摘要
目的探讨优化术中流程对合并下肢深静脉血栓(DVT)的手术患者术后结局的影响。方法收集2019年3月至2022年2月于首都医科大学附属北京积水潭医院接受手术治疗的合并下肢DVT患者的临床资料,将2019年3月至2021年4月采取术中常规处理的患者作为常规处理组(n=51),将自2021年5月开始采取术中优化流程的患者作为优化流程组(n=61)。比较两组患者的手术相关指标和术后结局。结果优化流程组患者的手术时间短于常规处理组患者,全身麻醉、术中低体温及术中输血的比例均低于常规处理组患者,术中出血量少于常规处理组患者,差异均有统计学意义(P﹤0.05)。优化流程组患者术后D-二聚体水平低于常规处理组患者(P﹤0.05)。优化流程组患者术后大腿周径差、小腿周径差及血栓长度均短于常规处理组患者(P﹤0.05)。两组患者住院期间均无死亡病例。优化流程组无患者发生肺栓塞,常规处理组有6例患者发生不同程度的肺栓塞,经过积极治疗后均治愈。两组患者术后肺栓塞的发生率比较,差异有统计学意义(P=0.020)。结论对于合并下肢DVT的手术患者,优化术中流程可以降低全身麻醉的使用率和术中输血的比例,减少术中出血量和低体温的发生,最终改善下肢DVT相关的临床表现,并有效预防继发的肺栓塞。
Objective To investigate the effect of optimized intraoperative procedures on the postoperative outcomes of surgical patients with deep vein thrombosis(DVT)of the lower extremity.Method The clinical data of patients with concomitant lower extremity DVT who received surgical treatment at Beijing Jishuitan Hospital,Capital Medical University from March 2019 to February 2022 were collected.Patients who received routine intraoperative treatment from March 2019 to April 2021 were selected as the routine processing group(n=51),and patients who underwent optimized intraoperative procedures starting from May 2021 were selected as the optimized process group(n=61).The surgical related indicators and postoperative outcomes between two groups of patients were compare.Result The surgery time of patients in the optimized process group was shorter than that of patients in the routine processing group,and the proportion of general anesthesia,intraoperative hypothermia,intraoperative blood transfusion were lower than those of patients in the routine processing group,and intraoperative blood loss was lower than those of patients in the routine processing group(P<0.05).The postoperative D-dimer levels of patients in the optimized process group was lower than that in the routine processing group,and the difference was statistically significant(P<0.05).The postoperative thigh circumference difference,calf circumference difference,and thrombus length of patients in the optimized process group were shorter than those in the routine processing group(P<0.05).There were no deaths during hospitalization in both groups.No pulmonary embolism occurred in the optimized process group,while 6 cases patients in the routine processing group experienced varying degrees pulmonary embolism,and all of these patients were cured after active treatment.There was statistical significance in the incidence of postoperative pulmonary embolism between the two groups(P=0.020).Conclusion For the patients undergoing surgery with lower extremity DVT,optimizing the intraoperative procedures can reduce the utilization rate of general anesthesia and the proportion of intraoperative blood transfusion,reduce the intraoperative blood loss and the occurrence of hypothermia,ultimately improve the clinical manifestations related to lower extremity DVT,and effectively prevent secondary pulmonary embolism.
作者
李春霞
李慧
郭榕晨
贾伟
Li Chunxia;Li Hui;Guo Rongchen;Jia Wei(Operating Room,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)
出处
《血管与腔内血管外科杂志》
2024年第1期42-45,97,共5页
Journal of Vascular and Endovascular Surgery
关键词
深静脉血栓
优化流程
D-二聚体
肺栓塞
不良事件
deep vein thrombosis
optimized procedure
D-dimer
pulmonary embolism
adverse event
