骨科患者静脉血栓栓塞症分级预防方案的构建

目的 基于Caprini风险评估量表,构建骨科住院患者静脉血栓栓塞症（venous thromboembolism,VTE）的分级预防方案,为临床护理人员血栓预防工作提供科学的依据。 方法 基于循证理念进行VTE预防方案的证据总结,形成初步框架,初拟方案共包括4项一级指标、12项二级指标、49项三级指标;选取23名医生及护理人员作为函询专家,进行2轮专家函询确定分级预防方案。 结果 本研究纳入7篇指南、3篇专家共识。通过专家函询构建了包括4项一级指标、12项二级指标、39项三级指标在内的VTE分级预防方案,2轮函询专家积极系数均为100%,权威系数为0.863,肯德尔和谐系数为0.111~0.192。 结论 基于Caprini量表构建的VTE分级预防方案具有科学性,本研究结果可帮助高危科室建立VTE分级预防流程与路径,为临床护士对患者进行VTE预防提供指导依据,保障患者安全。

Construction of hierarchical prevention scheme for venous thromboembolism in orthopedic patients in an evidence-based approach

Objective To construct a hierarchical prevention scheme for venous thromboembolism（VTE） in orthopedic inpatients,so as to provide scientific and practical guidance for VTE prevention of clinical nurses. Methods Firstly,according to the evidence-based concept,researchers summarized the evidence of VTE prevention scheme,and a preliminary framework was formed. The preliminary prevention scheme consisted of 4 first-level indicators,12 second-level indicators,and 49 third-level indicators. Secondly,2 rounds of expert consultations among 23 doctors/nursing experts were conducted to determine the hierarchical prevention scheme. Results A total of 365 guidelines/expert consensuses were retrieved. Removal of duplicates was conducted for 83 articles,and 112 articles were screened out through reading abstracts. After further reading of the full text,7 guidelines and 3 expert consensuses were finally included. The hierarchical prevention scheme for VTE was constructed through expert consultations that included 4 first-level indicators,12 second-level indicators and 39 third-level indicators. The positive coefficients of experts in 2 rounds of consultations were both 100%,the authority coefficient was 0.863,and the coordination coefficients ranged from 0.111 to 0.192. Conclusion The hierarchical prevention scheme for VTE based on the Caprini scale is scientific. The results of this study can help high risk departments to establish the hierarchical prevention process and path for VTE,providing guidance basis for clinical nurses to carry out VTE prevention and improve patient safety.