摘要
目的 探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值.方法 选取 2021 年7 月—2023 年7 月收治的创伤骨折200 例,根据术后是否发生下肢DVT分为发生组25 例与未发生组175 例.收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值.绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况.结果 发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P＜0.01);发生组术后3dVs、Vd低于未发生组,RI、D-二聚体高于未发生组(P＜0.01);发生组 Vs、Vd、RI 及 D-二聚体手术前后差值均大于未发生组(P＜0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P＜0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为 0.88.构建下肢DVT预测模型,其AUC为 0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10～0.90 时具有更高的临床价值.结论 手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高.
Abstract
Objective To explore the changes of ultrasonic blood flow parameters[peak systolic blood velocity(Vs),end-diastolic blood velocity(Vd),resistance index(RI)],and D-dimer(D-D)before and after surgery and the ap-plication value of composite model in early warning of deep vein thrombosis(DVT)in orthopedic trauma patients.Methods A total of 200 orthopedic trauma patients treated from July 2021 to July 2023 were selected and divided into occurrence group(n=25)and non-occurrence group(n=175).Baseline data and Vs,Vd,RI,and D-D before and after surgery were col-lected from the two groups of patients.A predictive composite model was constructed according to the influencing factors of oc-currence of lower-limb DVT in orthopedic trauma patients after surgery,and the predictive value of combination of difference in Vs,Vd,RI,D-D before and after surgery and composite model for occurrence of lower-limb DVT in orthopedic trauma pa-tients after surgery was evaluated.Decision curve analysis(DCA)was drawn to analyze the benefit of ultrasonic blood flow pa-rameters,D-D detection and composite model in predicting the occurrence of lower-limb DVT in patients with orthopedic trau-ma after surgery.Results The duration of surgery and the proportion of tourniquet use in the occurrence group were longer or higher than those in the non-occurrence group(P＜0.01).At 3 days after surgery,Vs and Vd in the occurrence group were lower than those in the non-occurrence group,and RI and D-D were higher than those in the non-occurrence group(P＜0.01).The difference in Vs,Vd,RI and D-D before and after surgery in the occurrence group was greater than that in the non-occurrence group(P＜0.01).Multivariate Logistic regression analysis showed that duration of surgery,intraoperative tourniquet use and the difference in Vs,Vd,RI and D-D before and after surgery were independent risk factors for lower-limb DVT in orthopedic trauma patients(P＜0.01).The difference in Vs,Vd,RI and D-D before and after surgery was used as the predictive indexes to draw the receiver operating characteristic(ROC)curve,and the area under the curve(AUC)of Vs,Vd,RI and D-D in combination in predicting the occurrence of lower-limb DVT was0.882(95%CI:0.829,0.923),and the sensitivity and specificity were both 0.88.The lower-limb DVT prediction model was constructed,and its AUC value was 0.920(95%CI:0.873,0.954).The detrended correspondence analysis(DCA)showed that the composite model had high-er clinical value when the threshold probability was 0.10-0.90.Conclusion The duration of surgery,the intraoperative use of tourniquet and the difference in Vs,Vd,RI and D-D before and after surgery are independent risk factors for DVT in ortho-pedic trauma patients.Compared with the difference in Vs,Vd,RI and D-D before and after surgery,the composite model es-tablished by combining multiple indexes has higher application value in the early warning of lower-limb DVT after surgery for orthopedic trauma.
维普
万方数据