新型冠状病毒肺炎合并骨创伤患者静脉血栓栓塞症防治的护理建议  

Suggestions for prevention and nursing techniques of venous thromboembolism in patients with corona virus 2019 combined with trauma

作　　者：毕娜[1] 付小洁 高远[3] 龚竹云[4] 董艳芬[5] 窦娜[6] 苏晓静[2] 朱宗红 周静[8] 张晓玲[9] 程凌燕[10] 杨玉凤 肖霞 Bi Na;Fu Xiaojie;Gao Yuan;Gong Zuyun;Dong Yanfen;Dou Na;Su Xiaojing;Zhu Zonghong;Zhou Jing;Zhang Xiaoling;Cheng Lingyan;Yang Yufeng;Xiao Xia(Department of Orthopedics,8th Medical Center of PIA General Hospital,Beijing 100091,China;Department of Orthopedics,1st Medical Center of PLA General Hospital,Beijing 100853,China;Nursing Department,1st Medical Center of PLA General Hospital,Beijing 100853,China;Departmentof General Surgery,2nd Medical Center of PLA General Hospital,Beijing 100853,China;Department of Vascular and Endovascular Surgery,1st Medical Center of PLA General Hospital,Beijing 100853,China;Department of Gynecology,1st Medical Center of PLA General Hospital,Beijing 100853,China;Department of Neurology,6th Medical Center of PLA General Hospital,Beijing 100048,China;Department of General Surgery,1st Medical Center of PIA General Hospital,Beijing 100853,China;Departmen of Oncology,1st Medical Center of PLA General Hospital,Beijing 100853,China;Department of Orthopedics,4th Medical Center of PLA General Hospital,Beijing 100048,China;Department of Functional Neurosurgery,3rd Medical Center of PLA General Hospital,Beijing 100039,China;Department of Orthopedics,6th Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第八医学中心骨科中心,北京100091 [2]解放军总医院第一医学中心骨科,北京100853 [3]解放军总医院第一医学中心护理部,北京100853 [4]解放军总医院第二医学中心综合外科,北京100853 [5]解放军总医院第一医学中心血管外科,北京100853 [6]解放军总医院第一医学中心妇产科,北京100853 [7]解放军总医院第六医学中心神经内科,北京100048 [8]解放军总医院第一医学中心普通外科,北京100853 [9]解放军总医院第一医学中心肿瘤内科,北京100853 [10]解放军总医院第四医学中心骨一科,北京100048 [11]解放军总医院第三医学中心功能神经外科,北京100039 [12]解放军总医院第六医学中心骨科,北京100048

出　　处：《中华创伤杂志》2020年第3期197-201,共5页Chinese Journal of Trauma

摘　　要：合并骨创伤的新型冠状病毒肺炎(COVID-19)患者是发生静脉血栓栓塞症(VTE)的高危人群,治疗COVID-19过程中必须重视VTE的防治。2019新型冠状病毒(2019-nCoV)通过诱导炎性介质释放、增加纤维蛋白原水平、损伤血管内皮细胞等多种途径引起血液高凝状态;创伤及手术直接或间接导致静脉血管壁损伤引起外源性凝血途径激活,微循环受到不同程度破坏,启动VTE形成的外源性途径。骨创伤患者治疗过程中,患肢制动、被迫卧床等处置使静脉血流缓慢,容易形成VTE;老年人常并存多种慢性疾病,是VTE的独立危险因素。此外,COVID-19患者持续高热、严重肺病、呼吸功能衰竭、脓毒血症及有创技术应用等,会进一步加重此类患者的VTE风险和救治难度。为配合临床一线有效开展COVID-19合并骨创伤患者的VTE防治,笔者对VTE防治提出护理建议,以期为此类患者的护理工作提供依据。Corona virus disease 2019(COVID-19)patients with trauma are at high risk of venous thromboembolism(VTE),which must be taken seriously in the therapeutic processes.Hypercoagulable state is induced by 2019 novel coronavirus(2019-nCoV)in many ways,such as increasing the level of inflammatory factors and fibrinogen,and inducing endothelial cell injury.The venous wall injuries from trauma and operation directly or indirectly trigger off the exogenous coagulation pathway and the microcirculation can be damaged at the same time,which may initiate the exogenous pathway of VTE.Immobilization of limbs and forced bed rest during the treatment of traumatic patients will slow venous blood flow.Chronic non-communicable diseases such as diabetes in the elderly were independent risk factors for VTE.Furthermore,the persistent fever,severe lung disease,respiratory failure,sepsis and invasive technology application add the risk of VTE and the difficulty of treatment.In order to help effective prevention VTE of for COVID-19 patients with trauma,the authors put forward relevant technical suggestions for prevention and nursing of VTE to provide basis for nursing work during pandemic of COVID-19.

关 键 词：冠状病毒感染 肺炎 静脉血栓栓塞 骨折 

分 类 号：R563.1[医药卫生—呼吸系统] R683[医药卫生—内科学]