彩色多普勒超声筛查下肢骨折患者术前深静脉血栓临床分析

目的探讨彩色多普勒超声筛查下肢骨折患者术前深静脉血栓的临床效果。方法选取2014-01—2016-01收治的750例下肢骨折手术患者,均使用彩色多普勒超声于术前1d进行下肢深静脉血栓筛查。回顾性分析患者的临床资料。结果彩超检查出60例下肢深静脉血栓,占8.00%。40岁以上患者深静脉血栓发生率高于40岁以下者;股骨骨折和多发骨折患者深静脉血栓发生率高于胫腓骨及内外踝骨折。差异均有统计学意义(P0.05)。结论下肢骨折患者深静脉血栓发生率较高,术前应采用彩色多普勒超声对深静脉血栓进行筛查,以降低手术风险。     

彩色多普勒超声诊断下肢深静脉血栓形成后综合征的应用价值

探讨彩色多普勒超声(CDUS)在下肢深静脉血栓形成后综合征诊治中的应用价值。对78例下肢深静脉血栓病例进行回顾性分析,观察病变血管特征、血栓范围、血栓回声特征、血流、侧支形成、继发静脉瓣改变情况,对比治疗前、后的改变及健肢相应血管特征,并与数字减影血管造影(DSA)检查结果行一致性比较。经CDUS检查并与对侧健肢、治疗后双重比较,发现病变血管内径、血管内膜及管内回声异常、血流速度及瓣膜功能不全方面差异均具有统计学意义(P0.05);CDUS诊断下肢深静脉血栓形成符合率达93.59%,与DSA诊断结果相符合,两者经Kappa检验,K值为0.674(P0.05)。CUDS具有无创、便捷、实施动态、可重复操作等优点,可指导临床进行早期下肢深静脉血栓形成后综合征的诊断、动态观察、疗效评判、预后判断的一种有效影像学方法。     

D-二聚体检测与彩色多普勒超声对骨折患者下肢深静脉血栓的诊断价值

目的 探讨D-二聚体(D-dimer,D-D)检测与彩色多普勒超声对骨折患者下肢深静脉血栓(DVT)的诊断价值.方法 回顾性分析40例下肢新鲜骨折患者在术前均行下肢血管造影术、彩色多普勒超声及D-D检测.D-D检测值>500/μg/L为阳性.根据造影结果将患者分为下肢血栓组(T组)和非血栓组(NT组).记录两组患者彩色多普勒及D-D检测结果.结果 T组D-D为(2 101士561)μg/L,NT组D-D为(1137±223)μg/L.两组差异无统计学意义.D-D检测敏感度为78.6%,特异度为19.2%,准确度为40.0%.阳性预测值为34.4%.阴性预测值为62.5%;彩色多普勒超声敏感度为57.1%,特异度为96.2%,准确度为82.5%,阳性预测值为89.0%,阴性预测值为81.0%.彩色多普勒超声的特异度、阳性预测值及准确度均明显高于D-D检测(P<0.05或P<0.01).结论 彩色多普勒超声是诊断骨折患者下肢DVT的首选方法,D-D检测既不能诊断也不能排除DVT.     

经皮血氧分压激光多普勒血流系统对下肢动脉粥样硬化早期诊断的临床应用价值

目的对比分析经皮血氧分压激光多普勒血流系统对下肢动脉粥样硬化早期诊断的临床应用价值。方法选择从2014年12月至2015年10月就诊于我科134例可疑下肢动脉粥样硬化病变患者。分别应用超声多普勒技术和经皮血氧分压激光多普勒血流监测技术对全部患者的病变程度做评估,以下肢动脉造影为金标准,将超声多勒普及经皮血氧分压激光多普勒诊断结果与下肢动脉造影结果进行对照。结果多普勒超声检查组,准确度、敏感度、特异度、阳性预测值、阴性预测值分别为69.4%,84.0%,14.3%,78.8%,19.04%。而经皮血氧分压激光多普勒检查组的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为94.0%,95.3%,89.5%,97.1%和83.3%。两组比较,差异具有统计学意义(P0.05)。结论经皮血氧分压激光多普勒检查,可有效提高早期下肢动脉粥样硬化的检出率及诊断敏感性、特异性及准确性,可以在临床推广使用。     

老年髋关节置换术后下肢深静脉血栓的预防

目的总结髋关节置换术后下肢深静脉血栓的预防措施。方法51例人工髋患者术前彩色多普勒超声筛检,双下肢无深静脉血栓,术后采用以低分子肝素抗凝为主的综合预防措施,术后48h,第4、7天复查彩超,阳性者行下肢深静脉造影,分析术后深静脉血栓的发病情况。结果51例人工髋术后4例发生下肢深静脉血栓,发生率为7.8%,未见症状性肺栓塞。结论对人工髋术后采取以低分子肝素抗凝为主的综合预防措施能显著降低术后深静脉血栓的发生率。     

