基于循证构建静脉血栓栓塞症预防护理敏感质量指标体系

目的 构建静脉血栓栓塞症预防护理敏感质量指标体系,为静脉血栓栓塞症预防护理质量评价和监测提供工具.方法 以"结构—过程—结果"模式为理论框架,采用澳大利亚JBI循证方法收集评价证据,由小组讨论筛选指标,初步拟订静脉血栓栓塞症预防护理敏感质量指标,进行2轮专家函询确立静脉血栓栓塞症预防护理敏感质量指标体系,最后通过层次分析法计算指标权重.结果 静脉血栓栓塞症预防护理敏感质量指标体系包含3项一级指标、6项二级指标、22项三级指标;2轮函询专家积极系数分别为84.85％与96.43％,权威系数分别为0.863与0.869,协调系数分别为0.099～0.163,0.096～0.135.结论 构建的静脉血栓栓塞症预防护理敏感质量指标体系过程严谨,具有可靠性,权重分配合理,可用于临床静脉血栓栓塞症预防护理质量评估.     

腹膜癌静脉血栓栓塞症高危患者围手术期预防护理

目的 总结腹膜癌患者围手术期静脉血栓栓塞症防治的规范化护理经验。方法依据腹膜癌患者围手术期的静脉血栓栓塞症防治技术,制订并实施腹膜癌患者手术期静脉血栓栓塞症防治的临床护理路径,并应用于256例腹膜癌静脉血栓栓塞症高危患者。结果术后发生静脉血栓栓塞症14例,其中深静脉血栓13例,均为下肢肌间静脉血栓,肺栓塞1例;通过定期随访,截至2022年1月1日,14例患者静脉血栓栓塞症均恢复良好。结论腹膜癌患者围手术期静脉血栓栓塞症防治临床护理路径的建立与实施,使围术期静脉血栓栓塞预防规范化,促进了患者术后康复。     

静脉血栓栓塞症临床决策支持系统的构建及应用

目的 构建深静脉血栓栓塞症临床决策支持系统及评价应用效果。方法 基于电子护理文书录入系统、医院运营管理决策分析系统,构建静脉血栓栓塞症临床决策支持系统,于2018年开始应用于静脉血栓栓塞症防控。结果 临床决策支持系统应用后,静脉血栓栓塞症预防率从2018年的88.00%提高到2020年的99.88%;全院静脉血栓栓塞症上报率从0.28%提高至0.44%,骨科静脉血栓栓塞症上报率由2.90%提高到3.95%(均P<0.01);全院有症状静脉血栓栓塞症发生率从0.07%下降至0.06%,骨科有症状静脉血栓栓塞症发生率由0.17%下降至0.03%(P<0.05,P<0.01)。结论 静脉血栓栓塞症临床决策支持系统为护士提供准确、客观的决策依据,促进静脉血栓护理行为规范化、服务标准化和品质同质化,有利于护理质量持续改进。     

静脉血栓栓塞症患者护理随访系统的设计与应用

目的 设计针对静脉血栓栓塞症出院患者的护理随访系统,观察并评价其应用效果.方法 组建研究团队,基于护理程序设计结构化随访表单,构建静脉血栓栓塞症出院患者健康教育知识库,以医院信息系统为支撑平台构建结构化护理随访系统,于2018年1月正式投入使用,统计运行期间各质量评价指标及随访结果.结果 截至2020年6月,随访静脉血栓栓塞症患者3 417例(4 783例次),静脉血栓栓塞症出院患者电话随访通话成功率为96.78％.2018～2020年30 d内因静脉血栓栓塞症或静脉血栓栓塞症相关原因再入院率由3.60％降至2.88％;患者服药依从性、用药信息了解度及对护理服务满意度逐年提高.结论 基于护理程序设计的结构化护理随访系统可有效提升随访工作质量及效率,为高质量、规范化、同质化随访服务提供保障.     

