术前血常规、凝血指标对神经外科手术患者术后DVT的预测效能

发布时间：2018-06-22 13:09

本文选题：神经外科 + 手术疗法　；参考：《山东医药》2017年11期

【摘要】：目的观察术前血常规、血凝指标在神经外科手术患者术后下肢深静脉血栓形成(DVT)预测中的效能。方法收集2015年1月~2016年1月收治的926例神经外科手术患者的临床资料。将患者根据术后是否发生DVT分为DVT组186例和非DVT组740例。用单因素Logistic回归比较两组患者血常规[包括白细胞计数、中性粒细胞计数、单核细胞计数、红细胞计数、血红蛋白、血小板计数]和凝血指标(D二聚体、凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原、凝血酶时间)。筛选出神经外科手术患者术后发生DVT的可能危险因素,然后行多因素Logistic回归分析,确定神经外科术后DVT的危险因素。采用受试者工作特征曲线(ROC曲线)法计算各危险因素预测神经外科患者手术后发生DVT的截断值。结果两组患者术前中性粒细胞计数、血红蛋白、D二聚体、纤维蛋白原水平相比,P均0.05。多因素logistic回归分析结果显示中性粒细胞计数升高(OR=1.662,95%CI为1.339~2.063,P0.01)及D二聚体水平升高(OR=1.535,95%CI为1.094~2.155,P=0.01)是神经外科术后DVT形成的独立危险因素。中性粒细胞计数值预测神经外科术后DVT形成的ROC曲线下面积为0.822,截断值为5.95×109/L,相应的预测敏感性为66.7%,特异性为82.7%;D二聚体水平预测神经外科术后DVT形成的ROC曲线下面积为0.789,截断值为0.546 mg/L,相应的预测敏感度为71.9%,特异性为82.7%。结论患者术前中性粒细胞计数与D二聚体水平升高可用于预测神经外科术后DVT的发生,效能较好。
[Abstract]:Objective To observe the efficacy of preoperative blood routine and hemagglutination index in the prediction of deep venous thrombosis (DVT) in the lower extremities after surgery in Department of neurosurgery. Methods the clinical data of 926 patients admitted to the Department of neurosurgery in January January 2015 were collected. The patients were divided into group DVT and 740 cases in non DVT group according to the occurrence of DVT after operation. Logistic regression compared the blood routine of two groups of patients [including leucocyte count, neutrophils count, monocyte count, red blood cell count, hemoglobin, platelet count] and coagulation index (D two polymer, prothrombin time, activated partial thromboplastin time, fibro white prothrombin, thrombin time). The possible risk factors of DVT were followed by multiple factor Logistic regression analysis to determine the risk factors of DVT in the Department of neurosurgery after operation. The subjects' work characteristic curve (ROC curve) was used to calculate the risk factors for the prediction of the cut-off value of DVT after operation in the Department of neurosurgery patients. Results the neutrophils count, hemoglobin, D two of the two groups of patients were measured before operation. P 0.05. multiple factor Logistic regression analysis showed that the increase of neutrophils count (OR=1.662,95%CI 1.339~2.063, P0.01) and D two polymer (OR=1.535,95%CI for 1.094~2.155, P=0.01) was an independent risk factor for DVT form after surgery in Department of neurosurgery. Neutrophil count predicted nerve. The area under the ROC curve formed by DVT after surgery was 0.822, the truncated value was 5.95 x 109/L, the corresponding predictive sensitivity was 66.7%, and the specificity was 82.7%. The D two polymer level predicted the area under the ROC curve of DVT in the Department of neurosurgery after operation, the truncated value was 0.546 mg/L, the corresponding predictive sensitivity was 71.9%, and the specificity was 82.7%. conclusion patients preoperative. Neutrophil count and elevated D two mer level can be used to predict the occurrence of DVT after operation in Department of neurosurgery.
【作者单位】：郑州大学第一附属医院;
【基金】：国家自然科学基金面上项目(81171177)
【分类号】：R651

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