术中综合物理干预预防妇科肿瘤手术患者下肢深静脉血栓的效果  

Effect of comprehensive intraoperative physical intervention on preventing deep vein thrombosis of lower extremity in patients undergoing gynecological tumor surgery

作　　者：高文汇[1] 戴靖华[1] 吴春梅[1] 翟娟娟 卫建峰[1] Gao Wenhui;Dai Jinghua;Wu Chunmei;Zhai Juanjuan;Wei Jianfeng

机构地区：[1]山西省人民医院麻醉手术科,太原030012

出　　处：《中华现代护理杂志》2022年第2期209-214,共6页Chinese Journal of Modern Nursing

基　　金：山西科技厅科研基金项目(No.201903D321171)。

摘　　要：目的探讨术中综合物理干预预防妇科肿瘤手术患者下肢深静脉血栓(DVT)的效果。方法采用便利抽样法,选取2020年1月—2021年1月在山西省人民医院接受手术的80例妇科肿瘤患者为研究对象,按照随机数字表法分为对照组和干预组,各40例。干预组术中运用间歇性充气加压设备(IPC)联合梯度加压弹力袜(GCS)进行干预。对照组术中单独运用IPC进行干预。比较两组患者手术前后下肢静脉(股总静脉、股深静脉、腘静脉和肌间静脉)的血液流速和管径、血凝指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)以及D-二聚体]及术后第3天下肢DVT发生率。采用Pearson相关分析患者术后D-二聚体水平和下肢静脉血液流速的相关性。结果两组患者术前下肢静脉血液流速和管径比较,差异均无统计学意义(P>0.05)。两组患者术后下肢静脉血液流速比较,差异均有统计学意义(t值分别为2.217、4.863、2.946、2.397;P<0.05);两组患者股总静脉、股深静脉和肌间静脉管径比较差异均有统计学意义(t值分别为2.117、2.756、2.274;P<0.05),腘静脉管径比较差异无统计学意义(P>0.05)。两组患者术前PT、TT、APTT、FIB、D-二聚体比较,差异均无统计学意义(P>0.05),两组患者术后FIB和D-二聚体比较,差异均有统计学意义(t值分别为-2.338、-3.554;P<0.05)。干预组患者术后第3天下肢DVT发生率为2.5%(1/40),对照组患者下肢DVT发生率为20.0%(8/40),差异有统计学意义(χ^(2)=6.135,P<0.05)。Pearson相关分析显示,患者术后D-二聚体水平和下肢静脉血液流速呈负相关(r值分别为-0.484、-0.442、-0.358、-0.308;P<0.01)。结论术中运用IPC联合GCS的综合物理干预措施,能降低妇科肿瘤患者下肢DVT发生率,值得临床应用。Objective To explore the effect of comprehensive intraoperative physical intervention to prevent deep vein thrombosis(DVT)of lower extremity in patients with gynecological tumor surgery.Methods From January 2020 to January 2021,80 gynecological tumor patients undergoing surgery in Shanxi Provincial People's Hospital were selected by convenience sampling as the research object.According to the random number table method,the patients were divided into the control group and the intervention group,each with 40 cases.The intervention group used intermittent pneumatic compression device(IPC)combined with graduated compression stockings(GCS)during the operation.In the control group,IPC was used alone for intervention.This study compared the blood flow rate and tube diameter of the lower extremity veins(common femoral vein,deep femoral vein,popliteal vein,and intermuscular vein),blood coagulation indexes[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer]before and after operation and the incidence of lower extremity DVT on the third day after operation between the two groups.Pearson correlation analysis was used to analyze the correlation between postoperative D-dimer and lower extremity venous blood flow rate.Results There was no significant difference between the two groups of patients in the preoperative lower extremity venous blood flow velocity and diameter(P>0.05).The comparison of postoperative lower extremity venous blood flow rate between the two groups were statistically significant(t=2.217,4.863,2.946,2.397;P<0.05).The diameters of common femoral vein,deep femoral vein and intermuscular vein between the two groups were statistically different(t=2.117,2.756,2.274;P<0.05),and there was no significant difference in the diameter of popliteal vein(P>0.05).There was no significant difference in PT,TT,APTT,FIB,D-dimer between the two groups of patients before operation(P>0.05).The differences in FIB and D-dimer between the two groups of patients were statist

关 键 词：静脉血栓形成 物理预防 妇科手术 间歇性充气加压设备 梯度加压弹力袜 

分 类 号：R473.73[医药卫生—护理学]