摘要
目的探讨骨科患者术中下肢深静脉血栓(DVT)风险增高的血流变化特点并分析其影响因素,为手术室护理干预提供临床指导。方法选取151例骨科择期手术患者为研究对象,术中使用多普勒超声诊断仪观察下肢血流改变特征,并收集患者基本资料、手术相关资料、术前实验室检查指标等,患者手术结束24 h内采血行D-二聚体凝血功能检测。结果D-二聚体检测结果显示,DVT高风险患者70例(46.36%),低风险81例(53.64%)。手术结束后DVT高风险患者下肢平均血流速度、血管内径显著低于或小于低风险患者(均P<0.05)。logistic回归分析显示,手术时间>120 min、凝血酶原时间(PT)>13.1 s、术中发生低体温和术中失血量>100 mL是骨科患者术中DVT风险增高的独立危险因素(均P<0.05)。结论骨科手术患者术中DVT发生风险较高,存在明显血流动力学改变。手术室护理人员需针对性地开展手术效率管理、术中低体温监测和预防、维持术中血容量稳定,有效降低骨科手术患者术中DVT发生风险。
Objective To explore the characteristics of blood flow in orthopedic patients with increased risk of intraoperative deep venous thrombosis(DVT)and analyze relevant influencing factors,so as to provide a reference for nursing intervention in the operating room.Methods A total of 151 patients who underwent elective orthopedic surgery were selected as the study subjects.Doppler ultrasound diagnostic instrument was used to observe the blood flow changes in lower extremities during the operation.The basic data of patients,operation-related data and preoperative laboratory examination indexes also were collected.Blood samples were collected from the patients within 24 hours after the operation for a D-dimer coagulation test.Results The results of the D-dimer test showed that there were 70 patients with a high risk of DVT(46.36%)and 81 patients with a low risk(53.64%).The mean blood flow velocity and vascular diameter of the patient′s lower limbs at high risk for DVT were significantly lower than those of patients at low risk after surgery(P<0.05 for both).Multivariate analysis showed that operation time>120 min,PT>13.1 s,hypothermia and intraoperative blood loss>100 mL were independent risk factors for increased risk of intraoperative DVT(all P<0.05).Conclusion Patients undergoing orthopedic surgery are at high risk of intraoperative DVT with significant hemodynamic changes.The nursing staff in the operating room need to carry out targeted surgical efficiency management,intraoperative hypothermia monitoring and prevention,maintain intraoperative blood volume stability,and effectively reduce the risk of DVT during the surgical process.
作者
方敏
高兴莲
王曾妍
柯稳
肖潇
梁元元
Fang Min;Gao Xinglian;Wang Zengyan;Ke Wen;Xiao Xiao;Liang Yuanyuan(School of Nursing,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《护理学杂志》
CSCD
北大核心
2024年第10期64-67,共4页
Journal of Nursing Science
基金
湖北省自然科学基金项目(2021CFB444)。
关键词
骨科手术
术中
下肢深静脉血栓
血流动力学
低体温
术中失血量
风险管理
手术室护理
orthopedic surgery
intraoperative
deep vein thrombosis
hemodynamics
hypothermia
intraoperative blood loss
risk management
nursing in operating room
