梗阻性黄疸围术期出血事件及凝血动态观测及护理干预

Perioperative Bleeding Events and Coagulation Dynamic in Patients with Obstructive Jaundice and Nursing Intervention

目的调查梗阻性黄疸患者围术期出血事件及凝血情况,探究相关护理干预。方法回顾性分析行外科手术治疗的154例恶性梗阻性黄疸患者临床资料,分析其术后30 d内出血事件发生情况,对比其手术前后凝血指标[纤维蛋白原(Fbg)、凝血酶原时间(PT)、白陶土部分凝血活酶时间(KPTT)]及D二聚体(D-D)水平变化差异。根据其围术期护理方式分为出血护理组(n=80)和常规护理组(n=74)两组对比其出血事件发生率和手术前后凝血指标变化情况。结果 154例受试患者术后30 d内出血事件总发生率为11.7%(18/154),其中术后30 d内胃肠吻合口出血8例(5.2%),腹腔内弥漫性渗血6例(3.9%),胃或十二指肠溃疡出血3例(1.9%),迟发性胆道出血1例(0.7%);术后第3天,所有受试者除Fbg水平较术前对比无统计学意义(P>0.05)外,PT、KPTT等凝血指标及D-D水平均较术前显著增高(P<0.05)。术后4周内,常规护理组胃肠吻合口出血率、腹腔内弥漫性渗血率、胃或十二指肠溃疡出血率、迟发性胆道出血率均略低于出血护理组,但组间对比无统计学意义(P>0.05);两组术后出血事件发生率对比5.0%VS 18.9%(P<0.05)。结论恶性梗阻性黄疸患者围术期存在较高的出血事件发生风险,出血护理干预措施,能降低围术期出血事件。

Objective To investigate the perioperative bleeding events and dynamic situations of blood coagulation in patients with malignant obstructive jaundice,and to explore the related nursing intervention measures. Methods The clinical data of 154 patients with malignant obstructive jaundice treated by surgery were analyzed retrospectively. The occurrence of bleeding events in 30 days after surgery was analyzed. The changes of coagulation indexes[fibrinogen（ Fbg）,prothrombin time（ PT）,Kaolin partial thromboplastin time（ KPTT） ]and D-dimer（ D-D） levels before and after surgery were compared. According to the perioperative nursing methods,the patients were divided into bleeding nursing group（ n = 80） and routine nursing group（ n =74） two groups. The incidence of bleeding events were compared. Results The results of investigation showed that the total incidence of bleeding events in 154 subjects in 30 days after surgery was 11. 7%（ 18 /154）.Among them,there were 8 cases（ 5. 2%） with gastrointestinal anastomotic bleeding in 30 days after surgery,6cases（ 3. 9%） with intraperitoneal diffuse errhysis,3 cases（ 1. 9%） with gastric or duodenal ulcer bleeding and1 case（ 0. 7%） with delayed biliary tract bleeding. On the 3 rd day after surgery,there were no significant differences in Fbg levels in all subjects before and after surgery（ P〉0. 05） while PT,KPTT and other coagulation indexes and D-D levels were significantly higher than those before surgery（ P〈0. 05）. Within 4weeks after surgery,the rates of gastrointestinal anastomotic bleeding,intraperitoneal diffuse bleeding,gastric or duodenal ulcer bleeding and delayed biliary tract bleeding in the routine nursing group were slightly lower than those in bleeding nursing group. However,there were no significant differences between the groups（ P〉0. 05）; The difference in incidence rate of postoperative bleeding events between the two groups was statistically significant [（ 5. 0） % VS（ 18. 9） %,P〈0. 05]. Conclusion Patients with malignant obstructive jaundice has relatively higher risk of bleeding events in perioperative period. nursing intervention to reducing the incidence of perioperative bleeding events.