预防骨科患者静脉血栓栓塞症的循证实践

目的基于前期构建的骨科患者静脉血栓栓塞症的预防方案,开展骨科患者静脉血栓栓塞症规范化分级预防的循证实践。 方法制订相应的护理质量审查指标及审查方法,根据基线审查结果分析障碍因素及促进因素,制订行动策略,并通过随机对照研究选取343例患者进行效果验证,试验组进行循证实践,对照组为常规预防。 结果根据循证方案,选择5条指标（血栓风险评估、出血风险评估、分级预防、弹力袜穿戴、护理记录）作为审查依据。循证实践后,试验组患者症状性静脉血栓栓塞症发生较对照组有所下降（住院期间2.45% vs. 2.78%;出院后1个月1.23% vs. 2.22%;出院后3个月1.23% vs. 2.22%）,差异无统计学意义;出院前患者血栓预防知识得分试验组（78.79±8.60）分明显高于对照组（66.05±7.68）分,差异有统计学意义（P<0.001）;护士对静脉血栓栓塞症相关知识的认知水平（危险因素与好发部位、临床表现、风险评估、机械预防、药物预防维度）得分明显提高,差异有统计学意义;护士对审查条目的执行率由循证实践前的36.92%、20% 、67.69%、58.46%、66.15%上升至100%、82.2%、100%、100%、98.16%,差异有统计学意义（P<0.001）。 结论基于证据的循证实践方案的转化可帮助减少患者症状性血栓发生,提高护士和患者认知水平,促进临床依从性,规范护理行为。     

急性静脉血栓栓塞症抗凝治疗的合理应用

治疗急性静脉血栓栓塞症时最紧迫的目标是预防肺栓塞、降低死亡率,其次是局限血栓范围、减轻症状、预防复发性静脉血栓事件和下肢深静脉血栓形成后综合征。应该即刻开始用肝素或低分子肝素抗凝治疗,同时使用或逐渐过渡到口服维生素K拮抗剂维持抗凝治疗。抗凝治疗可以有效地预防静脉血栓复发,但存在出血的风险,因而应根据静脉血栓复发和出血的风险,进行抗凝治疗时限的临床抉择。例如无诱因的急性静脉血栓栓塞症病人的静脉血栓复发风险较高。对于继发于一过性危险因素的静脉血栓栓塞症、出血风险较高的病例选择短期抗凝治疗;对无诱因的静脉血栓复发病例或有确认长期存在危险因素的静脉血栓栓塞症,如癌症、抗凝血酶缺乏等,选择长期的抗凝治疗。     

肾病综合征并发静脉血栓栓塞症的护理

静脉血栓栓塞症（vein thrombosis embolism,VTE）是包括深静脉血栓形成（deep vein thrombosis,DVT）、肾静脉血栓形成（renal vein thrombosis,RVT）和肺血栓栓塞症（pulmonary throm-bosis embolism,PTE）在内的一组血栓栓塞性疾病,有研究显示,未经治疗的PTE病死率为25%~30%,协和医院的研究结果表明经过治疗的病死率为7.0%。因此,加强VTE的研究对降低VTE的发病率,提高生存质量十分重要。我们2005年1月-2010年12月我院肾病综合征患者并发VTE7例,现将其治疗与护理情况报告如下。     

静脉血栓栓塞症的预防

静脉血栓栓塞症（venous thrombeembolism，VTE）包括深静脉血栓形成（deep venous thrombosis，DVT）和肺动脉栓塞（pulmonary embolism，PE）两种主要疾病。PE栓子大多来源于下肢DVT。西方人群DVT和PE发生率约为1‰和0．5‰，美国每年至少有20万新发VIE患者，发展中国家每年约有3～6千万人发病。PE临床漏诊率高，不经治疗病死率可高达25％～30％，美国每年至少有5万人死于PE，占死亡原因的第三位，仅次于肿瘤和心肌梗死。经积极的治疗后PE患者的死亡率可降至2％～8％。我国对VTE的研究和防治处于相对落后的状态，如何有效加强各级医师对VTE的认知和预防是现阶段迫切需要解决的问题。     

