下肢骨折内固定术后监测血浆D-二聚体及同型半胱氨酸临床意义.doc

下肢骨折内固定术后监测血浆D-二聚体及同型半胱氨酸临床意义[摘要] 目的：探讨血浆D-二聚体与同型半胱氨酸含量变化与内固定术后并发下肢深静脉血栓的相关性。方法：我院行手术内固定术的下肢骨骨折患者158例，根据术后是否发生DVT分为DVT组和对照组，于术前、术后24 h和48 h抽取静脉血2 ml，测定其血浆D-二聚体、同型半胱氨酸、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）。结果：DVT组D-二聚体、同型半胱氨酸血浆浓度术后24、48 h时较对照组高，有非常显著性差异（P＜0.01），PT、APTT仅在术后48 h高于对照组（P＜0.05），24 h时与对照组比较差异无统计学意义（P＞0.05）。术后D-二聚体、同型半胱氨酸血浆浓度值与DVT存在相关性（r=3.11，P＜0.05；r=4.53，P＜0.05），说明D-二聚体与同型半胱氨酸血浆浓度升高与DVT的发生存在正相关性。结论：无论凝血指标是否异常，D-二聚体和（或）同型半胱氨酸异常则血液都存在高凝状态或继发性纤溶功能亢进。血浆D-二聚体、同型半胱氨酸是下肢骨折内固定术后并发下肢深静脉血栓的独立危险因子，监测其变化可提高诊断血栓的的敏感性和特异性。 [关键词] 下肢骨折；D-二聚体；同型半胱氨酸；深静脉血栓；内固定术 [中图分类号] R683 [文献标识码]A [文章编号]1673-7210（2008）02（b）-013-02 The value of plasma D-dimer and homocysteic acid to predict deep vein thrombosis (DVT) in patients with lower limb bone fracture TAN-Ri （Xi-xiang People’s Hospital of Baoan, Shenzhen 518101, Ｃｈｉｎａ） [Abstract] Objective: To explore the value of plasma D-dimer and homocysteic acid for predicting deep vein thrombosis (DVT) in patients with lower limb bone fracture, who were treated by internal fixation. Methods:158 cases,treated by internal fixation, were divided into DVT and control groups, according to patients’condition.D-dimer,homocysteic acid, prothrombin time, and activated partial thromboplastin time were monitored. Results: The plasma content of D-dimer and homocysteic acid of patients in DVT group were higher than those in control group, both 24 hours and 48 hours after the operation. They had dependablity with DVT（r=3.11，P＜0.05；r=4.53，P＜0.05）.Conclusion:The low specificity of positive D-dimer and homocysteic acid assay have value for predicting occurrence of DVT in patients with lower limb fracture. [Key words] Lower limb fracture; D-dimer; Homocysteic acid; Deep vein thrombosis; Internal fixation 严重创伤，尤其是多发性长骨骨折后容易发生下肢深静脉血栓（deep vein throm，DVT）。DVT患者一般无临床表现，但一旦发生，可导致致命性肺血栓栓塞症和下肢深静脉功能不全等严重后果[1]。资料显示，术后24~48 h是下肢骨折患者DVT发生的最高峰，因此，寻找预测DVT发生的可靠血清学指标是目前研究热点。本课题将D-二聚体、同型半胱氨酸检测与凝血指标结合分析下肢骨折患者术后发生DVT的风险性，以指导临床治疗。 1 资料与方法 1.1一般资料 随机选取2004年1