| 摘要: |
| 目的：根据重症COVID-19肺炎患者做双下肢静脉超声检查及D-二聚体检查的情况，评估重症或危重症新冠肺炎下肢静脉血栓栓塞患者的死亡风险。
方法： 纳入了武汉金银潭医院(中国武汉)重症监护病房(intensive care unit ICU)于2020年1月1日至2020年2月20日之间收治的32例成年重症COVID-19肺炎患者，所有患者均进行双下肢静脉超声检查及D-二聚体检测。就发生血栓的患者是否死亡采用logistic回归分析。
结果：32例患者中21例检查发现双下肢静脉急性血栓，血栓发生率65.6%，发生血栓后死亡率52.3%；D-二聚体检测平均每人共检测过6次，28例多次检查均升高，异常率87.5%。结果显示D-二聚体标准差可作为自变量建立模型（P=0.034），其模型表达式：Logit （P）=-8.053+ 0.223 X6
结论： 当双下肢静脉血栓的患者出现D-二聚体明显升高且存在波动，提示存在死亡风险（本文与既往文献的不同在于：新冠状肺炎危重症患者D-二聚体在升高的基础上明显波动时，外加超声检查出双下肢静脉血栓（哪怕只是肌间静脉局部，也是存在较高死亡风险）。治疗时注意密切关注D-二聚体波动情况并及早进行双下肢静脉血栓筛查工作。 |
| 关键词: 重症COVID-19肺炎 静脉血栓栓塞症 双下肢静脉超声 D-二聚体 |
| DOI： |
| 投稿时间：2020-04-02修订日期：2020-04-17 |
| 基金项目: |
|
| Assessment of mortality risk associated with venous thromboembolism in severe and critically ill patients with COVID-19 pneumonia by lower extremity venous ultrasound and D-Dimer test |
| quyali,lishuo,zhanglingling,guoliyan,caowen,lvchaoyang,guoruijun |
| () |
| Abstract: |
| Summary
Objective: The study aimed to evaluate the risk of death from VTE in severe and critical patients with COVID-19 pneumonia using bilateral lower limb venous ultrasound and D-dimer examination.
Methods: In this single-centered, retrospective, observational study, we enrolled 32 adult severe and critical patients with COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between January 1, 2020 and February 20, 2020. All patients underwent bilateral lower extremity venous ultrasound and D-dimer test. The relationship between death of patients and vein thrombosis of bilateral lower extremities, and D-dimer levels was assessed using logistic regression analysis, which was performed including patients’ prognosis as the dependent variable, and sex, age, time to perform bilateral lower extremity venous ultrasound after admission, site of thrombus, mean and standard deviation (SD) of D-dimer levels as independent variables.
Results: Among the 32 patients, acute venous thrombosis of both lower extremities occurred in 21 patients, with an incidence of 65.6%. The mortality rate was 52.3% in those patients who developed acute venous thrombosis. Each patient underwent an average of 6 D-dimer tests, 28 (87.5%) had elevated D-dimer levels after each D-dimer test. In the logistic regression analysis, the significant variable was SD for D-dimer levels (P = 0.05), which was included in the final model, the logistic regression equation was as follows: Logit (P) = -29.445+0.367 X6.
Conclusion: In order to prevent death from VTE in these patients, bilateral lower extremity venous ultrasound examination should be performed early to identity patients with acute vein thrombosis, and more attention should be paid to the D-dimer level fluctuation during treatment.
Keywords: COVID-19; coronavirus; pneumonia; lower extremity venous ultrasound; D-Dimer level; mortality risk; venous thromboembolism; severe/critical conditions |
| Key words: |