信息化技术应用于静脉血栓栓塞症护理的研究进展

综述信息化技术在静脉血栓栓塞症护理领域中风险预测、警报接收与上报、抗凝防治管理、医护人员相关继续医学教育、患者疾病预后管理的应用现状，总结其应用阻碍因素，旨在为我国静脉血栓栓塞症护理信息化建设提供参考。     

应用Caprini风险评估模型预防下肢静脉曲张术后静脉血栓栓塞症

目的探讨Caprini风险评估模型预防下肢静脉曲张术后静脉血栓栓塞症的效果。方法将887例下肢静脉曲张手术患者按照入院时间分为对照组462例和观察组425例。对照组给予常规术后护理及治疗,观察组在此基础上使用Caprini风险评估模型评估患者静脉血栓栓塞症的风险,并根据风险程度采取相应的干预措施。结果观察组发生静脉血栓栓塞症1例,对照组发生9例,两组比较,差异有统计学意义(P0.05)。结论 Caprini风险评估模型用于下肢静脉曲张患者可有效降低术后静脉血栓栓塞症的发生,对静脉血栓栓塞症早期预防早期筛查具有重要意义。     

基于Caprini风险评估量表的分级护理对老年肺癌患者静脉血栓的预防

目的 探讨基于Caprini风险评估量表的分级护理对老年肺癌患者围手术期静脉血栓栓塞症的预防效果.方法 将228例行胸腔镜下肺癌根治术的老年患者根据入院时间分为对照组113例,干预组115例.对照组采用常规护理,干预组在常规护理的基础上采用Caprini风险评估量表评估患者发生静脉血栓栓塞症的风险等级,根据风险等级实施...     

及时干预法在骨科术后静脉栓塞症预防中的应用

目的探讨及时干预法在骨科术后静脉血栓栓塞症预防中的效果与评价。方法本院在2010年2月至2012年9月期间．共收治各类骨科手术患者70例,将其随机分成实验组（35例）和对照组（35例）,其中对照组给予传统常规护理,实验组则依据对静脉血栓形成的危险因素的评估结果及时给予特殊护理,对比分析两组患者的各项血常规结果及静脉血栓栓塞的发生率等。结果实验组患者发生静脉血栓栓塞1例,发生率为2．86％;对照组患者发生静脉血栓栓塞7例,发生率为20．00％,实验组的发生率显著低于对照组（X^2=5．0807,P〈0．05）。结论与传统常规护理相比,基于对静脉血栓形成的危险因素的评估结果而制定的特殊护理,可有效地降低静脉血栓的发生率,且不会对血常规指标造成影响,可见该法是一种安全有效的护理方法,应在临床中推广应用。     

基于PubMed数据库的静脉血栓栓塞症研究热点的共词聚类分析

目的检索静脉血栓栓塞症研究的相关文献,分析当前的研究现状和热点。方法通过PubMed检索2013~2017年发表的有关静脉血栓栓塞的文献,运用BICOMB和图形聚类工具gCLUTO对文献进行关键字词篇矩阵、双向聚类分析,形成主题词聚类曲线图、主题词聚类矩阵及主题词聚类树状图。结果共4 083篇文献纳入分析,抽取出现频次63次的主题词33个,聚类分析获得7个研究热点:静脉血栓栓塞症的流行病学研究、髋/膝关节置换术后静脉血栓栓塞症的预防和控制、新型口服抗凝药治疗心房颤动的相关研究、恶性肿瘤患者静脉血栓栓塞症的风险评估及预防性治疗、静脉血栓栓塞症抗凝药物选择的相关研究、抗凝药物应用合理性管理、静脉血栓栓塞症诊断的相关研究。结论近年来国内外学者重视静脉血栓栓塞症相关的研究,研究的重点主要集中在静脉血栓栓塞症的预防和控制措施以及抗凝药物的应用,但护理方面在该领域的研究较少。     

神经外科术后并发静脉血栓栓塞症的危险因素及其护理

目的 探讨神经外科手术后静脉血栓栓塞症形成的危险因素及护理措施。方法 回顾性分析22例下肢深静脉血栓形成（DVT）和3例肺栓塞（PE）患者的临床资料。结果 患者高龄、并存疾病、手木及应用脱水药物等是DVT和PE的危险因素。结论 对于神经外科手术后并存深静脉血栓栓塞症危险因素患者应提高警惕，一旦确诊，尽早实施抗凝、促溶药物加手术的综合治疗，并进行系统的护理，以提高患者生活质量。     

Primary prophylaxis of venous thromboembolism in surgical patients

Venous thromboembolism is a major risk for surgical patients during the perioperative period. Prevention of perioperative venous thromboembolism remains a critical component of surgical patient care. The risk for venous thromboembolism in surgical patients can be stratified by their risk factors and by the type of operation. Pharmacological prophylaxis for venous thromboembolism includes unfractionated heparin, low-molecular weight heparin, fondaparinux, warfarin, antiplatelet therapy, and direct thrombin inhibitors. Mechanical devices such as graduated compression stockings, intermittent pneumatic compressions, and venous foot pumps are also effective modalities for venous thromboembolism prophylaxis. The optimal preventive measure of venous thromboembolism should be based on the degree of risk for venous thromboembolism with the intensity of prophylaxis while balancing potential treatment benefits and risks in each individual patient. The epidemiology of venous thromboembolism, the methods for achieving venous thromboembolism prophylaxis, and the approach to institute venous thromboembolism prophylaxis in surgical patients undergoing various operative interventions are reviewed in this article.     

