性组中2例出现下肢DVT，阴性组浓度始终＜500 ?g/L，无DVT发生患者。结论 D-二聚体浓度的变化对DVT的发生具有敏感性，患者术后第3天D-二聚体浓度达到峰值，是预测DVT发生的最佳采血时间。
Abstract:
Objective To verify the sensitivity of D-dimer concentration monitoring to the occurrence of DVT after hip arthroplasty, and to determine the optimal blood collection time for D-dimer measurement. Methods A total of 60 patients undergoing hip replacement from March 2017 to 2018 in our hospital were collected and the concentrations of D-dimer were measured before operation. Color Doppler ultrasonography of the lower extremities were used to exclud DVT, patients with D-dimer mass concentration > (age×10) g/L were divided into positive group and the rest were negative group. Postoperative monitoring of D-dimer mass concentration was followed by color Doppler ultrasonography. The BMI index, age, surgical bleeding volume, gender, and the concentration of D-dimer at 1 d, 3 d, 5 d, 9 d and 14 d before and after surgery were statistically analyzed. Results The concentrations of D-dimer in the positive group at 1 d, 3 d, 5 d, 9 d and 14 d were (1,700±124) ?g/L, (2,318±246) ?g/L, (1,985±435) ?g/L, (1,752.3±221.3) ?g/L, (1,322±158) ?g/L, respectively. D-dimerization of the negative group were (343±98) ?g/L, (372±79) ?g/L, (356±59) ?g/L, (345±76) ?g/L and (226±102) ?g/L, respectively. The concentration of D-dimer in the positive group was significant higher than that in the negative group (P<0.05). 2 cases of the positive group were found DVT and patients in negative group remained 500 g/L below. Conclusion The change of D-dimer concentration is sensitive to DVT, The peak of D-dimer concentration on the 3rd day after operation was the best time to predict DVT.

参考文献/References:

1 中华医学会外科学分会血管外科学组, 深静脉血栓形成的诊断和治疗指南第2版 [J]. 中华普通外科杂志, 2012, 23(7): 605-607.
2 Freedman KB, Brookenthal KR, Fitzgerald RH, et al. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty [J]. J Bone Joint Surg Am, 2000, 82-A(7): 929-938.
3 潘颐聪. D-二聚体的监测对评估急性期下下肢静脉血栓的疗效及预后的作用 [D]. 南宁: 广西医科大学, 2013.
4 赵智越. 股骨颈骨折行髋关节置换术围手术期下肢深静脉血栓形成的影响因素及愈后分析 [D]. 长春: 吉林大学, 2015.
5 牛云峰, 李广贤, 刘金榜, 等. 髋关节置换后监测D-二聚体、纤维蛋白原及纤维蛋白降解产物对诊断预防下肢深静脉血栓的临床意义 [J]. 中国医药科学, 2014, 4(8): 16-19.
6 Schouten HJ, Gj G, Koek HL, et al. Diagnostic accuracy of conventional or age adjust D-dimer cut-off values in older patients with suspected venous thromboembolism:systematic review and meta-analysis [J]. BMJ, 2013, 346: 2492.
7 Areelus JI, Kudrna JC, Capfini JA. Venous thromboembolism following major orthopedic surgery: what is the risk after discharge? [J]. Orthopedics, 2006, 29(6): 506-516.
8 黄永祥. 浅谈D-二聚体检测的临床意义 [J]. 中国医学创新, 2011, 8(12): 175-176.
9 孙艳霞, 王秀玲. 血清D-二聚体检测应用于早期预警下肢深静脉血栓形成的敏感性与特异性评价 [J]. 中国实用医药, 2014, 9(14): 77-78.
10 司文腾, 张华果, 孙宜保, 等. 脊柱术后血浆D-二聚体浓度变化与深静脉血栓的关系研究 [J]. 中国骨伤, 2014, 27(5): 405-408.
11 刘安, 陈廖斌, 王欣, 等. 膝髋关节置换术围手术期血浆D-二聚体动态监测及临床意义 [J]. 中华关节外科杂志:电子版, 2013, 7(2): 145-149.
12 Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [J]. Chest, 2016, 149(2): 315-352.
13 Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) [J]. Eur Heart J, 2008, 29(18): 2276-2315.
14 Mazzolai L, Aboyans V, Ageno W, et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European society of cardiology working groups of aorta and peripheral circulation and pulmonary circulation and right ventricular function [J]. Eur Heart J, 2017, [Epub ahead of print].
15 陈宾, 林凤飞, 林朝晖, 等. 低分子肝素钙治疗老年创伤后急性深静脉血栓的临床应用 [J/CD]. 中华老年骨科与康复电子杂志, 2018, 4(2): 86-91.
16 Amin E, Bistervels IM, Meijer K, et al. Residual vein occlusion in relation to immediate compression and postthrombotic syndrome in deep vein thrombosis [J]. Blood, 2018, [Epub ahead of print].

