胸外科术后肺栓塞诊断中的D—二聚体检测及其临床分析(1)
摘要：目的 在胸外科术后对肺栓塞患者进行诊断的D-二聚体检测及其临床分析，探讨其意义。方法 选取2013年10月～2014年10月在我院收治的168例胸外科手术后发生肺栓塞的患者，回顾性分析其临床资料，并对其进行D-二聚体检测。结果 在进行胸外科手术的患者中，年龄大于五十岁的患者比年龄小于50岁的患者，肺栓塞发生率明显升高；肥胖的患者比体重标准的患者，肺栓塞发生率明显升高；患有恶性肿瘤的患者相较于良性肿瘤的患者，肺栓塞发生率明显升高；差异均具有明显统计学意义(P<0.05)。患者出现高龄、肥胖、合并恶性肿瘤等因素都是增加胸外科手术术后肺栓塞发生率的危险因素。对患者进行D-二聚体检测，敏感性和阴性预测值均为100%，假阳性率为94.1%。结论 肥胖、高龄、恶性肿瘤等因素，会增加患者胸外科手术术后肺栓塞发生率，用D-二聚体检测对肺栓塞患者进行诊断，检测出的阴性结果正确率高，值得在临床中推广应用。
关键词：肺栓塞；D-二聚体；分析
中图分类号：R655.3 文献标识码：A 文章编号：1006-1959(2017)13-0069-02
, 百拇医药
Abstract：Objective To investigate the significance of D-dimer in the diagnosis of pulmonary embolism after thoracic surgery and its clinical analysis. Methods A total of 168 patients with pulmonary embolism who underwent thoracic surgery from October 2013 to October 2014 were retrospectively analyzed for their clinical data and were analyzed for D-dimer.Results In patients undergoing thoracic surgery，the incidence of pulmonary embolism was significantly higher in patients older than 50 years than in those younger than 50 years；obese patients had a significantly higher incidence of pulmonary embolism than those with weight criteria；patients with malignant tumors had a significantly higher incidence of pulmonary embolism than patients with benign tumors；the differences were statistically significant(P<0.05).Patients with age，obesity，combined with malignant tumors and other factors are increased thoracic surgery after the incidence of pulmonary embolism risk factors.D-dimer detection was performed on patients，with sensitivity and negative predictive values of 100% and false positive rates of 94.1%.Conclusion Obesity，age，malignancy and other factors will increase the incidence of pulmonary embolism after thoracic surgery，diagnosis of pulmonary embolism with D-dimer detection， the detection of negative results of high accuracy，it is worth popularizing in clinical practice.
, 百拇医药
Key words：Pulmonary embolism；D-dimer；Analysis
肺栓塞發生的起因是体内栓子的脱落，各种类型的栓子脱落均会造成，最常见的是血栓，还有脂肪栓、空气栓、细菌栓等等[1]。通常，肺栓塞单独发生几率较小，是胸外科手术后的常见并发症，一旦并发症发生，患者容易因为呼吸系统的障碍，易发生呼吸困难，甚至窒息[2]。所以，我们对胸外科手术术后肺栓塞的诊断进行探讨，为提高患者提供更及时的治疗，减少手术风险，具有重要的意义。我院对168例胸外科手术中发生肺栓塞的患者进行研究如下。
1 资料与方法
1.1一般资料
选取2013年10月～2014年10月我院进行胸外科手术的的168例患者，同时在手术中并发肺栓塞症状。研究前，对168例患者的临床资料进行统计学分析：男性有70例，女性有98例，年龄在35～88岁，平均年龄(61.1±5.2)岁。选取30例患者进行D-二聚体检测，纳入标准[4]：住院患者；胸外科手术后发生肺栓塞；同意进行血浆D-二聚体检测和CT检查。
1.2方法