Perioperative management of chronic anticoagulation in orthopaedic surgery

The orthopaedic patient on chronic anticoagulation therapy is at risk of thromboembolism and hemorrhage in the perioperative period. To establish the most effective anticoagulation regimen, patients should be stratified according to the risk of arterial or venous thromboembolism. Timing of surgery, thromboembolic risk, and bleeding risk should be considered when developing an anticoagulation protocol. Retrievable inferior vena cava filters may be a viable alternative to bridging therapy in patients at high risk of venous thromboembolism and/or bleeding.     

髋关节置换术后成人患者血栓预防和管理的证据总结

目的总结髋关节置换术后成人患者血栓预防和管理的最佳证据,为临床护理提供依据。方法计算机检索国外BMJ最佳临床实践、国际指南协作网(GIN)、美国国立指南文库(NGC)、加拿大安大略注册护士协会(RNAO)等和国内中国生物医学文献服务系统、中国知网、万方数据和维普网等共计21个数据库和相关网站自建库至2020年4月关于预防髋关节置换术后成人患者血栓的指南、临床决策、推荐实践、证据总结、系统评价和专家共识。从中选出符合纳入标准的文献,再对纳入文献进行文献质量评价和证据提取。结果共纳入11篇文献,其中3篇指南、1篇临床决策、1篇证据总结和6篇系统评价;提取30条最佳证据,归纳为风险评估、预防方式选择、机械预防、药物预防、术后管理、健康教育6个方面。结论髋关节置换术后成人患者血栓预防和管理的证据总结涵盖从评估至术后管理全程,针对性强,可作为临床护理的参照与导引。     

重视腹部外科手术后下肢深静脉血栓形成和肺栓塞的防治

肺栓塞是下肢深静脉血栓形成最严重的并发症,对部分病人而言是一种隐匿性威胁。腹部外科手术后下肢深静脉血栓形成和肺栓塞并不少见,应该引起临床医生的足够重视。应建立以“防”为主的观念,对具有危险因素的病人采取积极的预防措施。同时临床医生应熟悉下肢深静脉血栓形成和肺栓塞的早期临床表现,结合病史和易患因素综合分析,提高警惕,及时诊断,减少误诊和漏诊。一旦明确诊断,则应积极采取各种有效措施进行合理治疗,将快速康复外科的理念应用于治疗过程中,争取达到更快更好的恢复。     

Treatment of venous thromboembolism in perioperative period

Venous thromboembolism, including deep vein thrombosis and pulmonary thromboembolism, is a common illness during postoperative period. Pharmacological antithrombotic therapy is the cornerstone for the treatment of venous thromboembolism. However, management of venous thromboembolism during postoperative period can be challenging, because of increased risk of bleeding associated with antithrombotic agents. Therefore, we should devise a strategy with mechanical support such as catheter intervention, inferior vena cava filter and percutaneous cardiopulmonary support during the period with increased bleeding risk.     

Thromboprophylaxis in surgical patients.

Venous thromboembolism is the most common preventable cause of death in surgical patients. Thromboprophylaxis, using mechanical methods to promote venous outflow from the legs and antithrombotic drugs, provides the most effective means of reducing morbidity and mortality in these patients. Despite the evidence supporting thromboprophylaxis, it remains underused because surgeons perceive that the risk of venous thromboembolism is not high enough to justify the potential hemorrhagic complications of anticoagulant use. The risk of venous thromboembolism is determined by patient characteristics and by the type of surgery that is performed. In this paper we identify the risk factors for venous thromboembolism and provide a scheme for stratifying surgical patients according to their risk. We describe the mechanism of action of the various forms of thromboprophylaxis and outline the evidence supporting thromboprophylaxis in different surgical settings. Finally, we recommend optimal forms of thromboprophylaxis in patients who undergo various types of surgery. Intermittent pneumatic compression, with or without elastic stockings, can be used for thromboprophylaxis in patients who undergo neurosurgical procedures; for patients who undergo vascular or cardiovascular procedures, long-term acetylsalicylic acid should be used for thromboprophylaxis. Low-molecular-weight heparin (LMWH) or warfarin is the choice for patients with spinal cord operations and all patients with major trauma who do not have contraindications to anticoagulation should receive thromboprophylaxis with LMWH.     

