关节置换患者围手术期深静脉血栓形成预防现状的多中心研究  

The prevention of Deep Vein Thrombosis in patients with joint replacement: a multicenter investigation

作　　者：张成欢 李莹[2] 刘云 黄燕鹏[4] 夏韦[5] 凌琳[6] 薛慧娟[7] 王颖[8] 董丰琴[9] 丁敏华[10] 朱冬梅[11] 严文婕 

机构地区：[1]南京中医药大学护理学院,210046 [2]南京军区南京总医院骨科 [3]卫生技术干部训练中心 [4]解放军第174医院骨科 [5]徐州医学院附属医院骨科 [6]解放军第101医院骨科 [7]解放军第82医院骨科 [8]解放军第97医院骨科 [9]解放军第98医院骨科 [10]解放军第105医院骨科 [11]解放军第81医院护理部 [12]解放军第100医院骨科

出　　处：《中国护理管理》2016年第2期180-185,共6页Chinese Nursing Management

摘　　要：目的 :调查骨科关节置换患者围手术期深静脉血栓形成(DVT)预防现状,为进一步规范骨科DVT护理预防措施提供依据。方法 :通过多中心研究方法,采用Autar量表及自行设计的护理预防措施调查表进行调查。结果:共有10家医院参与研究,最终纳入患者330名。Autar量表评分结果显示,术前108名(32.73%)、术后第1天322名(97.57%)及出院时269名(81.52%)患者处于中高风险。不同病种及不同手术方式术前、术后第1天及出院时Autar评分比较有统计学差异(P<0.05)。术前3.03%的患者穿弹力袜预防,0.61%的患者进行间歇性充气压力泵预防,0.30%的患者进行足底泵预防,0.91%的患者使用药物预防。术前66.06%的患者评估DVT风险,24.24%的患者得到DVT基本预防,26.67%的患者得到DVT相关知识宣教。术后3.03%的患者穿弹力袜预防,37.27%的患者进行下肢压力泵预防,5.75%的患者进行足底泵预防,88.18%的患者进行药物预防。护士在术后加强了DVT知识宣教及主动观察DVT临床表现(64.24%),对30.91%的患者进行基本预防,对20.00%的患者进行出血风险评估,对88.18%的患者避免下肢输液。另外,Autar量表评分与护士执行DVT预防措施率的相关性分析结果显示,患者的DVT评分情况与实际执行情况的无相关性(P>0.05)。结论 :本研究通过多中心调研结果显示,骨科关节置换手术患者术后多处于DVT中高风险状态,骨科DVT围手术期护理预防措施实施不尽人意。临床护理人员应加强对DVT的认知,应用评估工具识别高危患者,分级采取护理措施,联合使用物理预防及药物预防,评估药物预防引起的出血倾向,加强基本预防与健康宣教,从而有效降低DVT发生率。Objective： To investigate the prevention of Deep Vein Thrombosis（DVT） in patients with joint replacement and to provide the evidence for establishing prevention standard for the department of orthopedics. Methods： The trained nurses used Autar scale and self-designed questionnaire to assess patients with joint replacement in multicenter. Results： There were 330 patients form 10 hospitals investigated. Autar scale showed that, 108 patients（32.73%） before surgery, 322 patients（97.57%） after surgery and 269 patients（81.52%） discharged were in middle and high risk. There were significant differences of Autar scores（P〈0.05） in different diseases and surgeries in different time. Prevention conditions： before the surgery, 3.03% patients wore elastic stockings, 0.61% patients used intermittent pneumatic pressure pump, 0.30% patients used foot pump and 0.91% patients took medicine. The nurses had assessed 66.06% patients, provided basic prevention for 24.24% patients, and provided health education for 26.67% patients. After surgery, 3.03% patients wore elastic stockings, 37.27% patients used intermittent pneumatic pressure pump, 5.75% patients used foot pump, and 88.18% patients took medicine. The nurses had assessed 20.00% patients for the risk of bleeding, observed the clinic manifestation and provided health education for 64.24% patients. The nurses had provided basic prevention for 30.91% patients and avoided transfusion of lower limbs on 88.18% patients. There are no relevance between Autar scores and actual implementation（P〈0.05）. Conclusion： Patients with joint replacement are in a middle and high risk for DVT. The prevention measures are not good in department of orthopedics patients. The nurses must be aware of DVT, using specific scales to identify high risk patients, and use combined mechanical prevention measures and medicine preventions in time.

关 键 词：深静脉血栓形成 关节置换 多中心研究 

分 类 号：R47[医药卫生—护理学]