| 陈怿爽,吕一,马俊义.骨科大手术围手术期血浆D-二聚体和纤维蛋白原动态监测及临床意义[J].浙江中西医结合杂志,2017,27(2): |
| 骨科大手术围手术期血浆D-二聚体和纤维蛋白原动态监测及临床意义 |
| Dynamic monitoring and clinical significance of plasma D- dimer and fibrinogen in the perioperative period of major orthopedic surgery |
| 投稿时间：2016-07-18 修订日期：2016-08-30 |
| DOI： |
| 中文关键词: 骨科大手术 围手术期 D-二聚体 纤维蛋白原 深静脉血栓形成 |
| 英文关键词:Major orthopedic surgery Perioperative period D-dimer Fibrinogen Deep vein thrombosis |
| 基金项目:浙江省中医药重点学科（中医老年骨伤学）建设项目资助（编号：2012-xk-A17） |
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| 中文摘要: |
| 目的：探讨骨科大手术患者围手术期血浆D-二聚体(D-D)和纤维蛋白原(Fib)动态变化的规律，并研究其对预防深静脉血栓的临床价值。方法：对在我院住院的57例骨科大手术患者，按有无骨折创伤及伤后至手术时间分为新鲜骨折和非新鲜骨折两组，对两组患者血浆D-D和Fib指标在术前、术后2h、术后第1、3、5、7天连续测定，同时在术前及术后第5天进行下肢深静脉B超的检查确认有无深静脉血栓形成（DVT）。结果：两组患者术后均未发现DVT。围手术期两指标通过重复测量方差分析得出，D-D指标时间因素、分组因素、时间与分组因素交互作用均具有统计学意义，新鲜骨折组较非新鲜骨折组变化更显著；Fib指标的时间因素，时间与分组因素交互作用具有统计学意义，而分组因素无统计学意义。两者在术后2h即达到各自变化的极值，并在术后的3天内出现快速的回复。结论：血浆D-D和Fib的动态监测能够较好的反映创伤和手术对骨科大手术患者凝血和纤溶系统的影响，对术后3天内出现异常变化的患者，给予及时的下肢深静脉B超检查有助于发现DVT的发生。 |
| 英文摘要: |
| Objective: To investigate the dynamic changes of plasma D-dimer (D-D) and fibrinogen (Fib) in patients undergoing major surgery in the Department of orthopedics, and to study the clinical value of the study on the prevention of deep venous thrombosis.
Methods: In our hospital 57 patients with orthopedic surgery patients, the fracture trauma and injury to the operation time according to the fresh fractures and non fresh fractures in both groups, of two groups of patients with plasma D-dimer and FIB index in pre-operative and postoperative 2 hours, after 1, 3, 5, 7 days continuous determination, also in preoperative and postoperative day 5 were of lower extremity deep venous ultrasound examination confirmed deep vein thrombosis (DVT).
Results: No DVT patient was found in the two groups after operation. Peri operative period two indexes by repeated measurement analysis of variance analysis that time index of D-dimer and grouping factor, time and the grouping factor interaction has statistical significance, the fresh fracture group was lower than that in non fresh fracture group changed more significantly; index of FIB time factors, the interaction of time and group factors with statistical significance and grouping factor was not statistically significant. Both in the postoperative 2H reached the extreme value of their changes, and within 3 days after the emergence of a rapid response.
Conclusion: the dynamic monitoring of plasma D-dimer and fibrinogen can better reflect trauma and surgical fibrinolysis system in patients undergoing major orthopedic surgery of coagulation and fibrinolytic effects, within 3 days after the operation of appeared abnormal changes of patients and give timely lower extremity deep venous ultrasonography can occur in the discovery of DVT. |
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