Mantoni Margit Y, Kristensen Majken, Brogaard Marie Husted, Sivertsen Jacob Christian, Nielsen Jørn Dalsgaard, Strandberg Charlotte, Friis Steffen
Gentofte Hospital, Billeddiagnostisk Afdeling, DK-2900 Hellerup.
Ugeskr Laeger. 2008 Mar 31;170(14):1129-33.
The standard method for diagnosing deep vein thrombosis (DVT) involves determination of D-dimer and ultrasound scanning. In an attempt to reduce the number of ultrasound examinations we have supplemented this with a clinical probability estimate for DVT (DVT-score) over one year.
A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal fossa. If no DVT was revealed, the patient was contacted by telephone 7-10 days later, and was offered a repeat examination if symptoms persisted.
Three patients with chronic DVT were excluded. Normal D-dimer and low or moderate DVT-score was found in 103 patients, none had DVT. Only five patients with normal D-dimer had high DVT-scores, none had DVT, so that the benefit from determining DVT-scores was modest. Ultrasound scanning revealed DVT in 85 out of 397 patients with elevated D-dimer. A repeat examination was performed in 91 patients with persisting symptoms, and disclosed DVT in two.
We recommend that ambulatory patients with clinically suspected DVT have a D-dimer test. If D-dimer is elevated, compression ultrasound should be performed in the groin and the popliteal fossa.
诊断深静脉血栓形成（DVT）的标准方法包括测定D - 二聚体和超声扫描。为了减少超声检查的次数，我们在一年多的时间里增加了DVT临床概率评估（DVT评分）。
共有508例因疑似DVT到急诊室就诊的连续患者进行了D - 二聚体和DVT评分检查。D - 二聚体未升高且DVT评分为低或中度的患者未接受治疗。其余患者从腹股沟至腘窝进行超声扫描。如果未发现DVT，在7 - 10天后通过电话联系患者，若症状持续则提供再次检查。
排除3例慢性DVT患者。103例患者D - 二聚体正常且DVT评分为低或中度，均未发生DVT。仅5例D - 二聚体正常的患者DVT评分为高，均未发生DVT，因此测定DVT评分的益处不大。在397例D - 二聚体升高的患者中，超声扫描发现85例存在DVT。91例症状持续的患者进行了再次检查，其中2例发现DVT。
我们建议，临床上疑似DVT的门诊患者应进行D - 二聚体检测。如果D - 二聚体升高，应在腹股沟和腘窝进行加压超声检查。