符合上述纳入标准的30例患者，手术前进行血浆D-二聚体检测，胸外科手术后三天再次进行血浆D-二聚体检测。同时密切关注患者的症状，在进行D-二聚体检测和CT检测时，若患者出现胸痛、昏厥、呼吸困难，需马上采取平卧给氧等治疗措施，并进一步检查患者出现此症状的原因。检测D-二聚体具体步骤：①采集患者2 ml静脉血；②抗凝使用枸橼酸钠，防止血液凝固；③使用免疫比浊法进行D-二聚体检查，以上检查需要在2 h内完成。参考值：正常：34～264 μg/L；D-二聚体检测阳性：D-二聚体>500 μg/L。, 百拇医药(饶飞飞 徐宗祥 王东)
关键词：肺栓塞；D-二聚体；分析
中图分类号：R655.3 文献标识码：A 文章编号：1006-1959(2017)13-0069-02
, 百拇医药
Abstract：Objective To investigate the significance of D-dimer in the diagnosis of pulmonary embolism after thoracic surgery and its clinical analysis. Methods A total of 168 patients with pulmonary embolism who underwent thoracic surgery from October 2013 to October 2014 were retrospectively analyzed for their clinical data and were analyzed for D-dimer.Results In patients undergoing thoracic surgery，the incidence of pulmonary embolism was significantly higher in patients older than 50 years than in those younger than 50 years；obese patients had a significantly higher incidence of pulmonary embolism than those with weight criteria；patients with malignant tumors had a significantly higher incidence of pulmonary embolism than patients with benign tumors；the differences were statistically significant(P<0.05).Patients with age，obesity，combined with malignant tumors and other factors are increased thoracic surgery after the incidence of pulmonary embolism risk factors.D-dimer detection was performed on patients，with sensitivity and negative predictive values of 100% and false positive rates of 94.1%.Conclusion Obesity，age，malignancy and other factors will increase the incidence of pulmonary embolism after thoracic surgery，diagnosis of pulmonary embolism with D-dimer detection， the detection of negative results of high accuracy，it is worth popularizing in clinical practice.
, 百拇医药
Key words：Pulmonary embolism；D-dimer；Analysis
肺栓塞發生的起因是体内栓子的脱落，各种类型的栓子脱落均会造成，最常见的是血栓，还有脂肪栓、空气栓、细菌栓等等[1]。通常，肺栓塞单独发生几率较小，是胸外科手术后的常见并发症，一旦并发症发生，患者容易因为呼吸系统的障碍，易发生呼吸困难，甚至窒息[2]。所以，我们对胸外科手术术后肺栓塞的诊断进行探讨，为提高患者提供更及时的治疗，减少手术风险，具有重要的意义。我院对168例胸外科手术中发生肺栓塞的患者进行研究如下。
1 资料与方法
1.1一般资料
选取2013年10月～2014年10月我院进行胸外科手术的的168例患者，同时在手术中并发肺栓塞症状。研究前，对168例患者的临床资料进行统计学分析：男性有70例，女性有98例，年龄在35～88岁，平均年龄(61.1±5.2)岁。选取30例患者进行D-二聚体检测，纳入标准[4]：住院患者；胸外科手术后发生肺栓塞；同意进行血浆D-二聚体检测和CT检查。
1.2方法
符合上述纳入标准的30例患者，手术前进行血浆D-二聚体检测，胸外科手术后三天再次进行血浆D-二聚体检测。同时密切关注患者的症状，在进行D-二聚体检测和CT检测时，若患者出现胸痛、昏厥、呼吸困难，需马上采取平卧给氧等治疗措施，并进一步检查患者出现此症状的原因。检测D-二聚体具体步骤：①采集患者2 ml静脉血；②抗凝使用枸橼酸钠，防止血液凝固；③使用免疫比浊法进行D-二聚体检查，以上检查需要在2 h内完成。参考值：正常：34～264 μg/L；D-二聚体检测阳性：D-二聚体>500 μg/L。, 百拇医药(饶飞飞 徐宗祥 王东)
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