重型颅脑损伤后并发下肢深静脉血栓形成原因与预见性护理

Cause of deep Venous Thrombosis of Lower Extremity After Severe Craniocerebral Injury and Predictive Nursing

目的 探讨重型颅脑损伤后并发下肢深静脉血栓（DVT）的形成原因与预见性护理。方法 选择2012年7月～2014年7月医院收治的重型颅脑损伤患者80例,采用数字随机表法分为2组,对照组给予常规护理干预,对照组给予预见性护理干预,记录两组干预前后凝血指标及血小板参数变化,对比2组DVT发生率。结果 观察组DVT发生率为2.5%显著低于对照组15.0%（P〈0.05）;观察组D二聚体（D-D）、纤维蛋白原（Fbg）、纤维蛋白原降解产物（FDP）显著低于对照组（P〈0.05）,组织型纤溶酶原活物（t-PA）显著高于对照组（P〈0.05）;观察组护理后血小板计数（PLT）显著高于对照组（P〈0.05）,血小板分布宽度（PDW）、外周血小板p-选择素（CD62-P）显著低于对照组（P〈0.05）。结论手术因素、疾病因素、长期卧床治疗、静脉血管壁受伤等是重型颅脑损伤后并发DVT的重要原因,可给予预见性护理,减少DVT发生风险。

Objective To investigate the causes and prevention and treatment measures of deep ve- nous thrombosis （DVT） of lower extremity after severe craniocerebral injury and to prevent the occurrence of DVT. Methods 80 patients with severe craniocerebral injury treated in the hospital from July 2012 to July 2014 were selected and were divided into 2 groups by random number table method. The control group re- ceived routine nursing intervention, while the control group received predictive nursing intervention. The chan- ges of blood coagulation indexes and platelet parameters in the two groups before and after intervention were recorded. The incidence of DVT was compared between the 2 groups. Results The incidence of DVT in the observation group （2.5 % ） was significantly lower than that in the control group （ 15.0% ） （ P 〈 0. 05 ） ; D- di- met（D-D） , fibrinogen （Fbg）and fibrinogen degradation products （FDP）of the observation group were signifi- cantly lower than those of the control group ,while the tissue type plasminogen activator（ t-PA）was significantly higher than that of the control group （P 〈 0.05 ） ;The platelet count （PLT）of the observation group after nurs- ing was significantly higher than that of the control group ,while platelet distribution width（PDW） and periph- eral platelet p- selectin （ CD62- P） were significantly lower than those of the control group （ P 〈 0. 05 ）. Conclu- sion Surgical factors, disease factors,long-term stay in bed for treatment, venous blood vessel wall injury are an important causes of DVT after severe craniocerebral injury. Predictive nursing can be given to reduce the risk of DVT.