从重症监护角度思考普通外科围手术期静脉血栓栓塞症防治

普通外科围手术期病人,尤其是重症监护病人存在多种容易导致血栓形成的高危因素,因而较之其他病人,具有更高的静脉血栓栓塞症(VTE)发病风险,在该类人群中切实做好VTE防治工作刻不容缓。准确评估发病风险,是做好VTE的防治工作的关键第一步。目前常用的Caprini模型对于预测围手术期病人的血栓风险具有较高的敏感度,临床上将血浆标记物与该模型相结合,可进一步提高重症监护病人VTE风险的预测价值。重症病人的VTE预防及治疗须强调个体化,综合评价血栓与出血的风险,兼顾有效性及安全性,选择最佳策略和最优剂量,改善病人预后。     

Relationship between deep vein thrombosis and pulmonary embolism following THA and TKA

Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are at risk for venous thromboembolisms, including deep vein thrombosis and pulmonary embolism. Most deep vein thromboses are asymptomatic, but they can lead to long-term morbidity to the same extent as symptomatic events. The risk of complications of venous thromboembolisms depends on the location of thrombi; potential long-term complications include recurrent venous thromboembolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Risk of recurrence persists for several years after the initial event. Approximately 20% of recurrent events are pulmonary embolisms, and approximately half of those are fatal. The causal relationship between deep vein thrombosis and pulmonary embolism remains controversial. Some consider them distinct clinical entities, while others have found asymptomatic distal deep vein thrombosis to be associated with elevated risk of developing pulmonary embolism. Unique coagulation factors may be associated with orthopedic surgery patients that differentiate them from patients undergoing other types of surgery. Symptomatic and asymptomatic deep vein thrombosis can lead to the development of recurrent venous thromboembolism, pulmonary embolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension, all of which are associated with reduced quality of life and increased health care expenditures. Thromboprophylaxis is therefore important in patients undergoing THA or TKA. However, traditional anticoagulants are not ideal, particularly for long-term use. Orthopedic surgeons should be aware of the causes and potential sequelae of venous thromboembolism and of the new thromboprophylactic agents that can help prevent it.     

Thromboembolism Following Foot and Ankle Surgery: A Case Series and Literature Review

Venous thromboembolism following major orthopedic procedures of the hip and knee is well documented and patients are therefore routinely prophylaxed following these proximal lower extremity procedures. In contrast, foot and ankle surgery is considered by most health care professionals to be a low-risk procedure for the development of venous thromboembolism. As a result, pharmacologic deep venous thrombosis prophylaxis is rarely administered. This postoperative practice is supported by the literature regarding deep venous thrombosis following foot and ankle surgery. In this article, we review the risk factors and explore the occurrence of thromboembolism after foot and ankle surgery in the literature. We also present our retrospective study of patients who developed venous thromboembolism after forefoot, midfoot, hindfoot, and ankle procedures. Over the course of 1.5 years, 4 of a consecutive series of 1000 patients (0.4%) developed a deep venous thrombolism and 3 of 1000 (0.3%) developed nonfatal pulmonary emboli. In our series, each of our patients who developed venous thromboembolism had at least 2 identifiable risk factors. The incidence of venous thromboembolism following foot and ankle surgery is rare (less than 1%), and the need for routine propylaxis postoperatively is not supported by any high level of evidence studies. LEVEL OF CLINICAL EVIDENCE: 4.     

Prevention of deep vein thrombosis and pulmonary embolism

Venous thromboembolism is a major cause of perioperative morbidity and mortality. Immobilized medical patients are also at risk. Long-term sequelae represent a significant chronic health burden. Hospitalized patients should be assessed for their risk of thromboembolism and bleeding at regular intervals. Risk stratification using recommended models can be used to guide the choice of thromboprophylaxis. Both mechanical and pharmacological interventions reduce the incidence of venous thromboembolism. Extended prophylaxis is now recommended following high-risk orthopaedic and cancer surgeries and a number of newer oral antithrombotic agents are now available for this. Anaesthesia should be tailored to minimize the risk of venous stasis and maximize early postoperative mobilization.