本文選題：下肢靜脈血 + RAPT評分��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景靜脈血栓栓塞癥(VTE)是骨創(chuàng)傷患者常見的并發(fā)癥之一,主要包括深靜脈血栓(DVT)和肺栓塞(PE)。深靜脈血栓可以發(fā)生在人體的任何部位,但以下肢靜脈最為常見。下肢深靜脈血栓通常無明顯癥狀,而血栓一旦脫落,可隨血流進入肺循環(huán),導(dǎo)致肺栓塞的發(fā)生,嚴重肺栓塞可在短時間內(nèi)導(dǎo)致患者死亡。為此,我們需要對可疑下肢DVT患者進行早期篩查、診斷并行抗凝治療,繼而從源頭上防止部分肺栓塞的發(fā)生。目前臨床上常用的下肢DVT篩查方法主要包括臨床風險評估量表及D-二聚體,但臨床風險評估量表通常敏感性較差,而D-二聚體特異性較差,這給臨床工作帶來了極大的不便,促使我們尋找一種更加高效的下肢DVT篩查手段。目的分析評價RAPT評分、D-二聚體及RAPT評分結(jié)合D-二聚體篩查骨創(chuàng)傷患者下肢DVT的應(yīng)用價值,探討臨床最佳DVT篩查診斷流程。方法回顧性研究本治療組2016年07月至2016年12月期間可疑下肢DVT患者的RAPT評分、下肢靜脈超聲結(jié)果及當日D-二聚體值。依照下肢靜脈超聲結(jié)果作為下肢深靜脈血栓有無的"金標準",將患者分為DVT組及非DVT組,比較兩組之間RAPT評分及D-二聚體值有無顯著性差異。對比分析RAPT評分、D-二聚體及利用RAPT評分結(jié)合D-二聚體篩查骨創(chuàng)傷患者下肢DVT的應(yīng)用價值,尋找最適合骨創(chuàng)傷患者的下肢DVT篩查方法。結(jié)果共納入197例研究對象,其中DVT組96例,非DVT組101例。兩組患者在年齡及性別構(gòu)成上無顯著性差異。DVT組D-二聚體值為2.35(1.10,4.13)ug/ml,非DVT組D-二聚體值平均為0.98(0.50,1.12)ug/ml,兩組之間存在顯著性差異,P0.01;在RAPT評分方面,DVT組為10(6,12),非DVT組平均為4(3,9),兩組之間存在顯著性差異,P0.01。依RAPT評分分組,分為低危組(≤5分)及中高危組(5分),低危組患者排除血栓,中高危組患者需進一步行下肢靜脈超聲檢查以明確診斷,該篩查方法敏感性為78.12%,特異性為56.44%。受試者工作特征曲線(ROC)下面積為0.723,證明RAPT對診斷下肢靜脈血栓有一定的準確性。利用ROC曲線對患者D-二聚體值及下肢DVT有無進行分析,利用約登指數(shù)獲得最佳診斷值為1.125 μg/ml。該篩查方法敏感性為86.46%,特異性57.43%,ROC曲線下面積0.803。結(jié)合RAPT評分與D-二聚體新閾值篩查下肢DVT,即RAPT評分為低危且D-二聚體低于1.125 μ g/ml者排除血栓診斷,否則進一步行下肢靜脈超聲檢查明確診斷。該篩查方法敏感性為96.88%,特異性為42.57%,ROC曲線下面積為0.812。結(jié)論與單純利用RAPT評分或D-二聚體篩查下肢DVT相比,利用D-二聚體新閾值聯(lián)合RAPT的方法更好地兼顧了敏感性與特異性,在保證高敏感性的同時,進一步提高了特異性,減少了部分患者不必要的進一步影像學(xué)檢查。是符合臨床醫(yī)師要求和患者利益的有效篩查方法。
[Abstract]:Background Venous thromboembolism (VTET) is one of the common complications in patients with bone trauma, including DVT (deep vein thrombosis) and PEI (pulmonary embolism).Deep venous thrombosis can occur in any part of the human body, but the lower extremity vein is the most common.Deep venous thrombosis of the lower extremity usually has no obvious symptoms, but once the thrombus falls off, it can enter the pulmonary circulation with the blood flow, leading to the occurrence of pulmonary embolism, and the severe pulmonary embolism can lead to the death of the patient in a short time.Therefore, we need to screen suspected lower extremity DVT patients early, diagnose and treat with anticoagulant therapy, and then prevent partial pulmonary embolism from the source.At present, clinical risk assessment scale and D-dimer are the main screening methods of lower extremity DVT, but the sensitivity of clinical risk assessment scale is poor, and the specificity of D- dimer is poor, which brings great inconvenience to clinical work.Urge us to look for a more efficient screening method for lower extremity DVT.Objective to evaluate the value of RAPT score and RAPT score combined with Ddimer in the screening of lower extremity DVT in patients with bone trauma, and to explore the best clinical diagnostic procedure for DVT screening.Methods the RAPT score of suspected lower extremity DVT patients, the results of lower extremity venous ultrasound and the value of D-dimer were studied retrospectively in the treatment group from July 2016 to December 2016.The patients were divided into DVT group and non- group according to the results of lower extremity vein ultrasound as the "gold standard" for deep venous thrombosis of lower extremity. The RAPT score and D-dimer value were compared between the two groups.The application value of RAPT score and RAPT score combined with Ddimer in screening lower extremity DVT in patients with bone trauma was compared and analyzed to find the most suitable lower limb DVT screening method for patients with bone trauma.Results A total of 197 subjects were included, including 96 cases in DVT group and 101 cases in non-DVT group.There was no significant difference in age and sex composition between the two groups. The Ddimer value of DVT group was 2.35 鹵1.104.13ug.ml. the average Ddimer value of non- group was 0.980.50 鹵1.12ug.ml. there was a significant difference between the two groups (P0.01), and the RAPT score of DVT group was 10612g / ml, and that of non- group was 439g / ml, respectively.There was significant difference between the two groups (P 0.01).According to the RAPT score, the patients were divided into low risk group (鈮，

本文編號：1767697