脊柱术后D-二聚体变化规律及与深静脉血栓形成的临床研究

发布时间：2019-03-25 18:01

【摘要】：目的:探究脊柱术后D-二聚体浓度变化规律以及与深静脉血栓形成之间的关系。方法:选取2015年9月至2017年1月于我院脊柱外科行脊柱手术的患者165例,其中男98例,女67例;年龄26-84岁,平均年龄53.32±11.66岁。颈椎间盘突出症14例,颈椎管狭窄症13例,胸椎管狭窄症2例,腰椎间盘突出症62例,腰椎管狭窄症17例,腰椎滑脱症8例,脊柱侧弯2例,脊柱创伤47例,合并脊髓损伤20例。于术前、术后1天、术后3天、术后7天、术后14天清晨取所有患者空腹静脉血液测定D-二聚体浓度。所有患者于术前查双下肢深静脉彩色多普勒超声检查排除下肢深静脉血栓,术后怀疑下肢深静脉血栓则立即复查双下肢深静脉彩色多普勒超声,其余患者常规术后7天、14天复查双下肢深静脉彩色多普勒超声。术后出现血栓患者归为血栓组,未出现血栓患者归为非血栓组。所得数据使用SPSS22.0进行统计学分析,P0.05具有统计学意义。结果:165例患者术后共有12例出现深静脉血栓(7.27%),无出现肺栓塞患者。其中小腿肌间静脉丛血栓7例,腓静脉血栓2例,胫后静脉血栓2例,乆静脉血栓1例。于术后第6天发现血栓患者2例,术后第7天发现血栓患者5例,术后第8天发现血栓患者3例,术后第9天发现血栓患者2例。术后第1、3、7、14天血栓组与非血栓组患者D-二聚体浓度均高于术前,差异具有统计学意义(P0.01)。术前血栓组与非血栓组患者D-二聚体浓度无明显差异(P0.05)。术后第1、3、7、14天血栓组患者D-二聚体浓度均明显高于非血栓组,差异具有统计学意义(P0.01)。非血栓组患者术后血浆D-二聚体浓度升高幅度较小,术后第3天达到顶峰,后逐渐降低,术后第14天降至正常范围。血栓组患者术后血浆D-二聚体浓度升高幅度大,术后第7天达到顶峰,后逐渐降低,但术后第14天仍未降至正常范围。绘制ROC曲线,术后第1天曲线下面积(AUC)0.768,D-二聚体最佳临界值2.00ug/ml,敏感性91.7%,特异性55.6%。术后第3天曲线下面积(AUC)0.786,最佳临界值为4.42ug/ml,敏感性为66.7%,特异性80.4%。术后第7天曲线下面积(AUC)0.943,最佳临界值为4.71ug/ml,敏感性83.3%,特异性92.2%。结论:1.脊柱术后行常规功能锻炼下的DVT发生率约为7.27%。2.脊柱术后6至9天是DVT形成的高峰期,第7天测定血浆D-二聚体浓度对诊断DVT价值最大。3.脊柱术后DVT形成的D-二聚体临界值为4.71ug/ml,敏感性83.3%,特异性92.2%。
[Abstract]:Objective: to investigate the relationship between D-dimer concentration and deep venous thrombosis (DVT) after spinal surgery. Methods: from September 2015 to January 2017, a total of 165 patients (98 males and 67 females, with an average age of 53.32 卤11.66 years) who underwent spinal surgery in our hospital were selected. There were 14 cases of cervical disc herniation, 13 cases of cervical spinal stenosis, 2 cases of thoracic spinal stenosis, 62 cases of lumbar disc herniation, 17 cases of lumbar spinal stenosis, 8 cases of lumbar spondylolisthesis, 2 cases of scoliosis and 47 cases of spinal trauma. 20 cases were complicated with spinal cord injury. Before, 1 day, 3 days, 7 days and 14 days after operation, the fasting venous blood of all patients was taken to determine the concentration of D-dimer. All patients examined the deep vein color Doppler ultrasonography of both lower extremities before operation to exclude deep vein thrombosis of lower extremities. After operation, the patients suspected of deep vein thrombosis of lower extremities were immediately reexamined by color Doppler ultrasound of deep veins of both lower extremities, and other patients were routine 7 days after operation. Color Doppler ultrasonography of deep veins of lower extremities was performed on 14 days. The patients with thrombosis after operation were classified into thrombosis group and non-thrombus group. The data used SPSS22.0 for statistical analysis, P0.05 has statistical significance. Results: there were 12 cases (7.27%) with deep venous thrombosis (DVT) and no pulmonary embolism (PE) in 165 cases. There were 7 cases of myenteric venous plexus thrombosis, 2 cases of fibular vein thrombosis, 2 cases of posterior tibial vein thrombosis and 1 case of venous thrombosis. Thrombus was found in 2 cases on the 6th day, in 5 cases on the 7th day, in 3 cases on the 8th day, and in 2 cases on the 9th day after operation. The concentrations of D-dimer in thrombosis group and non-thrombus group were significantly higher than those before operation at 1,3,7,14 days after operation (P0.01). There was no significant difference in the concentration of D-dimer between the thrombus group and the non-thrombus group before operation (P0.05). The concentration of D-dimer in the thrombosis group was significantly higher than that in the non-thrombus group on the 1,3,7,14 days after operation, the difference was statistically significant (P0.01). In the non-thrombotic group, the plasma D-dimer concentration increased slightly, reached the peak on the 3rd day after operation, then decreased gradually, and returned to the normal range on the 14th day after the operation. The plasma D-dimer concentration in the thrombus group increased greatly, reached the peak on the 7th day after the operation, then decreased gradually, but still did not decrease to the normal range on the 14th day after the operation. The ROC curve was drawn, the area under the curve was (AUC) 0.768 on the first day after operation, the optimal critical value of D-dimer was 2.00ug / ml, the sensitivity was 91.7% and the specificity was 55.6%. On the 3rd day after operation, the area under the curve was (AUC) 0.786, the optimal critical value was 4.42ug / ml, the sensitivity was 66.7%, and the specificity was 80.4%. On the 7th day after operation, the area under the curve was (AUC) 0.943, the optimal critical value was 4.71 ug / ml, the sensitivity was 83.3%, and the specificity was 92.2%. Conclusions: 1. The incidence of DVT after spinal surgery with routine functional exercise was about 7.27%. From 6 to 9 days after spinal operation, the peak of DVT formation was observed, and the determination of plasma D-dimer concentration on the 7th day was the most valuable for the diagnosis of DVT. 3. The critical value of D-dimer formed by DVT after spinal operation was 4.71 ug / ml, with a sensitivity of 83.3% and a specificity of 92.2%.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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