成人重症患者深静脉血栓医护一体快速筛查流程的构建

目的 探讨适合我国成人重症患者深静脉血栓快速筛查的流程，为血栓预防护理提供参考。方法 应用循证护理方法，针对成人重症患者深静脉血栓筛查流程提出问题，进行系统检索、证据提取 等，形成成人重症患者深静脉血栓医护一体筛查的证据；通过2轮焦点小组访谈确定成人重症患者深静脉血栓医护一体快速筛查流程。结果 形成的成人重症患者深静脉血栓医护一体快速筛查流程包括风险评估、超声筛查、深静脉血栓预防、管理与质控4个步骤。结论 本研究构建的成人重症患者深静脉血栓医护一体快速筛查流程，可用于成人重症患者深静脉血栓风险筛查。     

恶性肿瘤患者下肢深静脉血栓形成术中物理预防的最佳证据总结

目的 总结恶性肿瘤患者下肢深静脉血栓形成术中物理预防的相关证据,为预防恶性肿瘤患者下肢深静脉血栓形成提供参考。 方法 依据证据的“6S”金字塔模型,系统检索数据库、专业协会网站等资源中与恶性肿瘤患者下肢深静脉血栓形成术中物理预防相关的证据,包括指南、系统评价、专家共识、临床决策、随机对照试验研究,检索时限为建库至2022年3月。由2名经系统循证护理培训的研究人员独立对文献进行筛选,并结合专业判断,对文献质量进行评价,提取汇总证据。 结果 共纳入9篇文献,包含指南4篇、系统评价1篇、专家共识1篇,随机对照试验研究3篇。总结的最佳证据包括评估、物理预防处方、健康教育与注意事项3个方面的23条推荐意见。 结论 恶性肿瘤患者下肢深静脉血栓形成术中物理预防的最佳证据涉及下肢深静脉血栓形成术中评估、预防、健康教育的全过程管理,在临床实践过程中,医护人员应结合临床实际情境,遵循个性化原则,审慎应用证据。     

脊柱外科围手术期患者下肢深静脉血栓诊断流程的构建及应用

目的 :将下肢深静脉血栓诊断的循证医学证据应用于脊柱外科围手术期患者下肢深静脉血栓诊断流程,以提高下肢深静脉血栓的早期检出率。方法:通过检索诊断下肢深静脉血栓的循证医学证据,结合临床情景和专业判断,最终纳入5条下肢深静脉血栓诊断的循证医学证据,并制定基于此5条循证医学证据的下肢深静脉血栓筛查诊断流程。选取2018年1～5月在中南大学湘雅二医院脊柱外科病房住院的443例围术期患者采取传统血栓诊断流程(传统方法组),即患者出现DVT临床表现或D-二聚体检测值明显高于其阳性临界值时再采取双下肢B超对患者DVT进行筛查诊断。于2018年7月1日～11月30日对同一病区住院的498例围术期患者行基于循证医学的DVT筛查诊断流程(新方法组)。比较两种方法应用前后,脊柱外科围术期患者DVT的发生率及患者确诊DVT时出现下肢肿胀、疼痛、皮肤颜色变紫变暗等DVT临床表现(症状性DVT)的发生情况;通过查看患者双下肢B超检查报告单统计患者DVT临床分型中周围型占比情况。结果:传统方法组与新方法组患者下肢深静脉血栓的发生率分别为2.93%、19.28%,两组比较差异有统计学意义(P0.05);症状性DVT占比分别为100%、18.75%,两组比较差异有统计学意义(P0.05);确诊为下肢深静脉血栓的患者中,周围型下肢深静脉血栓占比分别为7.69%、95.83%,两组比较差异有统计学意义(P0.05)。结论:开展基于循证医学的下肢深静脉血栓诊断实践,可提高脊柱外科围术期患者下肢深静脉血栓的早期检出率。     

脊柱外科术后患者深静脉血栓预防及管理的最佳证据应用

目的将脊柱外科术后深静脉血栓预防及管理的最佳证据应用于临床实践,降低患者深静脉血栓发生率。方法遵循澳大利亚JBI证据临床应用模式,检索并总结脊柱外科术后患者深静脉血栓预防及管理的最佳证据,制定审查指标,通过证据应用前的基线审查、实践变革和证据应用后再审查,判断实施效果。结果最佳证据应用后,患者深静脉血栓发生率由2.90%降至0;医护人员深静脉血栓预防及管理知识得分,出血风险评估、机械及药物预防、健康宣教执行率显著提高(均P0.01)。结论深静脉血栓预防及管理最佳证据的应用,可提高医护人员深静脉血栓预防及管理水平,规范预防管理行为,降低患者深静脉血栓发生率。     

