摘要
目的 探讨血栓弹力图(thromboelastography,TEG)和传统凝血试验(conventional coagulation test,CCT)相关参数对全膝关节置换术后下肢静脉血栓形成的预测价值.方法 选取2021年6月—2022年6月在聊城市第二人民医院进行全膝关节置换术的患者137例作为研究对象,将全膝关节置换术后发生静脉血栓的43例患者纳入静脉血栓组,将未发生静脉血栓的94例患者纳入非静脉血栓组.于术后的第3 d采用TEG和CCT评价患者的凝血功能状态,比较两组患者的TEG和CCT相关参数,采用ROC评估TEG和CCT相关参数在全膝关节置换术后静脉血栓形成的诊断价值,并采用logistic回归分析全膝关节置换术后静脉血栓形成的影响因素.结果 静脉血栓组和非静脉血栓组的α角、描记图最大振幅、凝血综合指数、活化部分凝血活酶时间、凝血酶原时间、D-二聚体比较,差异有统计学意义(P＜0.05).回归分析显示,α角、描记图最大振幅、凝血综合指数、D-二聚体是全膝关节置换术后发生下肢静脉血栓形成的影响因素(P＜0.05).描记图最大振幅、凝血综合指数、α角、D-二聚体、凝血酶原时间、活化部分凝血活酶时间的AUC曲线下面积分别为0.931、0.882、0.831、0.713、0.628和0.599.描记图最大振幅、凝血综合指数、α角的AUC大于D-二聚体、凝血酶原时间、活化部分凝血活酶时间的AUC(P＜0.05).结论 TEG 较CCT相关参数诊断全膝关节置换术后下肢静脉血栓形成效能更佳.
Abstract
Objective To explore the predictive value of TEG and CCT for venous thrombosis of lower limbs after total knee arthroplasty.Methods A total of 137 patients admitted to Liaocheng Second People's Hospital for total knee arthroplasty from June 2021 to June 2022 were selected as the study objects.Patients with venous thrombosis after total knee arthroplasty were classified as the venous thrombosis group(n=43),while those without venous thrombosis were classified as the non-venous thrombosis group(n=94).On the 3rd day after surgery,TEG and CCT were used to evaluate the coagulation function status of patients.The TEG and CCT related parameters were compared between two groups.The ROC curve were used to evaluated the diagnostic value of TEG and CCT related parameters in venous thrombosis after total knee replacement.The logistic regression was used to analyzed the factors affecting venous thrombosis in patients with total knee replacement.Results There were significant differences in α angle,maximum amplitude of trace,composite index of coagulation,activated partial thromboplastin time,prothrombin time and D-dimer between venous thrombosis group and non-venous thrombosis group(P<0.05).Regression analysis shows that,α angle,maximum amplitude of trace,composite coagulation index and D-dimer were the influencing factors for lower limb venous thrombosis in patients after total knee replacement(P<0.05).The area under ROC of maximum amplitude of trace,composite coagulation index,α Angle,D-dimer,prothrombin time and activated partial thromboplastin time were 0.931,0.882,0.831,0.713,0.628,and 0.599,respectively.The area under ROC of the maximum amplitude,composite coagulation index and α angle were significantly larger than D-dimer,prothrombin time and activated partial thromboplastin time(P<0.05).Conclusion TEG is more effective than CCT related parameters in diagnosing lower limb venous thrombosis after total knee arthroplasty.
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