高频超声及彩色多谱勒血流显像对下肢深静脉血栓的诊断价值

目的 探讨高频超声及彩色多谱勒血流显像（color doppler flow imaging,CDFI)对下肢深静脉血栓的诊断价值。方法 对32条经X线血管造影确诊为深静脉血栓的下肢深静脉进行超声观测，同时选择正常人36条下肢深静脉进行对比。结果 正常静脉图像清晰，回流通畅，不同形态不同类型的血栓对血管的阻塞及血栓急、慢性表现有不同的超声特点。结论 与有创的血管造影相比，超声具有无创、实时、安全可靠的特点，是诊断下肢深静脉血栓病变理想的方法。     

超声造影在肝移植术后肝动脉血栓诊断中的应用

目的评估超声造影在肝移植术后肝动脉血栓(HAT)诊断中的价值。方法 2004年1月至2012年8月在四川大学华西医院肝移植中心行肝移植手术的患者810例。患者术后均接受了彩色多普勒超声(彩超)检查,其中有58例怀疑HAT,从而继续接受超声造影检查。以肝动脉血管造影、手术结果和临床随访作为金标准,计算超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果超声造影诊断16例HAT,正确诊断15例,误诊1例,无漏诊病例。超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为1.0、0.977、0.983、0.938和1.0。本组患者HAT发生率和病死率分别为1.9%和53%。结论肝移植术后彩超检查怀疑HAT时应立即行超声造影检查,超声造影诊断肝动脉通畅的患者可避免肝动脉血管造影检查。     

骨盆髋臼骨折后深静脉血栓形成的诊断:彩色多普勒超声与静脉造影的比较研究

目的 比较彩色多普勒超声与静脉造影在骨盆、髋臼骨折后深静脉血栓形成(DVT)诊断中的准确性. 方法 回顾性分析2005年1月至2009年2月期间收治的73例骨盆或髋臼骨折患者资料,男54例,女19例;平均年龄为42.7岁(17 ～67岁).所有患者均通过彩色多普勒超声和静脉造影检查DVT. 结果 73例患者DVT的检查结果:彩色多普勒超声阳性37例,阴性36例;静脉造影阳性48例,阴性25例.静脉造影阳性的48例患者中,彩色多普勒超声阳性34例,阴性14例;静脉造影阴性的25例患者中,彩色多普勒超声阳性3例,阴性22例,彩色多普勒超声与静脉造影在诊断DVT方面差异无统计学意义(x2=3.407,P =0.065).以静脉造影作为诊断DVT的标准,彩色多普勒超声的敏感性为70.8％,特异性为88.0％,阳性预测值为91.9％,阴性预测值为61.1％. 结论 彩色多普勒超声可以作为骨盆、髋臼骨折后DVT的有效筛查方法.对彩色多普勒超声检查结果不确切及结果阴性而临床高度怀疑DVT的患者,可进一步行静脉造影检查.     

彩超检测在预防人工关节置换术后下肢深静脉血栓形成的应用

目的 探讨彩色多普勒超声监测抗凝及早期锻炼预防人工关节置换术后下肢深静脉血栓形成(DVT)的应用价值.方法 对接受人工髋、膝关节置换术患者199例予术前、术后进行双下肢深静脉彩色多普勒超声检测,为术后抗凝及早期锻炼提供依据,并对检出下肢深静脉血栓阳性患者及时进行溶栓等处理,追踪观察治疗效果.结果 149例接受全髋关节置...     

下肢静脉超声检出肌肉骨骼系统病变的临床价值

目的探讨下肢静脉超声检出肌肉骨骼系统病变的临床价值。方法回顾性收集因临床疑诊或需除外下肢深静脉血栓接受下肢静脉超声检查的8 288例患者的资料,分析下肢静脉超声检查对于肌肉骨骼系统病变的检出率及合并深静脉血栓等超声表现。结果下肢静脉超声检出肌肉骨骼系统病变134例,以腘窝囊肿(90/134,67.16%)最常见,其后依次为血肿(31/134,23.13%)、肌肉撕裂(5/134,3.73%)、脓肿(2/134,1.49%)、肿瘤(2/134,1.49%)、肌层囊肿(2/134,1.49%)、腘窝术后积液(1/134,0.75%)及膝关节滑膜增生(1/134,0.75%)。不同肌肉骨骼系统病变超声表现各异。腘窝未破裂囊肿最大径大于破裂囊肿(F=5.266,P=0.024)。134例中20例合并下肢深静脉血栓,其中肌肉撕裂患者最易合并血栓(1/5,20.00%)。结论下肢静脉超声检查可在判别有无深静脉血栓的同时检出肌肉骨骼系统病变,有助于修正或补充临床诊断及治疗方案,具有较高临床价值。     

