腰椎管狭窄症术后D―二聚体动态变化与下肢深静脉血栓发生的关系.docVIP

腰椎管狭窄症术后D―二聚体动态变化与下肢深静脉血栓发生的关系 　　[摘要] 目的 探讨腰椎管狭窄症术后D-二聚体动态变化与下肢深静脉血栓发生的关系。 方法 选取2014年1月～2015年4月于首都医科大学附属北京潞河医院行标准后正中入路减压融合手术的腰椎管狭窄症患者284例，在术前、术后即刻、术后第1天、第3天和第7天采集所有患者的静脉血液，离心后取上清液测定其D-二聚体含量，于术后第7天对所有患者进行下肢静脉彩超检查，根据患者的静脉彩超结果是否存在下肢深静脉血栓将患者分成血栓组（13例）和对照组（271例），比较两组患者在不同时间点的D-二聚体含量变化情况。 结果 所有血栓均为无症状血栓。在术前和术后的不同时间点内，血栓组血清D-二聚体含量较对照组高，差异有统计学意义（P 0.05或P 0.01）；ROC曲线下面积为0.84，95%CI为0.77～0.90，D-二聚体诊断腰椎管狭窄症术后即刻出现下肢深静脉的临界值为0.63 μg/mL，灵敏性为92.31%，特异性为68.27%，准确性为72.6%。 结论 在术后即刻以0.63 μg/mL含量的D-二聚体作为腰椎管狭窄症术后下肢深静脉血栓形成的预测和诊断手段，其灵敏性、特异性以及准确性均相对较高。 　　[关键词] 腰椎管狭窄症；D-二聚体；下肢深静脉血栓；关系 　　[中图分类号] R681.55 [文献标识码] A [文章编号] 1673-7210（2015）08（a）-0089-05 　　Relationship of dynamic changes of D-dimer after lumbar spinal stenosis surgery and occurrence of lower extremity deep venous thrombosis 　　YUAN Xin WANG Yanhui CHEN Xueming YU Zhenshan CUI Libin XU Songjie LIU Yadong QI Wenlong 　　Department of Spine Surgery， Beijing Luhe Hospital， Capital Medical University， Beijing 101149， China 　　[Abstract] Objective To investigate the relationship of dynamic changes of D-dimer after lumbar spinal stenosis surgery and occurrence of lower extremity deep venous thrombosis. Methods From January 2014 to April 2015， 284 patients with lumbar spinal stenosis receiving standard posterior approach of decompression and fusion in Beijing Luhe Hospital， Capital Medical University were enrolled. Venous blood of all patients was collected preoperatively， immediately after surgery， and 1， 3， 7 days postoperatively. After centrifugation， the supernatant was taken to determine the content of D-dimer. On the seventh day after surgery， all patients underwent color Doppler ultrasound examination in the lower extremity vein. According to whether there was lower extremity deep venous thrombosis by vein color Doppler ultrasound results， the patients were divided into the thrombus group （13 cases） and the control group （271 cases）. The changes of D-dimer contents at different time points between the two groups were compare