护士主导的多学科协作干预对外科术后静脉血栓栓塞症的预防效果  

Effect of nurse-led multiple disciplinary team-based intervention in the prevention of venous thromboembolism in paitents undergoing general surgery

作　　者：许祖存 李静[2] 胡新春 米颖[3] 许俭[4] 胡连莲[5] 吴玲[6] 齐华英[2] Xu Zucun;Li Jing;Hu Xinchun;Mi Ying;Xu Jian;Hu Lianlian;Wu Ling;Qi Huaying(Department of General Surgery,Tianjin First Central Hospital,Tianjin 300192,China;Department of Nursing,Tianjin First Central Hospital,Tianjin 300192,China;Department of Vascular Surgery,Tianjin First Central Hospital,Tianjin 300192,China;Department of Neurosurgery,Tianjin First Central Hospital,Tianjin 300192,China;Recovery Room,Tianjin First Central Hospital,Tianjin 300192,China;Department of Orthopedics,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院普通外科,300192 [2]天津市第一中心医院护理部,300192 [3]天津市第一中心医院血管外科,300192 [4]天津市第一中心医院神经外科,300192 [5]天津市第一中心医院复苏室,300192 [6]天津市第一中心医院骨科,300192

出　　处：《中国实用护理杂志》2020年第7期495-500,共6页Chinese Journal of Practical Nursing

基　　金：天津市第一中心医院科技基金(2019CF14)。

摘　　要：目的探讨护士主导的多学科协作干预对外科术后静脉血栓栓塞症的预防效果。方法2017年5月至2018年10月在天津市第一中心医院住院的118例拟行外科手术的患者按照随机数字表法分为研究组59例和对照组59例。对照组给予常规血栓预防护理,研究组实施护士主导的多学科协作干预。术后第3天采用彩色多普勒超声检查患者双下肢静脉血流情况;分别于术后24 h内和术后第3天检测患者血栓弹力图(TEG)值和血浆D-二聚体水平。结果研究组出现静脉血流淤滞发生率为94.9%(3/59),对照组为79.7%(12/59),研究组下肢静脉血流情况明显优于对照组,差异有统计学意义(Z值为2.477,P<0.05)。术后第3天,研究组血浆D-二聚体为(5.26±1.42)mg/L,对照组为(6.36±1.58)mg/L;研究组血浆D-二聚体明显低于对照组,差异有统计学意义(t值为3.991,P<0.05)。术后第3天,研究组凝血反应时间(R)、凝固角(Angel)、血栓最大强度(MA)、综合凝血指数(CI)分别为(5.30±0.91)min、(69.64±21.93)deg、(65.40±13.76)mm和1.23±0.20,对照组分别为(4.41±0.75)min、(76.64±16.02)deg、(70.98±13.39)mm和2.09±0.36,研究组R值明显高于对照组,Angel、MA、CI明显低于对照组,差异有统计学意义(t值为2.001~15.997,均P<0.05)。结论护士为主导的多学科协作可以改善外科手术患者静脉血流情况和凝血功能,降低静脉血栓栓塞症发生风险。Objective To investigate the effect of nurse-led multiple disciplinary team-based intervention in the prevention of venous thromboembolism in paitents undergoing general surgery.Methods A total of 118 patients who underwent general surgery in the Tianjin First Central Hospital from May 2017 to October 2018 were divided into study group and control group by random digits table method,with 59 cases in each group.The control group received routine thrombosis prevention nursing,the study group carried out nurse-led multiple disciplinary team-based intervention.The condition of lower limbs deep venous hemodynamic was detected by color Doppler ultrasonography at 3 days after surgery,the levels of D-dimer,thrombelastograph coagulation analyzer(TEG)coagulation parameters were also measured at after 24 hours of admission and postoperative day 3,respectively.Results The vein blood stasis rate was 94.9%(3/59)in the study group,79.7%(12/59)in the control group,the venous blood flow of the lower 1imbs in the study group was better than that in the control group(Z value was 2.477,P<0.05).At 3 days after surgery,the levels of D-dimer were(5.26±1.42)mg/L in the study group,(6.36±1.58)mg/L in the control group,D-dimer was decreased in study group compared to the control group,the difference was statistically significant(t value was 3.991,P<0.05).Coagulation reaction time(R)value and solidification angle(Angel),maximum thrombus intensity(MA),composite coagulation index(CI)levels were(5.30±0.91)min,(69.64±21.93)deg,(65.40±13.76)mm and(1.23±0.20)in the study group,those index were(4.41±0.75)min,(76.64±16.02)deg,(70.98±13.39)mm,(2.09±0.36)in the control group,R value were increased and Angel,MA,CI levels were decreased in the study group compared to the control group(t value was 2.001-15.997,P<0.05).Conclusions Nurse-led multiple disciplinary team-based intervention improves the lower limbs deep venous hemodynamic and coagulation function,as well as reduce the incidence of venous thromboembolism.

关 键 词：护士 多学科协作 静脉血栓症 预防 

分 类 号：R473[医药卫生—护理学]