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血栓弹力图在踝关节高能量损伤术后DVT形成中的应用

Application of thromboelastography in the prediction of deep vein thrombosis after high-energy ankle injury surgery

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目的 观察血栓弹力图(TEG)在踝关节高能量损伤术后下肢深静脉血栓形成(DVT)中的预测价值.方法 回顾性分析温州市中西医结合医院2019年1月至2021年12月住院治疗的踝关节高能量损伤术后患者62例的临床资料,根据是否出现下肢DVT分为对照组(未发生下肢DVT,n=42例)与观察组(发生下肢DVT,n=20例).比较两组常规凝血指标、TEG参数;采用受试者工作特征(ROC)曲线观察经典凝血功能参数与TEG参数在踝关节高能量损伤术后患者发生下肢DVT的预测价值.结果 观察组活化部分凝血活酶时间(APTT)为(33.29±3.40)s,明显短于对照组的(35.66± 3.36)s;观察组纤维蛋白原(FIB)(3.83±0.46)g/L、D-二聚体(D-D)(1.77±0.43)g/L,均明显高于对照组的(3.47±0.51)g/L、(1.56±0.35)g/L(t=2.59、-2.68、-2.05,均 P<0.05);两组凝血酶原时间(PT)、凝血酶时间(TT)差异均无统计学意义(均P>0.05).观察组凝血反应时间(R)、细胞凝集形成时间(K)分别为(3.80±0.83)min、(3.38±0.51)min,均短于对照组的(4.49±1.21)min、(3.82±0.55)min;观察组凝血块强度最大值(MA)、细胞凝集形成速率(α-Angle)分别为(78.69±9.22)mm、(83.37±9.30)°,均大于对照组的(68.33±9.10)mm、(71.25±8.35)°(t=2.30、2.96、-4.17、-5.15,均P<0.05).ROC曲线分析发现,联合诊断ROC曲线下面积(AUC)为0.983,大于上述各指标单独AUC面积(P<0.05).结论 APTT、FIB、D-D、R、K、MA、α-Angle水平在踝关节高能量损伤术后患者下肢DVT与非DVT患者之间差异较明显,各指标联合应用可作为踝关节高能量损伤术后患者的血栓防治依据,应用优势显著.
Objective To analyze the application value of thromboelastography(TEG)in the prediction of lower limb deep vein thrombosis(DVT)after high-energy ankle injury surgery.Methods The clinical data of 62 patients undergoing high-energy ankle injury surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to December 2021 were retrospectively analyzed.Based on the occurrence of lower limb DVT,the patients were divided into a control group(without lower limb DVT,n=42)and an observation group(with lower limb DVT,n=20).The conventional coagulation function indicators and TEG parameters were compared between the two groups.The receiver operating characteristic(ROC)curves were used to investigate the value of classic coagulation function indicators and TEG parameters in the prediction of lower limb DVT after high-energy ankle injury surgery.Results The activated partial thromboplastin time in the observation group was(33.29±3.40)seconds,which was significantly shorter than(35.66±3.36)seconds in the control group(t=2.59,P<0.05).The levels of fibrinogen and D-dimer in the observation group were(3.83 ±0.46)g/L and(1.77±0.43)g/L,respectively,which were significantly higher than(3.47±0.51)g/L and(1.56±0.35)g/L,respectively,in the control group(P=-2.68,-.05,both P<0.05).Prothrombin time and thrombin time showed no significant differences between the two groups(both P>0.05).Coagulation reaction time and cell agglutination formation time in the observation group were(3.80±0.83)minutes and(3.38±0.51)minutes,respectively,which were significantly lower than(4.49±1.21)minutes and(3.82±0.55)minutes in the control group(t=2.30,2.96,both P<0.05).The maximum clot strength and coagulation rate(α angle)in the observation group were(78.69±9.22)mm and(83.37±9.30)°,respectively,which were significantly greater than(68.33±9.10)mm and(71.25±8.35)° in the control group(t=-4.17,-5.15,both P<0.05).The ROC curve analysis found that the area under the ROC curve describing the prediction of combined indexes for lower limb DVT was 0.983,which was significantly greater than the area under the ROC curve describing the prediction of a single index for lower limb DVT(all P<0.05).Conclusion Activated partial thromboplastin time,fibrinogen,D-dimer,coagulation reaction time,red blood cell agglutination formation time,maximum clot strength,and α angle are significantly different between patients with DVT in the lower limb after surgery for an ankle injury and those without DVT.The combination of these indicators can serve as the basis for preventing and treating thrombosis in patients after high-energy ankle injury surgery,demonstrating remarkable practical advantages.

Ankle injuriesHigh-energy shock wavesPostoperative complicationsVenous thrombosisThrombelastographyPartial thromboplastin timeFibrinogenPyrimidine dimersProthrombin timeThrombin timeDiagnosis

王锋

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温州市中西医结合医院创伤骨科,温州 325000

踝损伤 高能量冲击波 手术后并发症 静脉血栓形成 血栓弹力描记术 部分促凝血酶原时间 纤维蛋白原 嘧啶二聚物 凝血酶原时间 凝血酶时间 诊断

浙江省温州市基础性科研项目

Y20220930

2024

中国基层医药
中华医学会,安徽医科大学

中国基层医药

影响因子:1.003
ISSN:1008-6706
年,卷(期):2024.31(1)
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