肺癌患者发生静脉血栓栓塞症的危险因素

目的 探讨肺癌患者发生静脉血栓栓塞症的危险因素。方法 收集2020年7月至2022年6月于首都医科大学附属北京积水潭医院住院的82例肺癌患者的临床资料,按照是否发生静脉血栓栓塞症将其分为血栓组（n=23）和对照组（n=59）。收集所有患者的一般资料,分析肺癌患者发生静脉血栓栓塞症的影响因素。结果 血栓组患者年龄、C反应蛋白水平、吸烟程度、合并慢性阻塞性肺疾病、化疗比例均高于对照组患者,差异均有统计学意义（P<0.05）。多因素Logistic回归模型分析结果显示,年龄≥65岁、C反应蛋白水平>5 mg/L、重度吸烟（>20包/年）、合并慢性阻塞性肺疾病、接受化疗均是肺癌患者发生静脉血栓栓塞症的独立危险因素（P<0.05）。结论 年龄、C反应蛋白水平、吸烟程度、慢性阻塞性肺疾病、化疗情况均是肺癌患者发生静脉血栓栓塞症的危险因素,临床实践中应密切关注患者上述指标,及时评估静脉血栓栓塞症的发生风险,据此进行适当的监测和预防。     

创伤性肝破裂出血患者预防静脉血栓栓塞症康复护理体会

目的 探讨预防创伤性肝破裂出血患者静脉血栓栓塞症的康复护理体会。方法 选取2020年1月至2023年3月本院收治的创伤性肝破裂出血患者为研究对象,以康复模式在本院开始推行时间（2022年2月12日）为分界线,将2020年1月1日至2022年2月11日就诊的56例患者纳入对照组实施常规护理,将2022年2月12日至2023年3月31日就诊的56例患者纳入观察组,实施康复护理。干预7d后,比较两组患者对于预防VTE相关知识的掌握程度;比较两组患者干预前及干预7 d后的血栓风险（Caprini风险评估量表）差异;统计两组患者在干预1月内静脉血栓栓塞症（VTE）发生率。结果 干预7 d后,观察组对预防VTE相关知识的掌握程度显著高于对照组（P<0.05）,两组患者Caprini评分显著降低,且观察组评分显著低于对照组（P<0.05）;干预1月内,观察组VTE发生率显著低于对照组（P<0.05）。结论对于创伤性肝破裂出血患者,采用康复模式能够有效预防静脉血栓栓塞症的发生,提高患者的自我效能感,值得临床重视,推广运用。     

静脉血栓栓塞症诊治现状与展望

静脉血栓栓塞症（VTE）是血管外科领域乃至住院病人中常见病之一,临床上可表现为深静脉血栓形成（DVT）和肺栓塞（PE）。由于VTE的临床症状较为隐匿,因此给其临床诊断和治疗带来了困难。VTE的临床诊断可根据临床症状表现和实验室检查相结合进行,预防和治疗DVT目前主要还是以抗凝治疗为主。展望未来,基因分析在VTE诊断价值的不断提高、新技术应用和新药物研发必将为VTE治疗带来曙光。     

精神疾病相关的静脉血栓栓塞症防治现状

静脉血栓栓塞症(VTE)因其可导致精神科住院患者突然死亡而受到精神病学领域的广泛关注。本文对近年来精神疾病患者发生VTE的危险因素、治疗、评估及预防进行综述,以期引起临床工作者的重视,从而及时进行个体化的预防和治疗。     

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。     

Caprini风险评估模型在静脉血栓栓塞症护理中的研究进展

综述Caprini风险评估模型在静脉血栓栓塞症护理中的研究进展。建议静脉血栓栓塞症诊疗模式逐渐向医护共同决策的分级护理模式转变,健全信息化风险预警系统,提升静脉血栓栓塞症的护理水平。     

