胸外科術(shù)后肺栓塞診斷中的D—二聚體檢測及其臨床分析

饒飛飛+徐宗祥+王東

摘要：目的 在胸外科術(shù)后對肺栓塞患者進行診斷的D-二聚體檢測及其臨床分析，探討其意義。方法 選取2013年10月～2014年10月在我院收治的168例胸外科手術(shù)后發(fā)生肺栓塞的患者，回顧性分析其臨床資料，并對其進行D-二聚體檢測。結(jié)果 在進行胸外科手術(shù)的患者中，年齡大于五十歲的患者比年齡小于50歲的患者，肺栓塞發(fā)生率明顯升高；肥胖的患者比體重標(biāo)準(zhǔn)的患者，肺栓塞發(fā)生率明顯升高；患有惡性腫瘤的患者相較于良性腫瘤的患者，肺栓塞發(fā)生率明顯升高；差異均具有明顯統(tǒng)計學(xué)意義（P<0.05）。患者出現(xiàn)高齡、肥胖、合并惡性腫瘤等因素都是增加胸外科手術(shù)術(shù)后肺栓塞發(fā)生率的危險因素。對患者進行D-二聚體檢測，敏感性和陰性預(yù)測值均為100%，假陽性率為94.1%。結(jié)論 肥胖、高齡、惡性腫瘤等因素，會增加患者胸外科手術(shù)術(shù)后肺栓塞發(fā)生率，用D-二聚體檢測對肺栓塞患者進行診斷，檢測出的陰性結(jié)果正確率高，值得在臨床中推廣應(yīng)用。

關(guān)鍵詞：肺栓塞；D-二聚體；分析

中圖分類號：R655.3 文獻標(biāo)識碼：A 文章編號：1006-1959（2017）13-0069-02

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.

Key words：Pulmonary embolism；D-dimer；Analysis

肺栓塞發(fā)生的起因是體內(nèi)栓子的脫落，各種類型的栓子脫落均會造成，最常見的是血栓，還有脂肪栓、空氣栓、細菌栓等等[1]。通常，肺栓塞單獨發(fā)生幾率較小，是胸外科手術(shù)后的常見并發(fā)癥，一旦并發(fā)癥發(fā)生，患者容易因為呼吸系統(tǒng)的障礙，易發(fā)生呼吸困難，甚至窒息[2]。所以，我們對胸外科手術(shù)術(shù)后肺栓塞的診斷進行探討，為提高患者提供更及時的治療，減少手術(shù)風(fēng)險，具有重要的意義。我院對168例胸外科手術(shù)中發(fā)生肺栓塞的患者進行研究如下。

1 資料與方法

1.1一般資料

選取2013年10月～2014年10月我院進行胸外科手術(shù)的的168例患者，同時在手術(shù)中并發(fā)肺栓塞癥狀。研究前，對168例患者的臨床資料進行統(tǒng)計學(xué)分析：男性有70例，女性有98例，年齡在35～88歲，平均年齡（61.1±5.2）歲。選取30例患者進行D-二聚體檢測，納入標(biāo)準(zhǔn)[4]：住院患者；……