摘要目的 探讨严重创伤患者D-二聚体(D-D)、纤维蛋白原(Fbg)和血小板指标(PLT、MPV、PDW)水平在术后诱发深静脉血栓(DVT)形成中的临床诊断价值.方法 以80例健康人为对照组,与321例严重创伤患者分别测定术前、术后1d和3d D-D、Fbg和血小板指标的水平,并进行术前术后的比较,创伤组分为骨折、脑外伤、多发伤三组.结果 不同创伤患者D-D、Fbg浓度和血小板指标与对照组比较明显增高,差异有统计学意义(P＜0.05),特别是脑外伤与多发伤两组显著增高(P＜0.01),D-D阳性率分别为22.8％、35.2％、40.9％.术后1d除了脑外伤组、多发伤组D-D水平与术前比较有明显增高(P＜0.05)外,其他指标与术前比较改变较小,D-D阳性率稍增高,但差异无统计学意义(P＞0.05).术后3d各创伤组Fbg水平明显下降,D-D明显升高,PLT数量减少,MPV、PDW数值增大,各数值与术前比较差异有统计学意义(P＜0.01或P＜0.05).D-D阳性率也明显增高达41％、59.2％、62.3％,与术前比较差异有统计学意义(P＜0.01).结论严重创伤患者术后D-二聚体浓度持续升高应警惕DVT的发生,有助于临床上尽早采取措施加以避免,对创伤患者的治疗及预后有十分重要的临床意义.

abstractsObjective To investigate the D-in patients with severe trauma in two dimers (D-D),fibrinogen (Fbg) and platelet parameters (PLT,MPV,PDW) level induced by postoperative deep vein thrombosis (DVT) in the formation of value in clinical diagnosis.Methods Eighty cases of healthy people as control group,were compared before and after operation and level and 321 severe traumatic patients were measured before surgery,after 1 days and 3 days of D-D,Fbg and platelet parameters,trauma were divided into fracture,traumatic brain injury,multiple injuries in three groups.Results Different trauma patients with D-D,Fbg concentration and platelet index compared with the control group increased obviously significant (P ＜ 0.05),especially the brain trauma and multiple injuries in two group increased significantly (P ＜0.01),the positive rate of D-D was 22.8％,35.2％,40.9％.Postoperative 1D in addition to brain injury group,trauma group D-D levels compared with those before operation were significantly increased with significant (P ＜ 0.05),other indicators compared with preoperative changes little,the positive rate of D-D increased slightly,but without statistical significance.Levels of Fbg 3D after the trauma group decreased significantly,D-D increased significantly,decreased the number of PLT,MPV,PDW value increases,the value of preoperative has the remarkable significance (P ＜ 0.01 or P ＜ 0.05).The positive rate of D-D was increased up to 41％,59.2％,62.3％,compared with those before operation by chi-square test was significant (P ＜0.01).Conclusion The patients with severe trauma patients after two D-dimer concentration should be alert to the occurrence of DVT,contribute to the clinically as soon as possible to take measures to avoid,there is an important clinical significance in the treatment and prognosis of trauma patients.