预防膝关节置换术后深静脉血栓的规范化护理干预

目的探讨膝关节置换术后预防深静脉血栓的规范化护理措施。方法对33例膝关节置换手术患者进行预防深静脉血栓系统规范化的护理干预。结果 33例膝关节置换患者能够积极配合医务人员的各项护理预防干预,术后无1例发生深静脉血栓。结论规范化护理干预可降低预防膝关节置换术后深静脉血栓的形成。     

骨科大手术后患者下肢深静脉血栓形成的预防及护理

目的总结骨科大手术后下肢深静脉血栓形成的预防及护理体会。方法术前、术后实行人文关怀,加强下肢深静脉血栓患者预防及护理措施。结果通过对263例骨科大手术患者进行预防及护理措施,减少了深静脉血栓并发症的发生,收到良好效果。结论加强有效的护理及预防措施。可降低下肢深静脉血栓发生率。     

老年手术患者下肢深静脉栓塞预防与护理

目的探讨老年手术患者下肢深静脉血栓形成的预防性护理措施,以降低其手术后下肢深静脉栓塞的发生率。方法笔者所在科室对60岁以上338例存在高危因素的患者行手术加强预防下肢深静脉血栓形成的护理。结果对LDVT进行护理预防干预后,只有2例发生LDVT。发生率为0．6％,明显低于未予干预患者的发生率。结论老年手术患者下肢深静脉血栓形成以预防为重点,预防是最根本有效的措施。     

基于Autar量表的围生期深静脉血栓形成高危因素评估表的设计与应用

目的探讨基于Autar量表的围生期深静脉血栓形成高危因素评估表的设计与应用效果。方法将800例剖宫产妇随机分为干预组和对照组各400例。对照组按围生期常规护理;干预组应用自制围生期深静脉血栓形成高危因素评估表进行评估,并根据评估结果采取针对性护理干预。结果两组深静脉血栓形成发生率比较,差异无统计学意义(P0.05)。对照组发生7例,干预组仅发生1例。结论应用基于Autar量表的围生期深静脉血栓形成高危因素评估表,可有效筛查深静脉血栓高危人群,针对性护理干预可降低患者术后深静脉血栓形成发生的风险。     

剖宫产术后并发下肢深静脉血栓形成的预防及护理

目的探讨剖宫产术后下肢深静脉血栓的预防和护理,降低剖宫产术后下肢深静脉血栓发生率。方法针对剖宫产术后下肢深静脉血栓形成的相关因素,对3207例剖宫产术者加强术前健康指导、术中、术后护理,并对发生下肢深静脉血栓4例患者采取一系列护理措施。结果4例患者均临床治愈,无并发症及后遗症。结论对剖宫产者合理实施护理措施,可有效降低下肢深静脉血栓的发生。     

骨科手术后患者深静脉血栓的形成及护理

目的：探讨骨科手术后患者深静脉血栓的形成及护理。方法选择在我院骨科行手术治疗的106例患者,随机分为实验组和对照组,分别给予不同护理干预,观察术后深静脉血栓的形成。结果实验组深静脉血栓形成发生率为1.89%;对照组发生率为13.21%。两组比较,差异有统计学意义（x2=4.88,P＜0.05）。结论加强护理能较好的预防骨科术后患者深静脉血栓的形成。     

危重症患者下肢深静脉血栓风险预测模型的构建及评价

目的 建立危重症患者下肢深静脉血栓风险预测模型,并评价预测效能.方法 选取重症医学科患者420例,分为建模组300例和验证组120例.应用Logistic回归分析筛选下肢深静脉血栓发生的独立危险因素,建立下肢深静脉血栓风险预测模型.应用Bootstrap法进行模型内部验证,利用验证组数据对模型进行外部验证.结果 Log...     

