| Background and ObjectiveVenous thromboembolism including deep vein thrombosis and pulmonary embolism,DVT and PE are two different clinical manifestations of the same disease at different stages and locations.Both are collectively referred to as VTE.DVT is a common complication in the perioperative period of abdominal surgery.The main features of DVT in the perioperative period of gastrointestinal surgery are early thrombosis,small venous thrombosis and large venous thrombosis.Although the loss of intermuscular venous thrombosis has rarely reported pulmonary embolism,the risk of fatal pulmonary embolism increases significantly when it develops into large vein thrombosis.Thus,it is very important to screen a simple and quick monitoring index of clinical indicators.However,D-Dimer is a unique product of hyperfibrinolysis,and its increase can reflect the formation of thrombus.Previous studies have confirmed that it is a sensitive indicator of the occurrence of thrombus diseases.But,the study of the correlation with the progress of thrombus and the progress of thrombosis are very few.PE is a type of syndrome in the circulatory system where thromboembolism forms or falls off from the circulatory disturbances that block the pulmonary artery or its branches.Its complex and diverse clinical manifestations,rapid disease progression,high rate of misdiagnosis,and high fatality rate seriously threaten the lives of patients and is also a high-risk disease in which contradictions between doctors and patients occur.Therefore,the screening of patients at high risk of death,timely and standardized treatment to reduce pulmonary embolism mortality remains a clinical problem to be solved.On the basis of the risk factors for the formation of DVT in the lower extremities after gastrointestinal surgery,this study further analyzes the risk factors for the progress of intermuscular venous thrombosis.Screening of simple and easy clinical indicators,so as to reduce the incidence of postoperative pulmonary embolism and lay the foundation for promoting the development of enhanced recovery after surgery(ERAS).At the same time,through the study of the clinical features of acute pulmonary embolism and risk factors for death,thereby improving the diagnosis and treatment of acute pulmonary embolism,reduce mortality,and provide reference for the prevention and treatment of PE in various specialties.Patients and Methods1.In this prospective study,we used color doppler ultrasound to monitor the formation and progress of perioperative venous thrombosis in all patients undergoing operation from November 2014 to August 2016 in gastrointestinal surgery department of the First Affiliated Hospital of Zhengzhou University.A total of 97 patients were in accordance with the standard of entry group.According to the occurrence of DVT and progress of lower extremity,it is divided into thrombus progression group and non progression group.The age,BMI,tumor,postoperative infection and the level of D-Dimer polymer before and after operation were statistically analyzed,and the relationship with the progression of thrombus was analyzed.SPSS22.0 software was used for statistical analysis.The risk factors for the progression of DVT in the lower extremities were screened,and the value of D-Dimer changes at different stages to predict the progression of DVT in the lower extremities was evaluated and the critical value was determined.2.A retrospective analysis of the first Affiliated Hospital of Zhengzhou University,2015.1-2015.12.Data collected from all hospitals diagnosed by CT pulmonary angiography(CTPA)were analyzed by big data analysis.A total of 142 patients met the inclusion criteria.According to the outcome of the prognosis,survival and death groups were divided into groups.Statistical analysis of relevant patient-related factors including age,gender,underlying disease(hypertension,coronary heart disease,diabetes),history of prior vascular thromboembolism,history of bed rest(intra-month),history of cancer(previous or present),presence of comorbid lower extremities DVT,history of trauma/fracture(within one month),co-infection,surgical history(within one month),and clinical testing criteria include white blood cell(WBC),platelet(PLT),C-reactive protein(C-Reactive protein(CRP),procalcitonin(PCT),D-dimer,fibrinogen(FIB),etc.,and analysis of the relationship with death.SPSS22.0 software was used for statistical analysis to