D-二聚体联合凝血酶时间检查对腹膜癌患者下肢深静脉血栓排除的诊断价值

目的:探讨D-二聚体(D-D)联合凝血酶时间(TT)检查对腹膜癌患者排除下肢深静脉血栓(DVT)的诊断价值。方法:以2015年5月—2017年5月收治的241例腹膜癌患者为研究对象,检查患者术前凝血及纤溶指标,用Wells风险模型对患者进行DVT可能性评分,对所有患者行双下肢静脉超声确诊是否存在DVT,并观察围手术期症状性静脉血栓栓塞(VTE)事件的发生情况。结果:241例患者中经下肢静脉超声确诊DVT共21例(8.7%),术后随访3个月均未出现症状性VTE事件。DVT患者与非DVT患者比较,TT明显缩短,纤维蛋白(原)降解产物与DD明显升高(均P0.05)。ROC曲线确定腹膜癌患者中TT诊断DVT的最佳临界值为13.55 s,联合D-D诊断下肢DVT的阴性预测值为100%,漏诊率为0。无论Wells评分低度或高度可能,联合试验的阴性预测值均为100%。结论:腹膜癌患者就诊时有一定的DVT的发生率,D-D联合TT检测对腹膜癌患者排除DVT诊断有很强的阴性预测价值,且不依赖于Wells评分,联合试验阴性者(D-D243 ng/m L DDU且TT13.55 s)可不接受下肢血管超声检查而安全排除下肢DVT。     

D-dimer and calf circumference in the evaluation of outpatient deep venous thrombosis

OBJECTIVE: Duplex ultrasonography (DU) is the primary method for diagnosis of deep venous thrombosis (DVT) but is relatively expensive and not always readily available. Attempts to exclude the diagnosis of DVT with D-dimer or clinical criteria independently have been unsuccessful. The goal of our study was to evaluate a second-generation rapid quantitative D-dimer and simple clinical parameters for screening of outpatients for DVT. Patients and Methods: Patients undergoing DU of the lower extremities for suspected DVT were prospectively evaluated. Patients undergoing lower extremity venous ultrasound scan for suspected pulmonary embolism or already on anticoagulant therapy were excluded from the study. Data were analyzed to assess the optimal combination of characteristics to include and exclude proximal DVT. RESULTS: One hundred fifty-six outpatients met inclusion criteria and were enrolled in the study. Elevated levels of D-dimer of 0.5 ng/mL or more were noted in 21 of 22 patients diagnosed with DVT, yielding a sensitivity of 95% and negative predictive value of 99%. Subjective symptoms of swelling or pain were present in 94% of all outpatients. Asymmetric calf swelling of more than 2.0 cm was noted in 14 of 22 patients (64%) with proximal DVT compared with 22 of 134 patients (16%) without DVT (P <.003). No single clinical history variable was significant on multivariate analysis. All outpatients with proximal DVT had either leg swelling of more than 2 cm or a positive D-dimer. CONCLUSION: A combination of a second-generation quantitative D-dimer and calf measurement provides an easy and effective means of excluding proximal DVT when screening outpatients. Patients with calf circumference 2.0 cm or less and a negative D-dimer may undergo nonemergent DU. Patients with a positive D-dimer or asymmetrical calf swelling of more than 2.0 cm alone or in combination should undergo emergent DU.     

血小板、中性粒细胞、血小板平均体积与淋巴细胞比值在急性深静脉血栓形成诊断中的价值

目的评价血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)和血小板平均体积/淋巴细胞比值(mean platelet volumeto-lymphocyte ratio,MPVLR)等指标对急性下肢深静脉血栓形成(deep vein thrombosis,DVT)的诊断价值。方法选取92例急性下肢DVT的患者作为病例组,86名健康体检者作为对照组,通过比较两组的血液相关指标来评价其对急性DVT的诊断价值。结果病例组的白细胞计数、中性粒细胞计数、血小板平均体积(mean platelet volume,MPV)值、PLR值、NLR值和MPVLR值均高于对照组,淋巴细胞计数低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NLR(OR=9.690,P<0.001)和MPVLR(OR=7.162,P<0.006)是急性下肢DVT发病的独立预测因素。NLR和MPVLR的曲线下面积(area under curve,AUC)值分别为0.871和0.963。NLR对急性DVT诊断的最佳截断值为2.15,灵敏度89.1%,特异度84.9%,MPVLR的最佳截断值为6.88,灵敏度42.4%,特异度84.9%。下肢肿胀天数>7 d组患者的MPVLR水平低于肿胀天数≤7 d组,差异有统计学意义(P=0.025)。结论MPVLR、NLR、MPV对急性下肢DVT有较大的诊断价值。NLR和MPVLR是DVT相关的独立预测因素,MPVLR在急性下肢DVT的早期诊断价值更大。     

