首页|动态监测D-二聚体及凝血-纤溶参数对深静脉血栓的意义

动态监测D-二聚体及凝血-纤溶参数对深静脉血栓的意义

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目的:观察D-二聚体(DD)动态变化及凝血-纤溶参数对开胸术后深静脉血栓(DVT)的意义.方法:选择40例开胸手术(食管癌根治术和肺叶切除术)患者,于术前、关胸时、术后1 d、术后3 d行血浆DD、纤维蛋白原(FIB)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)及凝固启动时间(CST)、最大凝固程度(MCE)、凝血达峰值时间(MCT)、平衡时间(BLT)和全反应时间(WFT)等凝血-纤溶图参数进行检测.术前所有患者下肢深静脉彩超检测均阴性.根据术后4-7 d下肢彩超检测结果将患者分为血栓(T)组(n=13)和非血栓(NT)组(n=27).结果:与NT组比较,T组DD关胸及术后各时点均明显升高(P<0.01～0.05),FIB术后3 d明显增加(P<0.05);与基础值比较,两组DD,FIB,MCE,BLT,WFT术后各时点均明显升高(P<0.01～0.05),而PI,APTT均于术后1 d明显缩短(P<0.01～0.05),TT于术后3 d明显缩短(P<0.01).结论:血浆DD动态监测对开胸术后并发DVT具有早期诊断价值,而凝血-纤溶参数对预测DVT的形成无指导意义;且所有参数均提示术后血液呈高凝状态.
Dynamic monitoring the diagnosis value of D-Dimer and Coagulation-fibrinolysis parameter on deep venous thrombosis
AIM: To observe the early diagnosis value of the dynamic change of D-Dimer (DD) and coagulation-fibrinolysis parameters on deep venous thrombosis(DVT) after an open chest operation. METHODS: Check and measure the blood plasma DD, fibrinogen(FIB), prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT) and concretion startup time (CST), maximum extent of coagulation (MCE), maximum coagulation time(MCT), the balance time(BLT) and the whole time of fibrinolysis reaction (WFT) of 40 patients undergoing thoracotomy(esophageal cancer radical correction and lobectomia pulmonalis) in pre-operation, closing chest, the 1st and 3rd days of post-operation. In pre-operation, the lower-limb deep venous color supersonic check results of all patients' were negative. According to the results of postoperative lower-limb color supersonic check from the 4th to the 7th day in post-operation, the patients were divided into Team Thrombosis (Team T) (n = 13) and team not thrombosis (Team NT) (n = 27). RESULTS: Compared with team NT, the DD of Team T in each time points of closing the chest and after operation rised obviously (P ＜ 0.01-0.05), the FIB of the 3rd day in post-operation increased obviously(P ＜ 0.05); Compared with the basic value, the DD, FIB, MCE, BLT and WFT of both team in each time points after operation rised obviously (P ＜ 0.01-0.05), the PT and APTT shortened obviously after the 1st day in post-operation (P ＜ 0.01-0.05), the TT shortened obviously after the 3rd day in post-operation (P ＜ 0.01). CONCLUSION: Dynamic monitoring the blood plasma DD possess the early diagnose value of DVT after the thoracotomy, but coagulation-fibrinolysis parameters have no early diagnose value of DVT, furthermore, all the parameters indicate that hypercoagulabale state appears in the blood after the thoracotomy.

D-Dimerthoracotomylower-limb deep venous thrombosiscoagulation and fibrinolysis dynamic-pattern

雷蕾、刘丹彦、吴会生、邹磊、安民、刘少星

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重庆医科大学附属第一医院麻醉科,重庆,400016

D-二聚体 开胸手术 下肢深静脉血栓 凝血-纤溶图

2009

第四军医大学学报
第四军医大学

第四军医大学学报

CSTPCDCSCD北大核心
影响因子：0.599
ISSN：1000-2790
年,卷(期)：2009.30(20)
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