基于人工智能技术的骨科VTE防治系统的开发与应用

目的 提高骨科患者静脉血栓栓塞（VTE）评估效率和准确性,减少VTE的发生。方法 将2 586例骨科住院手术患者按入院时间段分为对照组1 023例、观察组1 563例。对照组采用纸质评估表评估患者VTE情况、手动录入HIS等常规VTE风险管理;观察组开发VTE防治全链路系统进行患者VTE风险管理。结果 观察组VTE评估效率、评估正确率及医护人员管理满意度显著高于对照组（均P＜0.05）,VTE发生率显著低于对照组（P＜0.05）。结论 骨科VTE防治全链路系统的应用,可有效提高骨科住院手术患者VTE评估效率和正确率,减少VTE的发生,提高医护人员工作满意度。     

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.     

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...     

出院患者短信息随访系统的创建与应用

目的寻找最佳的出院患者健康教育方法。方法将2008年出院的32330例患者采用传统随访方法(对照组),对2009年出院的36099例患者采用短信息随访系统实施随访及健康教育(观察组)。结果观察组患者表扬医护人员次数及患者提合理化建议数显著高于对照组(均P<0.01);实施短信息随访系统后,住院患者满意度显著提高(P<0.05)。结论建立短信息随访平台实施出院患者随访及健康指导能及时有效解决出院患者的护理问题,增加患者对医院及医护人员的信赖,提高患者满意度,减少医护人员外出随访,减轻临床工作量,提高工作效率和社会效益。     

Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study

Venous thromboembolism (VTE) is a frequent complication after solid organ transplantation (SOT) and, specifically, after lung transplantation (LT). The objectives of this study were to evaluate prophylaxis with enoxaparin and to describe risk factors for VTE after LT. We retrospectively reviewed the clinical records of 333 patients who underwent LT in our institution between 2009 and 2014. We compared two consecutive cohorts: one that received enoxaparin only during post‐transplant hospital admissions and a second cohort that received 90‐day extended prophylaxis with enoxaparin. Cumulative incidence function for competing risk analysis was used to determine incidence of VTE during the first year after transplantation. Risk factors were analyzed using a Cox proportional hazards regression model. The cumulative incidence of VTE was 15.3% (95% CI: 11.6–19.4). Median time from transplant to the event was 40 (p25–p75, 14–112) days. Ninety‐day extended prophylaxis did not reduce the incidence of VTE. In this study, the risk factors associated with VTE were male gender and interstitial lung disease. VTE is a major complication after LT, and 90‐day extended prophylaxis was not able to prevent it. Large, multicenter, randomized clinical trials should be performed to define the best strategy for preventing VTE.     

Mechanical compression in the prophylaxis of venous thromboembolism

Venous thromboembolism (VTE) is an important cause of morbidity and mortality in a substantial number of the Australian community. There exists a considerable range of potential prophylactic measures aimed at reducing the risk of VTE. These antithrombotic regimens include pharmacological interventions and mechanical techniques to counteract venous stasis including graduated compression stockings and intermittent pneumatic compression (IPC) devices. This review particularly concentrates on evidence for the use of mechanical prophylaxis and the interrelationship with pharmacological methods of VTE prophylaxis. Mechanical and pharmacological methods of VTE prophylaxis are both effective and when used in combination have synergistic effects. Although there are a number of different IPC systems, little evidence is available at present that differentiates these on the basis of VTE prevention. Compliance and patient acceptance of IPC as a preventative measure has improved with miniaturization and device weight reduction. IPC should be used according to recommended guidelines. In moderate-risk patients when pharmacological prophylaxis is contraindicated, IPC can be used as an alternative. High-risk patients should receive both mechanical and pharmacological prophylaxis to reduce their relative risk. Until further evidence becomes available, the specific type of IPC unit chosen will generally be determined by ease of use, availability and cost.     