血浆D-二聚体和纤维蛋白原对急性下肢深静脉血栓形成的诊断价值

 目的 评估血浆D-二聚体(D-dimer,D-D)和纤维蛋白原(fibrinogen,Fg)及其二者比值(D/F值)在人工关节置换术后急性下肢深静脉血栓形成(deep vein thrombosis,DVT)中的诊断价值。方法 2009年8月至2011年12月接受全髋或全膝关节置换术后第3至5天行下肢深静脉造影检查的患者273例,根据造影检查结果将患者分为DVT组66例(男15例、女51例,中位年龄66岁)和非DVT组207例(男70例、女137例,中位年龄63岁)。比较两组患者术前及术后第3至5天血浆D-D值(免疫比浊法检测)、血浆Fg值(凝固法检测)及D/F值的差异,并对术后血浆D-D和D/F值进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果 术前血浆D-D值及Fg值比较,两组差异无统计学意义;术后两组血浆Fg值的差异无统计学意义,而血浆D-D值及D/F值的差异有统计学意义,DVT组高于非DVT组。术后血浆D-D和D/F值诊断DVT的ROC曲线下面积分别为0.688和0.684,差异无统计学意义。结论 血浆Fg对人工关节置换术后急性DVT没有诊断作用;而血浆D-D值和D/F值对筛查诊断有一定价值,但准确性较低。     

应用间歇性气体压缩装置预防人工髋关节置换术下肢深静脉血栓形成

目的探讨对有高出血风险患者应用间歇性气体压缩装置预防人工髋关节置换术后下肢深静脉血栓形成的效果及护理要点。方法2010年3月至2013年1月,对有高出血风险、需要行人工全髋关节置换术或人工股骨头置换术的患者58例,采用基本预防和下肢间歇性气体压缩装置物理预防。主要观察双下肢肢体颜色、肿胀、疼痛等病症,双下肢彩色多普勒超声检查结果。结果58例有高出血风险患者人工髋关节置换术后,其中5例发生患侧肢体疼痛、肿胀,3例无症状、体征,经彩色多普勒超声检查提示深静脉血栓形成共8例,发生率13．65％。结论有高出血风险患者人工髋关节置换术后应用间歇性气体压缩装置,正确使用、仔细观察并有效解决应用中的问题,能有效地预防和减少下肢深静脉血栓形成。     

高频超声引导下经腘静脉穿刺置管溶栓治疗下肢深静脉血栓

目的探讨经腘静脉穿刺置管直接溶栓治疗下肢深静脉血栓(DVT)的应用价值。方法收集经CDFI或下肢深静脉造影确诊为DVT的36例患者。对观察组患者行超声引导下患侧腘静脉穿刺,置入溶栓导管,经导管持续灌注尿激酶溶栓;对照组采用经外周静脉滴注尿激酶,比较两组的治疗效果。结果观察组(16例)患者自治疗后第2天患肢肿胀开始减退,第4～6天时肿胀明显减退,治愈3例,显效11例,有效2例,总体有效率为100%(16/16);对照组(20例)自第2～4天起患肢肿胀开始减退,第7～9天明显减退,显效8例,有效6例,无效6例,总体有效率为70.00%(14/20);两组治疗效果的差异有统计学意义(Z=3.270,P=0.002)。溶栓治疗前后观察组肢体肿胀缓解程度较对照组明显,患肢大腿及小腿周径的差异均有统计学意义(P均<0.01)。结论于高频超声引导下经腘静脉穿刺置管直接溶栓治疗DVT安全、微创、疗效确切,且并发症少。     

