摘要
目的:探讨血浆D-二聚体在老年髋部骨折患者出院后扩展抗凝中的指导意义。方法:回顾性分析2016年1月至2020年11月期间河北医科大学第三医院创伤急救中心收治的355例老年髋部骨折患者资料。男107例,女248例;平均年龄为79.0岁(65~102岁)。骨折类型:股骨颈骨折179例,股骨转子间骨折159例,股骨转子下骨折17例。于入院时、手术前、术后35 d检测患者血浆D-二聚体浓度,于入院时、手术前、出院前及术后35 d行下肢深静脉彩色多普勒超声检查。出院时存在深静脉血栓形成(DVT)者,于出院后15 d复查。根据患者血浆D-二聚体、彩色多普勒超声检查结果及症状、体征制定抗凝防治策略。比较患者不同时间点及血栓患者与非血栓患者的血浆D-二聚体浓度。结果:355例患者入院时、手术前、术后35 d血浆D-二聚体浓度分别为2.73(1.72,5.13)、1.31(0.72,2.58)、0.49(0.25,0.80)mg/L,术后35 d D-二聚体水平较入院时及手术前显著降低,差异均有统计学意义(P<0.05)。入院时、手术前、出院前及术后35 d存在DVT的患者例数分别为105、126、191、148例,其中绝大部分为远端DVT。术后35 d血栓患者与非血栓患者D-二聚体浓度分别为0.64(0.32,1.00)、0.37(0.22,0.68)mg/L,差异有统计学意义(P<0.05)。术后35 d血浆D-二聚体诊断DVT的受试者工作特征曲线下面积为0.665。结论:老年髋部骨折患者出院后的扩展抗凝及血浆D-二聚体连续监测至关重要。对于出院时有DVT的患者,血浆D-二聚体阴性为终止抗凝的标志;对于出院时无DVT的患者,术后35 d扩展抗凝是合理的。
Objective To study the clinical significance of plasma D-dimer for extended anticoagulation in the elderly patients with hip fracture after discharge.Methods The data were retrospectively analyzed of the 355 elderly patients with hip fracture who had been admitted to Emergence Center of Trauma and Department of Orthopedic Surgery,The Third Hospital of Hebei Medical University from January 2016 to November 2020.There were 107 males and 248 females with a mean age of 79.0 years(from 65 to 102 years).There were 179 femoral neck fractures,159 intertrochanteric fractures,and 17 subtrochanteric fractures.Plasma D-dimer concentrations were detected at admission,before surgery,and 35 days after surgery.Color Doppler ultrasonography of deep veins of lower extremities was performed at admission,before surgery,before discharge,and 35 days after surgery.The patients with deep vein thrombosis(DVT)at the time of discharge should were reexamined 15 days after discharge.Strategies for anticoagulation prevention and treatment were formulated according to the patients'plasma D-dimer,color Doppler ultrasonography results,symptoms and signs.Plasma D-dimer concentrations were compared between patients with thrombosis and without thrombosis at different time points.Results The plasma D-dimer concentrations for the 355 patients at admission,before surgery and 35 days after surgery were 2.73(1.72,5.13)mg/L,1.31(0.72,2.58)mg/L,and 0.49(0.25,0.80)mg/L,respectively.The level of D-dimer at 35 days after surgery was significantly lower than that at admission and before surgery(P<0.05).There were,respectively,105,126,191 and 148 patients with DVT at admission,before surgery,before discharge and 35 days after surgery,and the DVT was distal in most cases.The D-dimer concentrations for patients with thrombosis and without thrombosis at 35 days after surgery was 0.64(0.32,1.00)mg/L and 0.37(0.22,0.68)mg/L respectively,showing a significant difference(P<0.05).The area under the receiver operating characteristic curve of plasma D-dimer for the diagnosis of DVT at 35 days after surgery was 0.665.Conclusions Extended anticoagulation and continuous monitoring of plasma D-dimer are very important for elderly patients with hip fracture after discharge.For patients with DVT at discharge,negative plasma D-dimer is a sign for termination of anticoagulation;for patients without DVT at discharge,it is reasonable to extend anticoagulation 35 days after surgery.
作者
韩子望
杨旭庆
王庆贤
Han Ziwang;Yang Xuqing;Wang Qingxian(Emergence Center of Trauma,Department of Orthopedic Surgery,The Third Hospital of Hebei Medical University,Orthopedic Research Institution of Hebei Province,Key Laboratory of Biomechanics of Hebei Province,Shijiazhuang 050051,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第9期766-772,共7页
Chinese Journal of Orthopaedic Trauma
基金
河北省卫计委医学科学研究重点课题计划 (20170658)。
