【摘要】 [目的]回顾分析腰椎间盘突出症(lumbar disc herniation,LDH)预手术患者下肢深静脉血栓(deep vein thrombosis,DVT)形成的发生率,探讨LDH术前DVT形成的危险因素。[方法]山东省立医院2014年9月~2015年9月住院治疗患者220例,入院常规行D-二聚体检查(D-dimer concentration,DD),DD>0.5 mg/L或出现DVT症状(下肢肿胀、疼痛)的患者行下肢彩超检查。比较DVT组与无DVT组在年龄、性别、病史、基础疾病等方面的差异。[结果]LDH术前DVT发生率为5.90%(13/220),16侧肢体。未发生症状性肺栓塞。血栓组与非血栓组相比,在年龄、DD水平方面差异具有统计学意义,分别为(60.92±9.25)岁vs.(45.42±12.92)岁(P=0.001)、(1.87±1.41.15)mmol/L vs.(0.39±0.59)mmol/L(P=0.003)。两组在心脑血管病史、血脂异常方面差异具有统计学意义,分别为23.1%vs.0.5%(P=0.001)、61.5%vs.15.5%(P=0.000)。两组在性别、病程、糖尿病史、高血压病史方面无统计学差异。DD预测下肢深静脉血栓的受试者工作特征曲线(ROC)下面积0.895(95%可信区间:0.846,0.932;P<0.001)。DD>0.57 mg/L时对DVT预测的敏感度和特异度分别为84.62%和85.00%。[结论]LDH患者具有较高的术前DVT发生率。术前下肢血管评估是必要的。特别是高龄、心脑血管病史、高血脂患者尤为重要。更多还原

【Abstract】 [Objective] To investigated the risk factors of deep vein thrombosis(DVT) in patients with lumbar disc herniation(LDH) before surgery. [Methods] This study cohort consisted of 220 consecutive patients with LDH who were scheduled for surgical treatment from 2014 to 2015. As plasma D-dimer level more than 0.5mg/L or apparent clinical manifestation appeared before operation, the patient received a Doppler ultrasonography to confirm whether or not he or she suffered from DVT, which was defined as an intraluminal filling defect in a lower extremity vein. Parameters such as gender, age, illness history and underlying diseases were compared between the DVT and non-DVT groups. [Results] Of the 220 patients with LDH,DVT was preoperatively verified in 13 patients(5.90%) with ultrasonography. The patients with preoperative DVT had older age(60.92±9.25 vs 45.42±12.92 years, P=0.001), higher plasma D-dimer concentrations(1.87±1.41 vs 0.39±0.59 mg/L,P=0.003), dyslipidemia history(61.5% vs. 15.5% months, P=0.000), and experienced ischemic cardiovascular events(23.1% vs. 0.5%, P=0.001), compared with the non-DVT group. The area under the curve for the power of D-dimer level to predict DVT was 0.895(95% confidence interval 0.846~0.932, P<0.001). As D-dimer level higher than 0.57 mg/L,DVT could be predicted in a sensitivity of 84.62% and specificity of 85.00%, respectively. [Conclusion] Patients with LDH who are scheduled for surgery might have preoperative DVT. Preoperative DVT screening should be considered for the patients with LDH, especially for those who are older, have history of dyslipidemia and cardiovascular event.更多还原