血管超声对骨折术后下肢深静脉血栓的预测价值及与凝血-纤溶标志物的关系

李明辉 薛丹凤 张任远 陈丽华

摘 要 目的：分析下肢血管超声对胫骨平台骨折患者术后下肢深静脉血栓（DVT）的预测价值及与经典凝血-纤溶标志物的关系。方法：收集康复科2019年5月至2021年5月收治的胫骨平台骨折患者60例，均行下肢血管超声检查，将23例发生DVT的患者作为试验组1；37例未发生DVT的患者作为试验组2；选取同期门诊健康体检者30例作为对照组。比较三组间的凝血-纤溶标志物和超声血流动力学指标差异，并分析超声血流动力学指标与凝血-纤溶标志物的相关性。结果：对照组舒张末期流速（Vd）、和收缩期峰值流速（Vs）均低于試验组2，试验组2均低于试验组1（P<0.05）。对照组血流阻力指数（RI）高于试验组2，试验组2高于试验组1（P<0.05）。试验组1 D-二聚体（D-D）、纤维蛋白原（FIB）和纤维蛋白降解产物（FDP）均高于试验组2，试验组2均高于对照组（P<0.05）。试验组1部分活化凝血酶原时间（APTT）、凝血酶时间（TT）和凝血酶原时间（PT）均低于试验组2，试验组2均低于对照组（P<0.05）。Pearson相关性分析显示，Vd、Vs与D-D、FIB、FDP呈正相关，Vd、Vs与APTT、TT、PT呈负相关，RI与D-D、FIB、FDP呈负相关，RI与APTT、TT、PT呈正相关性（P<0.05）。结论：胫骨平台骨折术后DVT患者下肢血管超声血流动力学参数与凝血-纤溶标志物存在一定的相关性，通过下肢血管超声检查以及检测凝血-纤溶标志物，可预测DVT发生，临床应用价值较高。

关键词 下肢深静脉血栓；胫骨平台骨折；下肢血管超声；凝血-纤溶标志物

中图分类号：R274.12 文献标志码：A 文章编号：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.