目的 探讨新近入院骨折患者手术前血浆D-二聚体指标的检测对提示并发深静脉血栓的风险性评估.方法 收集2011年9月～2012年4月新近入院骨折患者1 268例,将其设为观察组,按照骨折创伤程度将其分成三组,A组:肢体单处闭合性骨折(654例)；B组:肢体单处开放性骨折(316例)；C组:肢体2处或2处以上骨折伴血管损伤或脏器损伤或下肢大骨折创伤(298例),以同期100名健康体检人员为对照组,采用免疫比浊法测定其血浆D-二聚体(D-D)指标,同时收集观察组中进一步做彩色多普勒超声、螺旋CT、血管造影等影像学检查的骨折患者339例,发现深静脉血栓(DVT)组12例,无DVT组327例,所有数据均用SPSS Statistic 17.0统计软件进行分析比较.结果 观察组D-D指标水平(2.68±2.53) mg/L明显高于对照组(0.27士0.22)mg/L,差异具有统计学意义(t=7.235,P＜0.01),其中骨折A组D-D(0.31±0.17)mg/L无明显变化(t=1.564,P＞0.05),骨折B组D-D(0.89±0.36)mg/L升高,差异有统计学意义(t=2.178,P＜0.05),而骨折C组D-D(6.64±2.33)mg/L明显升高(t=9.336,P＜0.01)；不同骨折组间比较:D-D指标差异也有明显统计学意义(F=18.047,P＜0.01)；与未并发DVT骨折组D-D(3.23±2.45)mg/L相比,并发DVT骨折组D-D(8.92±5.61)mg/L明显升高,差异具有统计学意义(t=11.792,P＜0.01).结论 骨折创伤较严重的患者较易并发DVT,其手术前血浆D-D指标的检测对提示并发DVT有很好的评估与预防指导作用.%Objective To study the evaluation of deep venous thromboembolism with the plasma d-dimer test in new preoperative f orthopaedic trauma patients. Methods 1 268 patients were chosed in the department of orthopaedic trauma in the General Hospital of Fengfeng Group of Jizhong Enery from September 2011 to April 2012 as the observation group. According to the fracture wound degree,they were separated into three groups,group A:body shall only closed fracture(n=654) ; group B:body shall only open fractures(n= 316); group C:body two places or more places with the blood vessel damage fracture or visceral injury or lower limb big fracture trauma(n=298). The same period in 100 healthy medical employees as the control group,and determined the plasma d-dimer (D-D) index by immune turbidity method. At the same time,339 patients were collected in the observation group that they futher determined color doppler ultrasound,spiral CT,angiography, etc,imaging examination, further found that they had deep venous thrombaembolism (DVT) 12 patients and no DVT fracture 327 patients. All data were analysed with SPSS Statistic 17. 0 statistical software carries. Results Compared the observation group with the control group,D-D increase obviously(2. 68±2. 53 mg/L,t=7. 235,P<0. 01). Group A had no obviously change (0. 31 ±0. 17 mg/L,t=l. 564, P>0. 05) ,group B had difference (0. 89±0. 36 mg/L,t=2. 178, P<0. 05) and D-D increased obviously that difference was obviously in group C (6. 64±2. 33 mg/L,t=9. 336,P<0. 01). Different groups of fracture was:D-D index difference also had the obvious statistical significance (F=18. 047, P<0. 01). Compared deep venous thromboembolism (DVT) group with no DVT group,plasma D-dimer increase obviously,differences had the most high (8. 92 + 5. 61 mg/L,t=ll. 792, P<0. 01). Conclusion The value of the plasma D-Dimer index determination in preoperative patients with fracture have useful to evaluate DVT.
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