彩色多普勒超声诊断全膝关节置换围手术期下肢深静脉血栓形成的临床价值

目的探讨彩色多普勒超声（CDUS）对诊断全膝关节置换围手术期下肢深静脉血栓（DVT）形成的临床价值。 方法选取2016年1月至2016年12月在北京市隆福医院准备行单侧全膝关节置换术（TKA）患者81例，术前采用CDUS检查下肢静脉，记录有无血栓、检测瓣膜功能及有无静脉曲张；术后于第2、5、7及14天查DVT发生情况，对形成血栓患者临床加强抗凝治疗并监测。并对血栓的可能风险因素进行分析，数据采用Logistic多因素回归分析。 结果术前均未检出深静脉血栓，其中股静脉反流29例，静脉曲张26例；术后检出下肢深静脉血栓25例，均发生于术后1周内，其中于术后第2天检出6例，第3~5天12例，第6~7天7例；血栓患者经加强抗凝及溶栓治疗14 d后复查，8例孤立血栓溶解，其余患者血栓均有不同程度的缩小，所有血栓均未向近端发展，未出现肺栓塞症状。采用Logistic多因素回归分析得出股静脉反流、静脉曲张及高血压是术后下肢深静脉血栓形成的危险因素，术后发生DVT的风险倍数分别增加到7.42、7.38、7.34倍。 结论CDUS能筛选出DVT高危患者，早期发现并监测TKA术后下肢DVT的形成，对临床采取预防措施及提供个体化干预治疗有重要的价值。

Value of color Doppler ultrasonography in diagnosing deep venous thrombosis of lower limbs in perioperative period of total knee arthroplasty

ObjectiveTo assess the value of color Doppler ultrasonography (CDUS) in diagnosing deep venous thrombosis (DVT) of the lower limbs in the perioperative period of total knee arthroplasty (TKA). MethodsEighty-one patients who would underwent unilateral TKA at Beijing Longfu Hospital from January 2016 to December 2016 were selected. Preoperatively, CDUS was used to examine the veins of the lower limbs as well as thrombosis, valvular function, and varicose veins. The incidence of DVT in the lower extremities was examined on the second, fifth, seventh, and fourteenth days after surgery. Anticoagulant therapy was strengthened, and patients with thrombosis were monitored. The possible risk factors for DVT were analyzed by multivariate Logistic regression analysis. ResultsNo deep vein thrombosis was detected before operation, but 29 cases of femoral vein reflux and 26 cases of varicose veins were detected. Postoperatively, 25 cases of lower extremity DVT were detected, all of which occurred within 1 week after surgery, including 6 cases detected on the 2nd day after surgery, 12 cases on the 3rd to 5th days, and 7 cases on the 6th to 7th days. After 14 days of intensive anticoagulant and thrombolytic treatment, eight cases of isolated thrombolysis were detected, and the thrombi of the remaining patients all decreased to varying degrees. All the thrombi did not develop toward the proximal end and showed no symptoms of pulmonary embolism. Multivariate Logistic regression analysis showed that femoral venous reflux, varicose veins, and hypertension were risk factors for postoperative DVT of the lower limbs, with the risk increased by 7.42, 7.38, and 7.34 times, respectively. ConclusionsCDUS can not only screen out patients at a high risk for DVT of the lower limbs, but also detect and monitor the formation of DVT of the lower limbs after TKA operation, which is of great value for clinical prevention and individualized intervention.