腹部外科病人术后症状性静脉血栓栓塞症多中心临床流行病学研究

目的探讨腹部外科病人术后症状性静脉血栓栓塞症(VTE)的流行病学特点。方法回顾性分析上海交通大学医学院附属第九人民医院、滁州市第一人民医院、郑州大学第二附属医院、上海市奉贤区奉城医院4家医院自2015-01-01—2019-06-30期间就诊于普通外科,入院后行腹部外科手术的病人共计24336例相关临床资料,并观察术后14 d内发生VTE事件的情况。结果VTE事件发生率为0.89%(216/24336),其中,深静脉血栓形成(DVT)发生率0.75%(183/24336),肺动脉栓塞(PE)发生率0.35%(86/24336)。男性VTE事件发生率为0.85%(123/14443),女性为0.94%(93/9893),男女VTE事件发生率差异无统计学意义(χ^2=2.15,P>0.05)。DVT病人常见的症状是下肢肿胀177例(96.72%),疼痛104例(56.83%),浅静脉曲张36例(19.67%)。PE病人常见的症状是呼吸困难和气促77例(89.53%),胸痛55例(63.95%)。DVT易累及左下肢;混合型最多见,左、右下肢分别为61.11%(88/144)和52.11(37/71)。PE病人最常见低危组病人45例(52.32%)。常见的VTE危险因素包括:年龄≥40岁208例(96.30%),手术时间>45 min 139例(64.35%),恶性肿瘤病史99例(45.83%)。主要的腹部外科手术类型是消化道恶性肿瘤手术105例(48.61%),胆囊切除术73例(33.80%)。腹腔镜手术(1.61%,179/11123)较开放手术(0.28%,37/13213)VTE事件发生率低(χ^2=45.56,P<0.05)。VTE相关病人的病死率为0.10%(25/24336)。结论腹部外科病人术后VTE发生率已经明显降低,医生应当根据其流行病学特点,早期发现,早期诊断和早期预防干预,避免严重不良事件的发生。     

The effects of information platform-based nursing on preventing venous thromboembolism in patients with hip fractures

PurposeVenous thromboembolism (VTE) is a major health issue among hip fracture patients. This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient's drug compliance and reduce the incidence of VTE in hip fracture patients.MethodsThis study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform (study group) between January 2016 and September 2017. All the patients included in the both groups were hip fracture patients who had an age over 50 years, treated with surgery, and hospitalized ≥ 48 h. Patients were excluded if they admitted to hospital due to old fractures, had a severe bleeding after 72 h of admission, diagnosed with any type of VTE, or refused to participate in the study. The information platform was divided into medical, nursing, and patient interface. Based on the information platform, medical practitioners and nurses could perform risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up, and other aspects of nursing interventions for patients. This study compared essential characteristics, drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. SPSS 18.0 software (IBM Corp., NY, and USA) was used for statistical analysis.ResultsAltogether 1177 patients were included in the control group, and 491 patients in the study group. Regarding baseline data, patients in the study group had more morbidities than those in the control group (p < 0.05). The difference of drug compliance between the two groups was statistically significant (p < 0.001): 761 (64.7%) of the patients in the control group and only 30 (6.1%) patients in the study group had poor drug compliance. In terms of VTE, 10.7% patients (126/1177) in the control group had VTE, and the rate in the study group was 7.1% (35/491), showing a statistically significant difference (p = 0.02). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 days vs. 13.7 days, p < 0.001). Subgroup analyses of the study group showed that the incidence of VTE in patients with poor, partial, and good compliances were 56.7% (17/30), 5.8% (10/171), and 2.8% (8/290), respectively, revealing a significantly huge difference (p < 0.001).ConclusionsPoor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE. The mobile application may be an effective tool to prevent VTE in hip fracture patients.