Use of D-dimer to aid in excluding deep venous thrombosis in ambulatory patients

BACKGROUND: Duplex imaging is currently the gold standard for diagnosing deep venous thrombosis (DVT), but its nonselective use overburdens vasuclar laboratories, particularly during off hours. It is the purpose of this study to determine if a new D-dimer assay could be used as an aid in determing whether duplex imaging could be performed on an elective or emergent basis in patients with suspected DVT. METHODS: D-dimer levels were measured and venous duplex examinations were obtained in all patients. D-dimer assays were performed using the Tina-quant latex agglutination test (Roche Diagnostics, Mannheim, Germany). Venous duplex examinations were performed using colorflow doppler. RESULTS: Between September 1, 2002 and April 30, 2003, 148 patients were seen in the emergency department for suspected DVT. Nineteen patients (12.8%) had positive venous duplex examinations and 129 (87.2%) duplex examinations were negative. None of the 19 patients with positive venous duplex studies had D-dimer levels within of the normal range (0 to 0.49). The sensitivity, specificity, positive predictive value, and negative predictive value of the D-dimer test were 100%, 48.8%, 22.4%, and 100%, respectively. CONCLUSION: The D-dimer test can effectively used without adjuncting risk stratification as an aid in excluding the diagnosis of DVT in ambulatory patients. Its routine use could significantly reduce the need for the performance of emergent venous duplex examinations.     

Diagnosis of deep venous thrombosis of the lower limb by Doppler ultrasound technique

In this study, eighty limbs (71 patients) with clinically suspected deep venous thrombosis (DVT) were investigated by both venography and Doppler ultrasonography. Diagnosis was confirmed by venography in 67 limbs and Doppler ultrasonography was positive in 66 of them with the Doppler sensitivity of 98%. In the remaining 13 limbs clinically suspected to have DVT, neither venography nor Doppler ultrasonography found any abnormality in the venous system of the lower limbs.     

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目的　探讨二维彩色多普勒超声显像 (CDFI)对下肢深静脉血栓形成 (DVT)的诊断价值。方法　1998～ 2 0 0 3年对 97例下肢DVT病人进行CDFI检查 ,了解病肢深静脉的管壁、管径、血栓位置、大小、范围、静脉瓣功能及静脉血流情况。结果　 97例 (98条 )下肢DVT病例中 ,伴有下肢深静脉瓣功能不全者 6例。其中 ,中央型 2 1条 (2 1 4 2 % ) ,周围型 4 6条 (4 6 94 % ) ,全肢型 31条 (31 6 4 % )。病肢左右侧之比为 3 3:1(P <0 0 0 1)。结论　CDFI在下肢DVT方面具有特异性表现 ,可以成为下肢DVT诊断、预后判断和随访的首选方法。     

Thrombosis in unusual sites of the lower extremity veins

BACKGROUND: Thrombosis in unusual locations in the lower extremity veins has not been assessed. These veins are not imaged routinely and therefore information about them is lacking. METHODS: This study was designed to evaluate the natural history of deep vein thrombosis (DVT) in unusual sites. Patients with DVT in all thigh veins but the femoral vein were included. Patients with thrombi in any other vein in the first examination and those with history of DVT were excluded. Duplex ultrasound (DU) examination was performed to exclude thrombosis in the lower extremity in patients with signs and symptoms of venous thromboembolism and also in high-risk, asymptomatic patients. All veins from the distal external iliac vein to the lower calf were imaged. The deep femoral, femoropopliteal, lateral thigh, sciatic, and muscular thigh veins were examined. These patients were followed at 1 week, 1 month, 6 months, 1 year, and yearly thereafter, for thrombus propagation, resolution, and reflux. RESULTS: Among the 15,850 DU performed in the vascular laboratory at Loyola University Medical Center, in a 10-year period to rule out DVT, 2568 (16.2%) were positive and 14 cases (7 males, 0.54% among the patients with DVT and 0.088% among the entire population) involved thromboses in unusual locations. Ten cases involved the left lower extremity and four the right. The unusual DVT cases were associated with medical and surgical conditions or were idiopathic in 11 patients, whereas three had Klippel-Trenaunay syndrome (KTS). The veins involved in the first group of patients were the deep femoral (8), the femoropopliteal (2), and the deep external pudendal (1). The patients with KTS had involvement of muscular thigh veins (1), and the lateral thigh vein and the sciatic vein (2). Thrombi propagation with extension to the common femoral vein was seen in four of the 14 patients: two from the deep femoral vein, one from the femoropopliteal vein, and one from the deep external pudendal vein. There were two incidences of pulmonary embolism (PE) one of which was fatal. At final follow-up, two patients developed recurrent DVT and nine had signs and symptoms of chronic venous disease. CONCLUSIONS: The involvement of the studied veins in DVT is extremely rare. Thrombosis in these veins can follow the natural course of thrombosis in the more usual locations and is associated with lethal incidences of PE. Therefore, the association of these veins with all the grave sequelae of thromboembolic disease suggests that inclusion of these veins in routine lower extremity duplex scans would be beneficial.