摘要
【目的】探讨凝血指标及血栓分子标志物水平对创伤性骨折患者术后发生深静脉血栓(DVT)的预测价值。【方法】回顾性分析2018年10月至2021年10月作者医院收治的78例创伤性骨折患者的临床资料,根据术后是否发生DVT将其分为DVT组(n=32)与非DVT组(n=46)。比较两组患者性别、年龄、合并症、骨折部位、手术时间、术中出血量、术后出血量、术后止血药物使用、术中输血、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、血栓分子标志物[凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PIC)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物(t-PAIC)、可溶性血栓调节蛋白(sTM)]等DVT相关因素水平,通过受试者工作特征(ROC)曲线分析FIB、D-D、TAT、PIC、t-PAIC、sTM预测患者术后发生DVT的价值,并采用多因素Logistic回归分析患者术后发生DVT的危险因素。【结果】两组患者性别、年龄、合并症、骨折部位、手术时间、术中出血量、术后出血量、APTT、PT、术后止血药物使用、术中输血,组间比较差异均无统计学意义(P>0.05)。DVT组FIB、D-D、TAT、PIC、t-PAIC、sTM显著高于非DVT组,差异有统计学意义(P<0.05);经ROC曲线分析显示,FIB=4.766 g/L、D-D=4833.945 ng/mL、TAT=6.077 ng/mL、PIC=1.089μg/mL、t-PAIC=7.754 ng/mL、sTM=8.552 TU/mL是预测骨折患者术后发生DVT的最佳截断值;Logistic回归分析显示,FIB≥4.766 g/L、D-D≥4833.945 ng/mL、TAT≥6.077 ng/mL、PIC≥1.089μg/mL、t-PAIC≥7.754 ng/mL、sTM≥8.552 TU/mL是骨折患者术后发生DVT的危险因素(P<0.05)。【结论】创伤性骨折患者术后DVT风险与FIB、D-D、TAT、PIC、t-PAIC、sTM水平有关,应对其凝血指标及血栓分子标志物水平密切监测,以防术后DVT的发生。
【Objective】To investigate the value of coagulation indexes and thrombus molecular markers in predicting postoperative deep venous thrombosis(DVT)in patients with traumatic fracture.【Methods】The clinical data of 78 patients with traumatic fracture treated in the author's Hospital from October 2018 to October 2021 were analyzed retrospectively.According to whether DVT occurred after operation,they were divided into DVT group(n=32)and non DVT group(n=46).The gender,age,complications,fracture site,operation time,intraoperative bleeding,postoperative bleeding,use of postoperative hemostatic drugs,intraoperative blood transfusion,coagulation indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(D-D)],thrombin antithrombin complex(TAT),plasmin were compared between the two groups;the levels of DVT related factors such as anti plasmin complex(PIC)-α2,tissue plasminogen activator plasminogen activator inhibitor complex(t-PAIC),soluble thrombomodulin(sTM)were analyzed.The value of FIB,D-D,TAT,PIC,t-PAIC and sTM was predicted by ROC,and the risk factors of postoperative DVT were determined by multivariate logistic regression analysis.【Results】There was no significant difference in gender,age,complications,fracture site,operation time,intraoperative bleeding,postoperative bleeding,APTT,PT,use of postoperative hemostatic drugs and intraoperative blood transfusion between the two groups(P>0.05).FIB,D-D,TAT,PIC,t-PAIC and sTM in the DVT group were significantly higher than those in the non DVT group(P<0.05);By ROC analysis,FIB=4.766 g/L,D-D=4833.945 ng/mL,TAT=6.077 ng/mL,PIC=1.089μG/mL,t-PAIC=7.754 ng/mL and sTM=8.552 TU/mL were the best cutoff values for predicting postoperative DVT in patients with fracture;Logistic regression analysis showed that FIB≥4.766 g/L,D-D≥4833.945 ng/mL,TAT≥6.077 ng/mL and PIC≥1.089μG/mL,t-PAIC≥7.754 ng/mL and sTM≥8.552 TU/mL were the risk factors of postoperative DVT in patients with fracture(P<0.05).【Conclusion】The risk of postoperative DVT in patients with traumatic fracture is related to the levels of FIB,D-D,TAT,PIC,t-PAIC and sTM.The levels of coagulation indexes and thrombus molecular markers should be closely monitored to prevent the occurrence of postoperative DVT.
作者
王勇
鱼红进
WANG Yong;YU Hong-jing(Department of Emergency Surgery,Ankang Central Hospital,Ankang Shaanxi 725000)
出处
《医学临床研究》
CAS
2022年第5期713-716,共4页
Journal of Clinical Research
作者简介
通讯作者:鱼红进,E-mail:1244540498@qq.com。
