床旁彩超联合凝血-纤溶标志物对ICU患者下肢DVT的诊断评价

doi:10.7517/issn.1674-0475.220317

摘要/Abstract

摘要： 本研究探讨床旁彩超、凝血-纤溶指标检查对于诊断重症监护病房（ICU）患者并发下肢深静脉血栓的价值及采取集束化护理干预措施的效果。选取ICU治疗的164例高度怀疑并发下肢深静脉血栓患者作为研究对象，根据超声静脉血管造影诊断患者是否并发深静脉血栓（DVT）将其分为DVT组（94例）、非DVT组（70例），均接受床旁彩超及凝血-纤溶指标检查；DVT组患者采用随机数字表分为干预组和对照组，各47例，两组均采用溶栓和（或）抗凝治疗，干预组同时给予集束化干预措施。结果显示，DVT组的纤维蛋白原（Fib）、D-二聚体（D-D）、血小板聚集率（PAgT）、凝血酶-抗凝血酶Ⅲ复合物（TAT）值均高于非DVT组（P<0.05）；94例DVT患者，超声诊断DVT与超声血管造影结果的整体符合率为77.66%；超声诊断DVT的灵敏度为77.66%、特异度为78.57%。在治疗5 d、7 d后，干预组患者的髌上15 cm、髌下10 cm肢体周径均小于对照组（P<0.05）；床旁彩超、凝血-纤溶指标检查对于发现ICU患者并发下肢深静脉血栓具有一定的价值，DVT患者在溶栓的基础上联合集束化干预能够尽快达到溶栓效果，缓解患者的临床症状。

关键词: 床旁彩超, 凝血-纤溶指标, 重症监护病房, 下肢深静脉血栓, 集束化护理

Abstract: This study investigated the value of bedside color Doppler ultrasound and coagulation-fibrinolysis markers examination in diagnosing intensive care unit (ICU) patients complicated with lower extremity deep vein thrombosis and the effect of cluster nursing intervention measures. 164 patients with deep vein thrombosis in the lower extremities who were highly suspected of being treated in the ICU were selected as the research subjects. According to whether patients complicated with deep vein thrombosis (DVT) diagnosed by ultrasound venous angiography, they were divided into 94 cases in the DVT group and 70 cases in the non-DVT group, and all patients received bedside color Doppler ultrasound and coagulation-fibrinolysis index examination. The patients in the DVT group were randomly divided into the intervention group and the control group with 47 cases in each group, at the same time both groups were treated with thrombolysis and/or anticoagulation, and the intervention group was also given bundled interventions. The results showed that the values of fibrinogen (Fib), D-dimer (D-D), platelet aggregation rate (PAgT) and thrombin-antithrombin III complex (TAT) in the DVT group were all higher than those in the non-DVT group (P<0.05). In 94 patients with DVT, the overall coincidence rates of ultrasound diagnosis of DVT and ultrasound angiography was 77.66%. The sensitivity of ultrasound in diagnosing DVT was 77.66% and the specificity was 78.57%. After 5 and 7 days of treatment, the limb circumferences of the patients in the intervention group 15 cm above the patella and 10 cm below the patella were smaller than those in the control group (P<0.05). The bedside color Doppler ultrasound and coagulation-fibrinolysis markers examination are of certain value in detecting ICU patients complicated with lower extremity deep vein thrombosis. Combining cluster intervention on the basis of thrombolysis in DVT patients can achieve thrombolysis effect as soon as possible, and relieve the clinical symptoms of patients.

Key words: bedside color Doppler ultrasound, coagulation-fibrinolysis index, intensive care unit, lower extremity deep vein thrombosis, clustered nursing

焦庆丰, 鲁梅丽, 潘迎春, 何院玲, 杨晓帆. 床旁彩超联合凝血-纤溶标志物对ICU患者下肢DVT的诊断评价[J]. 影像科学与光化学, 2022, 40(5): 1128-1132.

JIAO Qingfeng, LU Meili, PAN Yingchun, HE Yuanling, YANG Xiaofan. Diagnostic Evaluation of Bedside Color Doppler Ultrasound Combined with Coagulation-fibrinolysis Markers in ICU Patients with Lower Extremity DVT[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(5): 1128-1132.

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