A prospective study of a focused, surgeon-performed ultrasound examination for the detection of occult common femoral vein thrombosis in critically ill patients

HYPOTHESIS: A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. DESIGN: A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies. SETTING: Surgical intensive care unit. PATIENTS: All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis. MAIN OUTCOME MEASURE: Presence of deep vein thrombosis in the common femoral veins. RESULTS: During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy. CONCLUSION: A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected.     

复合护理干预预防骨科术后深静脉血栓的临床研究

目的探讨复合护理干预模式改善骨科术后深静脉血栓（DVT）的预防效果，为骨科病房降低血栓发生率提供实践指导。 方法前瞻性收集2016年5月至2018年2月内蒙古医科大学第二附属医院骨科收治的骨科大手术术后患者166例，其中试验组性别人数（男/女，35/48），对照组性别人数（男/女，36/47）；试验组和对照组年龄均为（57±6）岁，以随机数字表法随机分为试验组和对照组各83例。对照组患者接受一般围手术期护理，试验组按照复合护理干预的思维和方法，制定针对性DVT预防护理流程，观察两组患者术后主要血液指标（血浆D-二聚体、血小板）变化、DVT发生率及患者满意度。 结果与对照组比较，试验组术后DVT近端发生率（2.41%），远端发生率（4.82%）更低（χ²=26.231，P<0.05），患者的护理满意度（97.2%）评价较高（χ²=11.093，P<0.05）。同时，试验组术后24 hD-二聚体水平（6.4±0.5）较对照组低、血小板计数（142±26）较对照组高（t=2.061，t=11.582，P<0.05）。 结论复合护理干预用于骨科围手术期临床实境，可以有效降低血栓发生率，不增加出血风险，对于骨科术后深静脉血栓的合理防控具有重要临床意义。     

应用间歇性气体压缩装置预防人工髋关节置换术下肢深静脉血栓形成

目的探讨对有高出血风险患者应用间歇性气体压缩装置预防人工髋关节置换术后下肢深静脉血栓形成的效果及护理要点。方法2010年3月至2013年1月,对有高出血风险、需要行人工全髋关节置换术或人工股骨头置换术的患者58例,采用基本预防和下肢间歇性气体压缩装置物理预防。主要观察双下肢肢体颜色、肿胀、疼痛等病症,双下肢彩色多普勒超声检查结果。结果58例有高出血风险患者人工髋关节置换术后,其中5例发生患侧肢体疼痛、肿胀,3例无症状、体征,经彩色多普勒超声检查提示深静脉血栓形成共8例,发生率13．65％。结论有高出血风险患者人工髋关节置换术后应用间歇性气体压缩装置,正确使用、仔细观察并有效解决应用中的问题,能有效地预防和减少下肢深静脉血栓形成。     

血栓弹力图指导预防腹腔镜结直肠肿瘤患者术后下肢深静脉血栓形成的应用研究

目的:探讨血栓弹力图指导预防腹腔镜结直肠手术患者术后下肢深静脉血栓形成(LDVT)的综合干预措施,以降低DVT发生率。方法:收集2018年1月至2018年12月接受腹腔镜结直肠手术的100例患者,术后患者返回病房后即采用VTE风险因素评估表(Caprini评分);评分≥2分的中高危DVT患者,进一步采用TEG监测,并采取主动与被动物理干预措施,采取下肢压力梯度治疗仪及不同的物理运动治疗,包括踝关节背伸、跖屈活动、双下肢足泵运动,床上活动使用卧床患者功能锻炼器进行,同时予以适当的药物干预。结果:与干预前相比,干预后48 h、1周、2周,患者TEG参数R值、MA值改善差异有统计学意义(P<0.05);高凝患者数量减少(P<0.05)。干预后2周,仅1例患者发生下肢深静脉血栓,发生率为1.02%。结论:采用血栓弹力图联合Caprini评分系统对腹腔镜结直肠手术后患者LDVT筛查具有积极的指导作用,采取积极有效的综合护理及药物干预措施,可有效改善凝血功能、降低术后下肢深静脉血栓的发生。     

Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening

Patients admitted to in-patient rehabilitation programs have an increased risk for developing deep venous thrombosis (DVT). However, the utility of screening for lower extremity DVT using duplex ultrasound in this high-risk population is not well characterized. The purpose of this study is to identify whether or not screening lower-extremity duplex exams are indicated in this high-risk population. Screening lower extremity duplex exams were performed on all patients admitted to the rehabilitation center at Mt. Sinai Hospital over a 3-year period. Charts were reviewed for patient age, gender, diagnosis, date of screening and follow-up duplex exams, presence and location of venous thrombosis at each duplex exam, history of anticoagulation, and medical DVT prophylaxis. The presence of DVT at screening, the location of DVT along the lower extremity, and the outcome of calf DVT were analyzed in terms of gender, underlying diagnosis, and history of DVT prophylaxis. Lower extremity DVT was detected in 34% of patients. Twenty-three percent of patients had isolated calf vein thrombosis. Men were more likely than women to have DVT. Calf DVTs progressed in 3% of patients over an average follow-up of 2 weeks. The presence of DVT, its location along the lower extremity, and the outcome of calf vein DVT had no significant relationship to underlying diagnosis or history of prophylaxis. Screening duplex exams to detect lower extremity DVT in rehabilitation patients is useful. Screening altered management in 26% of patients, prompting either anticoagulation or repeat duplex exam.     

Meta-analysis of randomised controlled trials on daily sedation interruption for critically ill adult patients

Sedation is often used to improve comfort, reduce anxiety and stress and to facilitate nursing care of critically ill patients in the intensive care unit. This meta-analysis examined the benefits and risks of daily sedation interruption in critically ill adult patients. A total of five randomised controlled trials, comparing daily sedation interruption with no interruption in 699 critically ill patients, from the Cochrane controlled trials register, Embase and MEDLINE databases (1966 to April 2010) were identified and subject to meta-analysis. With the limited data available, daily sedation interruption was not associated with a significant reduction in duration of mechanical ventilation, length of intensive care unit and hospital stay, or mortality. Daily sedation interruption was associated with a reduced risk of requiring tracheostomy (odds ratio 0.57, 95% confidence interval 0.35 to 0.92, P = 0.02; F = 3%) but not an increased risk of removal of the endotracheal tube by the patients (odds ratio 1.3, 95% confidence interval 0.41 to 4.10, P = 0.65; F = 49%). The current evidence suggests that daily sedation interruption appears to be safe, but the significant heterogeneity and small sample sizes of the existing studies suggest that large randomised controlled studies with long-term survival follow-up are needed before daily sedation interruption can be recommended as a standard sedation practice for critically ill adult patients.     

Duplex scanning of central vascular access sites in burn patients.

Seventy-one burned patients requiring intensive care unit management underwent 570 central venous and 167 femoral arterial catheterizations. These patients were surveyed by repeated physical examinations and duplex scans for vascular-related complications. Catheter sites were rotated every 3 days. No arterial thrombi or occlusions were noted. Fourteen patients (19.6%) had 19 positive venous duplex scans. Five patients (7%) had symptomatic deep venous thrombosis (DVT) and nine (12.6%) had asymptomatic DVT. Mean number of venous cannulations before a positive scan was 4.3 (range 1 to 17). All five symptomatic patients had DVT that originated in the lower extremities. No patient had clinical evidence of a pulmonary embolus, or limb morbidity resulting from the DVT. Follow-up duplex scans in the five asymptomatic and three symptomatic patients showed complete resolution in each case. This study demonstrates the high incidence and natural history of central DVT in a group of critically ill burn patients.     

患者血栓风险评估效果探讨及下肢深静脉血栓护理体会

目的总结下肢深静脉血栓(DVT)患者的护理经验,探索患者入院采用Wells评估表效果及DVT合理护理措施。方法收集我院近5年来482例DVT患者临床资料,前4年采用常规护理方法,2017年后采用Well′s评分表对入院患者行DVT风险预测以及统计患者DVT的实际符合率,对确诊DVT患者进行一系列沟通及日常重点检查工作,突出专科护理及必要的抢救准备。比较2017年与前4年DVT发病情况,探讨新的护理经验。结果实施规范VET防治、实行规范护理措施后,2017年的121例DVT患者只发生3例肺栓塞(PE),DVT并发PE的发生率为2.48%,与往年相比,PE并发率明显下降,其差异有统计学意义(P0.05)。结论 Wells评分系统能较准确预测DVT患者。对确诊DVT患者的做好护理沟通,完善DVT专科护理及必要的抢救准备,有助于降低并发PE的发生率及死亡率。