相似文献/References:

[1]徐明 付志厚 孙海宁 曲新涛 于秀淳.腓骨近端截骨与单髁关节置换治疗膝关节内侧单间室骨关节炎的疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
　Xu Ming,Fu Zhihou,Sun Haining,et al.Comparison study of proximal fibular osteotomy versus unicompartmental knee arthroplasty for medialcompartment osteoarthritis of the knee[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(06):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
[2]杨朝君 孙智文 田洪涛.腓骨近端截骨术与人工全膝关节置换术治疗内翻型膝关节骨关节炎的短期疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
　Yang Zhaojun,Sun Zhiwen,Tian Hongtao.Comparison on the short term treatment of varus knee osteoarthritis by proximal fibular osteotomy versus total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(06):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
[3]李雪靖,张雪松,刘思思,等.腓骨近端截骨联合关节镜下清理治疗内翻型膝关节骨关节炎的成本效果分析[J].中华老年骨科与康复电子杂志,2016,(04):222.[doi:10.3877/cma.j.issn.2096-0263.2016.04.006]
　Li Xuejing,Zhang Xuesong,Liu Sisi,et al.Cost-effectiveness analysis of proximal fibular osteotomy combined with arthroscopy debridement for medial compartment knee ostoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(06):222.[doi:10.3877/cma.j.issn.2096-0263.2016.04.006]
[4]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,(04):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
　Li Zhirui,Zhang Jing,Tang Peifu.Progress of surgical treatment for femoral intertrochanteric fracture in the elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(06):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
[5]李涛,王英振,李玉龙,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折安全性的 Meta分析[J].中华老年骨科与康复电子杂志,2017,(02):109.[doi:10.3877/cma.j.issn.2096-0263.2017.02.008]
　Li Tao,Wang Yingzhen,Li Yulong,et al.Safety of cement and cementless hemiarthroplasty for femoral neck fractures in elderly patients: a meta- analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):109.[doi:10.3877/cma.j.issn.2096-0263.2017.02.008]
[6]陈佳,李西成.髋部骨折：争议与挑战[J].中华老年骨科与康复电子杂志,2017,(04):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
　Chen Jia,Li Xicheng.Hip fracture: Controversy and challenge[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
[7]贾建波,禹宝庆,吴良浩,等.传统后路与微创 SuperPath入路的半髋置换治疗老年股骨颈骨折疗效比较[J].中华老年骨科与康复电子杂志,2017,(04):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
　Jia Jianbo,Yu Baoqing,Wu Lianghao,et al.Hip hemiarthroplasty for senile femoral neck fractures: minimally invasive SuperPath approach versus traditional posterior approach[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
[8]扈鑫,高石军,董江涛,等.中老年全膝关节置换术后下肢深静脉血栓形成的解剖部位分布特点[J].中华老年骨科与康复电子杂志,2017,(05):296.[doi:10.3877/cma.j.issn.2096-0263.2017.05.009]
　Hu Xin,Gao Shijun,Dong Jiangtao,et al.The anatomical distribution of lower extremity deep vein thrombosis of middle-aged, and older patients after total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):296.[doi:10.3877/cma.j.issn.2096-0263.2017.05.009]
[9]姚尧,乔梁,王业贤,等.床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用[J].中华老年骨科与康复电子杂志,2018,(02):70.[doi:10.3877/cma.j.issn.2096-0263.2018.02.002]
　Yao Yao,Qiao Liang,Wang Yexian,et al.The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(06):70.[doi:10.3877/cma.j.issn.2096-0263.2018.02.002]
[10]楚翔宇,程文俊,王俊文,等.老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点[J].中华老年骨科与康复电子杂志,2018,(02):75.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]
　Chu Xiangyu,Cheng Wenjun,Wang Junwen,et al.Features of deep venous thrombosis in aged patients with femoral neck fracture during the perioperative period[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(06):75.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]

备注/Memo

备注/Memo:
基金项目：内蒙古医科大学科技百万工程（联合）项目（YKD2016KJBWLH019）
更新日期/Last Update: 2018-11-23