screen out risk factors for death patients.Results1.Lower extremity DVT occurred during the perioperative period of 97 patients with gastric and intestinal diseases.Among the first types of thrombus diagnosis,there were 94 cases of intermuscular venous thrombosis(96.9%),3 cases of fibula thrombosis(3.1%),and 16 cases with thrombus progression(16.5%).2.Thrombus progression occurred in 1 cases of posterior tibial vein thrombosis and 2 cases of fibula venous thrombosis at the time of 72 h reexamination.The other 13 cases were in the postoperative 120 h review found thrombosis progress,there were 4 cases of posterior tibial vein thrombosis,1 cases of deep femoral vein thrombosis,3 cases of peroneal vein thrombosis,2 cases of thrombus of popliteal vein and 3 cases of thrombosis in size.There was no recurrent thrombosis after 120 h in the remaining cases.3.Univariate logistic regression analysis revealed postoperative infection(OR=4.15,95%Cl : 1.15~14.99),and continued increase in postoperative D-ders(D3(OR=1.3,95%Cl : 1.10~1.56)?D31(OR=1.2,95%Cl : 1.06~1.50)?D32(OR=1.36,95%Cl : 1.12~1.64)were positively correlated with thrombosis and thrombus progression.Multivariate logistic regression analysis showed that postoperative D-d Sustained increase in aggregates was an independent risk factor for the progression of DVT in the lower extremities(D3(OR=1.42,95%Cl : 1.15~1.75)D32(OR=1.48,95%Cl : 1.16~1.88)D31(OR=1.36,95%Cl : 1.11~1.66))4.The ROC curve analysis showed that the optimal cut-off values for plasma D-dimer levels D32,D3,and D31 were 0.87 mg/L,2.26 mg/L,and 1.65 mg/L,respectively,and their AUC(95% CI)was 0.89(0.79,0.99),0.86(0.78,0.94),0.80(0.67,0.92),the sensitivity to predict the progression of lower extremity DVT was 0.88,0.86,0.88,respectively,and the specificity was 0.89,0.93,and 0.68.5.There were a total of 142 patients diagnosed by CTPA throughout the year,including 21 deaths and a mortality rate of 14.79%.After CTPA diagnosis,the shortest death time was 1.6 hours and the longest was 56 days with an average of 12.4 days.6.The distribution of acute pulmonary embolism in our hospital was uneven,mainly distributed in the Department of Respiratory 46 cases,cardiology 37 cases,ICU 18 cases,interventional department 12 cases,cardiac surgery in 5 cases,vascular surgery in 4 cases,general surgery in 4 cases,emergency department 4 In other cases,there were 7 cases in other departments.7.The general clinical data of the two groups showed that there were significant differences in infection,physician cognition,D-dimer,FIB,CRP,and PCT between the two groups(P<0.05).Other relevant factors were not statistically significant(P>0.05).8.Univariate logistic regression analysis indicated infection(OR=2.82,95%Cl : 1.07-7.4),PLT>350(OR=8.91,95%Cl :2.92-27.16),D-dimer(3.38-6.22)mg/ L(OR=4.69,95%Cl: 1.10-20.04)D-dimer >6.22 mg/L(OR=11.33,95%Cl: 2.94-43.63),PCT >1.27 ng/ml(OR=63.52,95%Cl: 7.94-508.09)may increase the risk of death in patients with acute pulmonary embolism,and physicians' knowledge OR=0.31(95%Cl : 0.11-0.86)may reduce the risk of death in patients with acute pulmonary embolism.9.When adjusted for age,sex,tumor,hypertension,diabetes,history of thromboembolism,surgical history,trauma/fracture,presence of DVT in the lower limbs,WBC,PLT,FIB,CRP,and other confounding factors,Logistic regression analysis showed that coronary heart disease(OR=6.69,95%Cl : 1.332,33.582)D-dimer> 6.22 mg/L(OR=7.398,95%Cl: 1.699,32.216),PCT> 1.27 ng/ml(OR=43.982,95%Cl: 4.896,395.098),can increase the risk of death in patients with acute pulmonary embolism.Similar to univariate logistic regression analysis,physicians' cognition(OR=0.195%Cl: 0.02,0.45)may reduce the risk of death in patients with acute pulmonary embolism.Conclusion1.Postoperative infection and continuous elevation of D-two dimers were closely related to the progression of DVT in the lower extremities.Postoperative D-Dimer continued to rise(D32)greater than 0.87mg/L,which has certain clinical value in predicting the progression of lower extremity DVT.2.Coronary heart disease,D-dimer>6.22mg/L,PCT>1.27ng/ml,is an independent risk factor for acute pulmonary embolism death risk.3.Physician cognition is a protective factor to reduce the risk of death from acute pulmonary embolism.Enhancing clinicians' understanding of acute pulmonary embolism is an important measure to reduce the risk of death. |
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