VTE三级管理四级网络综合防控体系在肾移植患者围术期中的应用分析  

Application of VTE three-level management and four-level network comprehensive prevention and control system in perioperative period of kidney transplant patients

作　　者：王静[1] 乔建红[1] 张淑香[1] 王兆浩 张恩胜 门同义[1] 沈彬[1] 操晓红[1] Wang Jing;Qiao Jianhong;Zhang Shuxiang;Wang Zhaohao;Zhang Ensheng;Men Tongyi;Shen Bin;Cao Xiaohong(Department of Urology,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong,China;Department of Neurosurgery,PKU Care Luzhong Hospital,Zibo 255400,Shandong,China;Department of Pediatrics,Maternal and Child Health Care of Shandong Province,Jinan 250014,Shandong,China.)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)泌尿外科,山东济南250014 [2]北大医疗鲁中医院神经外科,山东淄博255400 [3]山东省妇幼保健院儿科,山东济南250014

出　　处：《实用器官移植电子杂志》2020年第3期174-179,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：山东省重点研发计划(2017RKB14047)。

摘　　要：目的应用静脉血栓栓塞症(venous thromboembolism,VTE)三级管理四级网络综合防控体系,有效预防肾移植患者围术期静脉血栓的发生。方法采用病例前后对照研究方法,整群抽样,选取2019年222例肾移植患者作为实验组2018年190例肾移植患者作为对照组。两组患者均实施肾移植手术治疗,对照组患者采用VTE常规预防护理措施,实验组采用VTE三级管理四级网络综合防控体系进行VTE风险防治管理。两组患者均于术前1 d及术后1、7 d监测血浆D-二聚体(D-Dimer,D-D)水平,于术前1 d、术后7 d行彩色超声多普勒检查双下肢静脉血流情况。实验组于术前1 d及术后1、7、14 d应用Caprini 2005风险评估模型进行评分并采取相应预警方案。比较两组术后VTE发生率、病死率、住院天数,分析实验组Caprini 2005风险评估模型评分及分层情况以及发生VTE情况。结果两组术前1 d和术后1 d D-D指标差异无统计学意义(P> 0.05),术后7 d两组D-D指标差异有统计学意义(P <0.05)。对照组双下肢静脉血流超声阳性率发生率高,与实验组相比差异有统计学意义(P <0.05)。对照组住院天数多于实验组,差异有统计学意义(P <0.05)。两组患者术后均未发生肺血栓栓塞症(pulmonary thromboembolism,PTE),均无死亡病例,对照组VTE发生率高于实验组,差异有统计学意义(P <0.05)。实验组2例患者分别于术后7 d和14 d发生小腿肌间静脉血栓(calf muscular vein thrombosis,CMVT),且预警分层为高危和极高危。结论采用静脉血栓栓塞症三级管理四级网络综合防控体系,对肾移植患者围术期VTE的发生进行筛查并给予有效的干预措施,能够及早发现并积极预防VTE的发生,保证患者的安全。Objective To assess the venous thromboembolism(VTE) three-level management and fourlevel network comprehensive prevention and control system in effectively preventing perioperative venous thrombosis in kidney transplant patients. Methods The case control study was used for cluster sampling. A total number of 222 kidney transplant patients operated in 2019 were selected as the experimental group, and 190 kidney transplant patients operated in 2018 were used as the control group. Patients in both groups received kidney transplantation. The VTE routine preventive care measures were used in the control group. The VTE three-level management and fourlevel network comprehensive prevention and control system for VTE risk prevention and management were used in the experimental group. Plasma D-Dimer(DD) levels were monitored at 1 day before surgery as well as 1 d and 7 d after surgery in both groups, and color Doppler ultrasound examination of blood flow in both lower limbs was performed at 1 d and 7 d after surgery. The experimental group was scored by the Caprini 2005 risk assessment model at 1 d before surgery as well as 1 d, 7 d and 14 d after surgery, the corresponding early warning program was adopted. The incidence of VTE, mortality and length of hospital stay were compared between the two groups, and the Caprini2005 risk assessment model score and stratification of the experimental group were analyzed. Results There was no significant difference in D-D index between the two groups before surgery and 1 d after surgery(P > 0.05),there was a statistically significant difference between the two groups in D-D index at 7 days after surgery(P < 0.05). The positive venous blood flow in the lower limbs of the control group was significantly higher than the experimental group(P < 0.05). The control group had significant longer hospital stays than the experimental group(P < 0.05). No postoperative PTE and death occurred in the two groups of patients. The incidence of VTE in the control group was higher than that in the experi

关 键 词：静脉血栓栓塞症 预防 肾移植 防控体系 围术期 

分 类 号：R473.6[医药卫生—护理学]