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目的探讨D-二聚体在老年恶性肿瘤患者围术期预测下肢深静脉血栓形成(DVT)的价值。方法选择2014年5月至2014年12月确诊并择期手术治疗的120例老年恶性肿瘤住院患者,术前24 h和术后1、3、5、10、20d测定血浆中D-二聚体水平,对于围手术期疑似DVT的患者,采用彩色多普勒检查诊断确诊,如不能明确诊断则结合静脉造影确诊。结果 120例患者术后DVT发生率为20.8%;术前检测D-二聚体用于围手术期是否出现DVT的判断敏感度为96.0%,特异性较为11.6%;术前D-二聚体阳性组围手术期出现DVT的概率显著高于阴性组,差异有统计学意义(22.2%vs 8.3%,P<0.01)。确诊DVT的25例患者在确诊DVT前23例呈现持续上升趋势,2例出现一过性下降后突然上升。Logistic回归分析显示,年龄越大出现DVT的几率越大(P<0.05)。结论D-二聚体水平对老年恶性肿瘤患者DVT的预测具有重要价值,对于高龄或术后D-二聚体水平持续后突然升高患者要做好DVT的预防工作。
Objective To investigate the value of D-dimer in the prediction of perioperative lower extremity deep vein thrombosis (DVT) in elderly patients with malignant tumors. Methods A total of 120 elderly patients with malignant tumors diagnosed and undergoing elective surgery from May 2014 to December 2014 were enrolled in this study. Plasma D-dimer levels were measured at 24 h and 1,3,5,10 and 20 d after operation , For the perioperative DVT suspected patients diagnosed by color Doppler diagnosis, if not clear diagnosis is confirmed with venography. Results The incidence of postoperative DVT in 120 patients was 20.8%. The sensitivity and specificity of detecting D-dimer before surgery for perioperative DVT were 96.0% and 11.6% respectively. Preoperative D-dimer The positive rate of perioperative DVT was significantly higher than the negative group, the difference was statistically significant (22.2% vs 8.3%, P <0.01). Twenty-five patients diagnosed with DVT showed an increasing trend before the diagnosis of DVT, and two patients suddenly increased after transient decrease. Logistic regression analysis showed that the older the greater the chance of DVT (P <0.05). Conclusion The level of D-dimer is of great value in the prediction of DVT in elderly patients with malignant tumor. The prevention of DVT should be done in patients with sudden increase of elderly or postoperative D-dimer.