D-二聚体监测在髋关节置换术后DVT诊治中的应用研究

目的验证D-二聚体质量浓度监测髋关节置换术后DVT发生的敏感性，确定行D-二聚体测量的最佳采血时间。 方法回顾性收集2017年3月至2018年8年在内蒙古医科大学第二附属医院行髋关节置换手术的患者60例，术前测定全部患者的D-二聚体质量浓度、双下肢彩色多普勒超声检查排除DVT，将D-二聚体质量浓度>（年龄×10）μg/L者分为阳性组，其余为阴性组。术后监测D-二聚体质量浓度并行彩超检查。对两组的BMI指数、年龄、手术出血量、性别，以及术前、术后1 d、3 d、5 d、9 d、14 d的D-二聚体浓度进行统计分析。 结果术后1 d、3 d、5 d、9 d、14 d阳性组D-二聚体质量浓度分别为（1 700±124）μg/L、（2 318±246）μg/L、（1 985±435）μg/L、（1 752±221）μg/L、（1 322±158）μg/L，阴性组的D-二聚体质量浓度分别为（343±98）μg/L、（372±79）μg/L、（356±59）μg/L、（345±76）μg/L、（226±102）μg/L，不同时间点阳性组D-二聚体质量浓度均大于阴性组，差异均有统计学意义（均P<0.05）。术后彩超检查发现阳性组中2例出现下肢DVT，阴性组浓度始终<500 μg/L，无DVT发生患者。 结论D-二聚体浓度的变化对DVT的发生具有敏感性，患者术后第3天D-二聚体浓度达到峰值，是预测DVT发生的最佳采血时间。

Effect of dynamic monitoring of D-dimer on prediction of deep venous thrombosis in lower extremity after hip arthroplasty

ObjectiveTo verify the sensitivity of D-dimer concentration monitoring to the occurrence of DVT after hip arthroplasty, and to determine the optimal blood collection time for D-dimer measurement. MethodsA total of 60 patients undergoing hip replacement from March 2017 to 2018 in our hospital were collected and the concentrations of D-dimer were measured before operation. Color Doppler ultrasonography of the lower extremities were used to exclud DVT, patients with D-dimer mass concentration > (age×10) g/L were divided into positive group and the rest were negative group. Postoperative monitoring of D-dimer mass concentration was followed by color Doppler ultrasonography. The BMI index, age, surgical bleeding volume, gender, and the concentration of D-dimer at 1 d, 3 d, 5 d, 9 d and 14 d before and after surgery were statistically analyzed. ResultsThe concentrations of D-dimer in the positive group at 1 d, 3 d, 5 d, 9 d and 14 d were (1,700±124) μg/L, (2,318±246) μg/L, (1,985±435) μg/L, (1,752.3±221.3) μg/L, (1,322±158) μg/L, respectively. D-dimerization of the negative group were (343±98) μg/L, (372±79) μg/L, (356±59) μg/L, (345±76) μg/L and (226±102) μg/L, respectively. The concentration of D-dimer in the positive group was significant higher than that in the negative group (P<0.05). 2 cases of the positive group were found DVT and patients in negative group remained 500 g/L below. ConclusionThe change of D-dimer concentration is sensitive to DVT, The peak of D-dimer concentration on the 3rd day after operation was the best time to predict DVT.