摘要
目的 评价术前血管超声参数预测妇科恶性肿瘤患者术后下肢深静脉血栓形成(DVT)的价值.方法 选取全身麻醉下择期手术妇科恶性肿瘤患者99例,年龄＞18岁,BMI＜30 kg/m2,ASA分级Ⅱ或Ⅲ级.于术前行血管超声检查,记录股总静脉(CFV)、股深静脉(DFV)、腘静脉(POV)、小腿肌间静脉(IMV)流速和管径.于术后1～8 d每日超声检查下肢静脉(包括胫前静脉、胫后静脉、IMV、CFV、DFV、POV),判断是否发生DVT.采用受试者工作特征曲线评价各指标预测下肢DVT的准确性,根据约登指数最大原则确定截断值.结果 下肢DVT发生率为13.1％.术前CFV流速和管径、DFV流速和管径、POV流速和管径、IMV流速和管径预测下肢DVT的曲线下面积(95％置信区间)分别为 0.769(0.616～0.923)和 0.800(0.644～0.950)、0.797(0.641～0.954)和 0.771(0.596～0.945)、0.806(0.645～0.968)和 0.754(0.606～0.903)、0.764(0.615～0.914)和 0.818(0.645～0.990)(P＜0.05),其预测截断值分别为 27.13 cm/s 和 11.93 mm、19.31 cm/s 和 10.15 mm、16.04 cm/s 和 8.79 mm、14.39 cm/s 和 8.68 mm,灵敏度、特异度分别为 90.0％、71.4％和 90.0％、74.3％,90.0％、74.3％和90.0％、68.6％,90.0％、82.9％和 90.0％、72.9％,90.0％、70.0％和 80.0％、87.1％.结论 术前血管超声参数可准确预测妇科恶性肿瘤患者术后下肢DVT的发生.
Abstract
Objective To evaluate the value of preoperative vascular ultrasound parameters in pre-dicting the postoperative lower extremity deep venous thrombosis(DVT)in patients with gynecological malig-nant tumors.Methods Ninety-nine patients with gynecological malignant tumors,aged＞18 yr,with body mass index＜30 kg/m2,of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ,sched-uled for elective surgery under general anesthesia,were selected.Vascular ultrasound examination was per-formed before surgery.The flow velocity and diameter of common femoral vein(CFV),deep femoral vein(DFV),popliteal vein(POV),and intermuscular vein(IMV)were recorded.Ultrasound examination of lower limb veins(including anterior tibial vein,posterior tibial vein,IMV,CFV,DFV,POV)were conduc-ted at 1-8 days after surgery to determine whether a DVT occurred.The receiver operating charcateristic curve was used to evaluate the accuracy of each indicator in predicting the lower extremity DVT,and the cut-off val-ue was determined based on the maximum principle of Jorden index.Results The incidence of lower extremi-ty DVT was 13.1％.The area under the curve(95％confidence interval)of the preoperative CFV flow velocity and diameter,DFV flow velocity and diameter,POV flow velocity and diameter,IMV flow velocity and diam-eter in predicting the lower extremity DVT were 0.769(0.616-0.923)and 0.800(0.644-0.950),0.797(0.641-0.954)and 0.771(0.596-0.945),0.806(0.645-0.968)and 0.754(0.606-0.903),0.764(0.615-0.914)and 0.818(0.645-0.990),respectively(P＜0.05),and the predicted cut-off values were 27.13 cm/s and 11.93 mm,19.31 cm/s and 10.15 mm,16.04 cm/s and 8.79 mm,14.39 cm/s and 8.68 mm,re-spectively,and the sensitivity and specificity were 90.0％,71.4％and 90.0％,74.3％;90.0％,74.3％and 90.0％,68.6％;90.0％,82.9％and 90.0％,72.9％;90.0％,70.0％and 80.0％,87.1％,respectively.Conclusions Preoperative vascular vascular ultrasound parameters can accurately predict the occurrence of postoperative lower extremity DVT in patients with gynecological malignant tumors.
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