髋关节置换术前合并深静脉血栓行下腔静脉滤器置入的护理对策

Nursing Countermeasures of Implanted Inferior Vena Cava Filter before Hip Arthroplasty Combined with Deep Venous Thrombosis

目的探讨髋关节置换术前合并深静脉血栓(DVT)行下腔静脉滤器置入的护理对策。方法回顾性分析2015年6月~2017年12月我科行髋关节置换术的495例患者的临床资料,其中10例出现术前合并DVT。10例患者于手术当天预先置入下腔静脉滤器(未行溶栓术),术后连续给予35d利伐沙班抗凝治疗。根据血栓形成的时间给予针对性心理干预与个性化护理对策。观察患者术口感染、血肿形成、二次DVT形成、肺栓塞及术后1年髋关节功能恢复情况。采用焦虑自评量表(SAS)、生活满意指数A量表(LSIA)、Harris评分量表分别评估患者干预前后焦虑情绪、生活满意情况与髋关节功能。结果所有患者术后均未出现术口感染、血肿、二次DVT和肺栓塞,4例出现轻微下肢肿胀。患者干预后SAS、LSIA、Harris评分与术前比较,差异均有统计学意义(t=8.588、-7.008、-32.566,P<0.05)。结论在髋关节置换术前合并DVT治疗中置入腔静脉滤器可有效降低患者肺栓塞发生率,针对性心理干预与个性化护理可缓解患者的焦虑情绪,增加其生活满意度,促进髋关节功能恢复。

Objective To explore the nursing countermeasures of implanted inferior vena cava filter (IVCF) before hip arthroplasty combined with deep venous thrombosis (DVT).Methods The clinical data of 495 patients who underwent hip arthroplasty in our department from June 2015 to December 2017 were analyzed retrospectively.Among them,there were 10 patients with preoperative DVT.They were given IVCF on the day of surgery (no thrombolysis was performed),and given anticoagulant treatment with Rivaroxaban in 35 days after operation.Patients were given targeted psychological intervention and personalized nursing countermeasures according to the time of thrombosis.Infection,hematoma,recurrent DVT,pulmonary embolism and the condition of hip joint function recovery after 1 year of surgery of patients were observed.Anxiety emotion,life satisfaction and joint function of patients were evaluated by self-rating anxiety scale (SAS) score,lifesatisfaction index A (LSIA) score and Harris score respectively.Results No infection,hematoma,DVT of the second time,pulmonary embolism were noted in the 10 patients,and there were 4 cases with mildly swollen of lower limbs.There were significant differences on the SAS,LSIA and Harris scores between pre-intervention and post-intervention ( t =8.588,-7.008,-32.566,P <0.05).Conclusion Implanted IVCF before hip arthroplasty combined with DVT can reduce the occurrence rate of pulmonary embolism,targeted psychological intervention and personalized nursing countermeasures can relieve anxiety emotion,increase the life satisfaction and promote the joint function.