医护一体化防栓体系在骨科病房临床应用的研究

目的探讨骨科医护一体化静脉血栓栓塞症(VTE)防控体系的临床应用价值。 方法收集暨南大学附属顺德医院2015年10月至2019年3月收治的骨科患者临床病历资料，纳入受伤至入院时间≤24 h、于骨科行手术治疗且病历资料完整、年龄≥ 18岁的患者；排除入院前已患有VTE、正在使用抗凝药物、有严重精神障碍的患者、以及有VTE药物和物理防治禁忌的患者。选取2017年12月至2019年3月实施VTE防控体系后收治的215例患者作为研究组，选取2015年10月至2017年11月实施VTE防控体系前收治的180例患者作为对照组，所有患者均获得3个月以上的随访，对两组患者VTE防治的依从性，下肢深静脉血栓形成(DVT)、肺血栓栓塞症(PTE)的发生率和死亡率，大出血事件的发生率，与VTE相关的医疗纠纷发生率均采用χ²检验进行比较分析；住院时间采用t检验进行比较分析。 结果研究组VTE防治的依从性为93.0%，对照组为5.0%(χ²＝304.680，P<0.05)。研究组DVT、PTE发生率、死亡率分别为2.8%、0、0，对照组DVT、PTE发生率、死亡率分别为16.1%、3.3%、2.8%(χ²＝21.526、5.219、4.030，P<0.05)。研究组大出血事件的发生率两组比较差异无统计学意义(χ²＝0.106，P>0.05)。研究组VTE相关的医疗纠纷发生率为0，对照组为2.8%，两组比较差异有统计学意义(χ²＝4.030，P<0.05)。研究组患者住院时间(14.0±3.0)d少于对照组的(15.7±3.4)d(t＝2.622，P<0.05)。 结论骨科医护一体VTE防控体系的实施可有效提高患者VTE防治的依从性，降低VTE、PTE发生率、死亡率及VTE相关的医疗纠纷发生率，缩短住院时间，不增加大出血事件的发生率，具有良好的临床应用价值。

Clinical application of integrated medical anti-suppression system in orthopedic wards

ObjectiveTo explore the clinical application value of the integrated venous thromboembolism (VTE) prevention and control system for orthopedics. MethodsThe clinical medical records of orthopedic patients admitted to Shunde Hospital of Jinan University from October 2015 to March 2019 were collected. The inclusion criteria: injury to admission time≤24 h; orthopedic surgery and complete medical records; age≥18 years old. Exclusion criteria: the patients who had VTE before admission, the patients were taking anticoagulant drugs, severe mental disorders and communication difficulties; contraindications of VTE medications and physical control. A total of 215 patients admitted to the VTE prevention and control system from December 2017 to March 2019 were selected as the study group. Another 180 patients who were admitted to the VTE prevention and control system from October 2015 to November 2017 were selected as the control group. All the patients were followed up for more than three months. The compliance with VTE prevention and treatment, the incidence of deep venous thrombosis (DVT), pulmonary thromboembolism (PTE), and the incidence of major bleeding events were observed. The incidence of medical disputes related to VTE was analyzed by chi-square test; the hospitalization time was compared and analyzed by t test. ResultsThe compliance of VTE in the study group was 93.0%, and that in the control group was 5.0% (χ²=304.680, P<0.05). The incidence and mortality of DVT and PTE in the study group were 2.8%, zero, and zero respectively. The incidence of DVT and PTE in the control group was 16.1%, 3.3%, and 2.8% (χ²=21.526, 5.219, 4.030, P<0.05). The incidence of major bleeding events showed no significant difference between the two groups (χ²=0.106, P >0.05). The incidence of VTE-related medical disputes was zero in the study group and 2.8% in the control group. The difference between the two groups was statistically significant (χ²=4.030, P<0.05). The hospitalization time of the study group was (14.0±3.0) d, which was less than that of the control group (15.7±3.4) d (t=2.622, P<0.05). ConclusionThe implementation of VTE prevention and control system for orthopedics can effectively improve the compliance of patients with VTE prevention, reduce the incidence of VTE, PTE, mortality and VTE-related medical disputes, shorten the length of hospital stay, without increasing the incidence of major bleeding events.