D-二聚体在老年恶性肿瘤患者围术期预测下肢深静脉血栓的价值研究

目的探讨老年恶性肿瘤患者手术前后血浆D-二聚体值对围术期下肢深静脉血栓（DVT）的价值及对肿瘤围术期患者预防DVT的处理及效果。方法回顾性分析我院2008年1月至2012年5月行手术的老年肿瘤患者187例，其中男172例，女15例，平均年龄（75±10．1）岁。所有患者于术前、术后（当日、术后1、2、3、5、7、10、15、20、30d）测定血浆D-二聚体，并于术前、术后f每隔1周或出现症状时）行下肢血管超声检查。记录肿瘤部位、病理类型、术后使用抗凝药与否及使用抗凝药时机、血栓患者出现血栓的时间及部位。结果187例患者中3例发生下肢DVT。所有患者中术前有71例（38％）血浆D-二聚体值超过0．5mg／L，平均（0．83±1．09）mg/L；所有患者血浆D-二聚体值手术后当日即有明显升高，平均（2．55±3．33）mg／L，术后第5天出现峰值，平均（3．97±3．52）mg／L，术后1个月仍未恢复至术前状态；腺癌、非腺癌患者术后血浆D-二聚体值比较，差异无统计学意义（P〉0．05）；肺部与消化系统间比较，差异有统计学意义（P〈0．05），其余不同部位肿瘤术后血浆D-二聚体值比较，差异无统计学意义（P〉0．05）。结论老年肿瘤患者围术期血浆D-二聚体值预测下肢DVT有很高的敏感性，但特异性很低，仍是目前非常重要的监测方法；术后预防性药物抗凝对于预防下肢DVT有一定效果，但要谨慎使用。

Evaluation of plasma D-dimer in prognosing lower limbs deep vein thrombosis of elderly cancer patients within perioperative period

Objective To explore the value of plasma D-dimer in prognosing lower limbs deep vein thrombosis （DVT） of cancer elderly patients within perioperative period and show the management and effectiveness in preventing lower limbs DVT of cancer patients within perioperative period in our hospital. Methods A retrospective analysis was done on for 187 cancer patients with operation which concludes 172 male and 15 female from Jan, 2008 to May,2012. The average age is （75±10.1） years. Plasma D-dimer was continuous tested in preoperative,postoperative （concluding the very day,the 1 st day, 2nd day, 3rd day, the 5th day, the 7th day,the 10th day,the 15th day,the 20th day,1 month） , Lower limbs blood vessel ultrasonography in preoperative and postoperative（week about or the onset of symptoms ）. Then recording all patients＂ detailed clinical data which included the region and pathological type of cancer,using anticoagulant drug or not,the time using anticoagulant,the time and region existing DVT of DVT patients. Results 3 of 187 patients suffered from lower limbs DVT. Plasma D-dimer of 71 in all patients （71/187,38%） was more than 0.Smg/L in the preoperative,The mean value was （0.83±1.09）mg/L;In all patients,plasma D-dimer increased obviously on the very day of operation,The mean value is （2.55±3.33）mg/L, and reached the peak at the 5th day in the postoperative,The mean value is（3.97±3.52）mg/L,but didn＇t recover to preoperative state;The plasma D-dimer had no significant difference between adenocarcinoma and non adenocarcinoma （P=0.15〉0.05）;In different region carcinoma,the plasma D-dimer in the postoperative had some difference between lung and digestive system （P=0.007〈0.05）,while had no difference in others （P〉0.05）. Conclusions Traditional plasma D-dimer value in proguosing lower limbs deep vein thrombosis （DVT） of elderly cancer patients within perioperative period has very high sensitivity and very low specificity,but it is also a very important monitoring method;The using of anticoagulant in the postoperative has a certain effect in preventing lower limbs DVT of elderly caner patients.