摘要
目的:探讨三位一体共管模式在骨科大手术患者围术期静脉血栓栓塞症(VTE)预防中的应用效果。方法:采用回顾性病例对照研究分析2019年1月至2019年8月温州医科大学附属第二医院收治的120例行骨科大手术患者临床资料,其中男46例,女74例;年龄43~89岁[(63.7 ± 11.3)岁]。骨折类型:股骨转子间骨折58例,股骨颈骨折52例,膝关节病10例。手术类型:闭合复位内固定手术58例,全髋置换术37例,人工股骨头置换术15例,全膝置换术10例。60例采用传统护理(传统护理组),60例采用联动共管护理(共管护理组)。传统护理组给予传统的预防血栓护理、常规VTE风险评估、治疗、宣教等;共管护理组在传统护理基础上采用三位一体共管模式管理,包括三位一体健康宣教,建立VTE预防小组及VTE跟踪表,术后加强康复护理与锻炼,优化药物、营养、疼痛管理等。比较两组术后第3,7天患肢肿胀率、入院时及术后第3,7天的D-二聚体水平、术后第7天VTE发生率、住院时间及护理满意度。结果:共管护理组术后第3,7天患肢肿胀率[13%(8/60)、8%(5/60)]显著低于传统护理组[42%(25/60)、30%(18/60)]( P < 0.05)。入院时两组D-二聚体水平差异无统计学意义( P > 0.05);共管护理组术后第3,7天D-二聚体水平[3.40(2.11,6.10)μg/ml、3.70(2.61,6.82)μg/ml]显著低于传统护理组[6.37(3.60,9.81)μg/ml、6.42(3.62,9.83)μg/ml]( P < 0.01)。共管护理组术后第7天VTE发生率[3%(2/60)]显著低于传统护理组[13%(8/60)]( P < 0.05)。共管护理组住院时间[(10.1 ± 2.2)d]短于传统护理组[(11.4 ± 4.3)d]( P < 0.05);共管护理组住院期间护理满意度[93%(56/60)]高于传统护理组[72%(43/69)]( P < 0.05)。 结论:对于骨科大手术患者,围术期三位一体共管模式可减少术后患肢肿胀发生率,降低D-二聚体水平,减少VTE发生率,缩短住院时间,提高护理满意度。
Objective:To explore the effect of“trinity”co-management mode in prevention of venous thromboembolism(VTE)during perioperative period in patients undergone major orthopedic surgery.Methods:A retrospective case-control study was conducted to analyze the clinical data of 120 patients undergone major orthopedic surgery in Second Affiliated Hospital of Wenzhou Medical University from January 2019 to August 2019,including 46 males and 74 females at age range of 43-89 years[(63.7±11.3)years].Of all,58 patients were with intertrochanteric fracture,52 with femoral neck fracture and 10 with gonarthrosis.Hip fracture operation was performed in 58 patients,total hip replacement in 37,artificial femoral head replacement in 15 and total knee replacement in 10.A total of 60 patients were treated with traditional care,including traditional prevention of thrombosis,conventional VTE risk assessment,treatment and related health education(traditional care group),and 60 patients a with“trinity”co-management care(co-management care group)on the basis of the traditional care,including the trinity of health education,establishing VTE prevention group and VTE tracking table,strengthening postoperative rehabilitation care and exercise,optimization of medicine,nutrition and pain management.Swelling rate of injured limb,D-dimer level on admission and at postoperative days 3 and 7,incidence of VTE at postoperative day 7,length of hospital stay and patient satisfaction were compared between the two groups.Results:Three days and seven days after operation,swelling rate of the injured limb in co-management care group[13%(8/60),8%(5/60)]was significantly lower than that in traditional care group[42%(25/60),30%(18/60)](P<0.05).There was no significant difference in level of D-dimer between the two groups on admission(P>0.05).Three days and seven days after operation,level of D-dimer[3.40(2.11,6.10)μg/ml,3.70(2.61,6.82)μg/ml]in co-management care group was significantly lower than that in traditional care group[6.37(3.60,9.81)μg/ml,6.
作者
朱雅
金莉雅
陈玉梅
徐雪雪
Zhu Ya;Jin Liya;Chen Yumei;Xu Xuexue(Department of Orthopedics,Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Orthopedic Hospital Affiliated to Wenzhou Medical University,Wenzhou 325000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第8期739-743,共5页
Chinese Journal of Trauma
基金
温州市基础性科研项目(Y20190389,Y20190274)
浙江省医药卫生科技计划项目(2020KY184)。
关键词
静脉血栓栓塞
外科手术
围术期护理
Venous thromboembolism
Surgical procedures,operative
Perioperative nursing
