血管超聲對骨折術后下肢深靜脈血栓的預測價值及與凝血-纖溶標志物的關系

李明輝 薛丹鳳 張任遠 陳麗華

摘 要 目的：分析下肢血管超聲對脛骨平臺骨折患者術后下肢深靜脈血栓（DVT）的預測價值及與經典凝血-纖溶標志物的關系。方法：收集康復科2019年5月至2021年5月收治的脛骨平臺骨折患者60例，均行下肢血管超聲檢查，將23例發生DVT的患者作為試驗組1；37例未發生DVT的患者作為試驗組2；選取同期門診健康體檢者30例作為對照組。比較三組間的凝血-纖溶標志物和超聲血流動力學指標差異，并分析超聲血流動力學指標與凝血-纖溶標志物的相關性。結果：對照組舒張末期流速（Vd）、和收縮期峰值流速（Vs）均低于試驗組2，試驗組2均低于試驗組1（P<0.05）。對照組血流阻力指數（RI）高于試驗組2，試驗組2高于試驗組1（P<0.05）。試驗組1 D-二聚體（D-D）、纖維蛋白原（FIB）和纖維蛋白降解產物（FDP）均高于試驗組2，試驗組2均高于對照組（P<0.05）。試驗組1部分活化凝血酶原時間（APTT）、凝血酶時間（TT）和凝血酶原時間（PT）均低于試驗組2，試驗組2均低于對照組（P<0.05）。Pearson相關性分析顯示，Vd、Vs與D-D、FIB、FDP呈正相關，Vd、Vs與APTT、TT、PT呈負相關，RI與D-D、FIB、FDP呈負相關，RI與APTT、TT、PT呈正相關性（P<0.05）。結論：脛骨平臺骨折術后DVT患者下肢血管超聲血流動力學參數與凝血-纖溶標志物存在一定的相關性，通過下肢血管超聲檢查以及檢測凝血-纖溶標志物，可預測DVT發生，臨床應用價值較高。

關鍵詞 下肢深靜脈血栓；脛骨平臺骨折；下肢血管超聲；凝血-纖溶標志物

中圖分類號：R274.12 文獻標志碼：A 文章編號：1006-1533（2021）20-0030-04

Predictive value of vascular ultrasound for deep venous thrombosis of lower extremity after fracture operation and its relationship with coagulation-fibrinolysis markers

LI Minghui1， XUE Danfen2， ZHANG Renyuan1， CHEN Lihua3（1.Diagnosis and Treatment Department； 2. Clinical Laboratory； 3. Rehabilitation Department of the Fifth Rehabilitation Hospital of Shanghai， 201602， China）

ABSTRACT Objective： To analyze the predictive value of lower extremity vascular ultrasound for postoperative deep venous thrombosis（DVT） in patients with tibial plateau fractures and its relationship with classic coagulation-fibrinolysis markers. Methods： Sixty patients with tibial plateau fractures admitted to the Rehabilitation Department from May 2019 to May 2021 were collected， all underwent lower extremity vascular ultrasound examinations， 23 patients with DVT were selected as the experimental group 1； thirty-seven patients without DVT were selected as the experimental group 2； thirty patients with healthy physical examination in the outpatient clinic during the same period were selected as the control group. The differences of coagulation-fibrinolysis markers and ultrasonic hemodynamic indexes among the three groups were compared and the correlation between ultrasonic hemodynamic indexes and coagulation-fibrinolysis markers analyzed. Results： The end diastolic velocity（Vd） and peak systolic velocity（Vs） in the control group were lower than those in the experimental group 2， and those in the experimental group 2 were lower than those in the experimental group 1（P<0.05）. The blood flow resistance index（RI） in the control group was higher than that in the experimental group 2， and that in the experimental group 2 was higher than that in the experimental group 1（P<0.05）. D-Dimer（D-D）， fibrinogen（FIB） and fibrin degradation products（FDP） in the experimental group 1 were higher than those in the experimental group 2， and those in the experimental group 2 were higher than those in the control group（P<0.05）. Partial activated prothrombin time（APTT）， thrombin time（TT） and prothrombin time（PT） in the experimental group 1were lower than those in the experimental group 2， and those in the experimental group 2 were lower than those in the control group（P<0.05）. Pearson correlation analysis showed that Vd and Vs were positively correlated with D-D， FIB， and FDP， Vd and Vs were negatively correlated with APTT， TT， and PT， RI was negatively correlated with D-D， FIB， and FDP， and RI was positively correlated with APTT， TT， and PT（P<0.05）. Conclusion： There is a certain correlation between ultrasonic hemodynamic parameters of blood vessels of lower extremities and coagulation-fibrinolysis markers in the patients with DVT after tibial plateau fracture， ultrasound examination of blood vessels in the lower extremities and detection of coagulationfibrinolysis markers can predict the occurrence of DVT， and the clinical application value is high.