基于发生风险列线图模型的护理干预在妇科腹腔镜术后DVT患者中的应用

Application of nursing intervention based on DVT risk assessment nomogram in gynecologic laparoscopic patients

目的探讨基于妇科腹腔镜术后DVT发生风险列线图的护理干预对患者术后DVT的影响。方法收集2015年7月—2017年7月在中国医科大学附属盛京医院接受妇科腹腔镜手术431例患者临床资料,分析影响术后DVT的独立危险因素,通过R软件建立妇科腹腔镜术后DVT发生风险的列线图模型。前瞻性纳入100例拟行妇科腹腔镜手术患者,按照随机数字表法随机分为研究组50例和对照组50例,对照组术后实施常规护理,研究组在对照组基础上实施基于DVT风险列线图模型的护理方案。比较干预前、干预后第3天、第5天两组患者血浆D-二聚体水平和术后第3天、第5天DVT发生率。结果431例腹腔镜手术患者术后DVT发生率10.4%(45/431);Logistic回归分析显示,年龄、D-二聚体≥0.5 mg/L、头高足低手术体位、术中失血量≥400 ml、手术时间≥1 h、卧床时间>5 d是导致术后发生DVT的独立危险因素。列线图模型预测妇科腹腔镜术后DVT发生风险的C-index为0.857,区分度良好。基于列线图的护理干预后,研究组术后第3天、第5天血浆D-二聚体含量分别为(0.47±0.09)、(0.54±0.17)mg/L,均低于对照组,差异有统计学意义(P<0.05);术后第5天,研究组DVT发生率为2.0%(1/50),对照组为14.0%(7/50),差异有统计学意义(P<0.05)。结论基于列线图模型的护理干预措施能降低妇科腹腔镜术后DVT发生率。

Objective To investigate the effectiveness of the nursing intervention on deep vein thrombosis(DVT)predicting after gynecologic laparoscopic surgery based on the risk assessment nomogram.Methods From July 2015 to July 2017,the clinical data of 431 patients undergoing gynecologic laparoscopic surgery at Shengjing Hospital of China Medical University were collected.The independent risk factors affecting postoperative DVT were analyzed.The R software was used to establish a nomogram model of DVT risks after gynecologic laparoscopic surgery.A prospective enrollment of 100 patients undergoing gynecologic laparoscopic surgery was randomly divided into a study group of 50 patients and a control group of 50 patients by random number table.The control group received routine care after surgery.The study group implemented a care plan based on the DVT risk nomogram model beyond what was given the the control group.The plasma D-dimer levels and the incidence of DVT on the 3rd and 5th day after surgery were compared between the two groups before and after the intervention.Results The incidence of postoperative DVT in the 431 patients underwent laparoscopic surgery was 10.4%(45/143).Logistic regression analysis showed that age,D-dimer≥0.5 mg/L,head position during operation,blood loss≥400 ml,operation time≥1 h,bed time>5 d were independent risk factors of postoperative DVT.The nomogram model predicted a C-index of 0.857 for the risk of DVT after gynecologic laparoscopic surgery,and the discrimination was good.After the nursing intervention based on the nomogram,the plasma D-dimer level of the study group was(0.47±0.09)and(0.54±0.17)mg/L on the 3rd and 5th day after the operation,respectively,which were lower than the control group.The difference was statistically significant(P<0.05).On the 5th day after surgery,the incidence of DVT in the study group was 2.0%(1/50),and that in the control group was 14.0%(7/50).The difference was statistically significant(P<0.05).Conclusions Nursing interventions based on the nomogram model can reduce the incidence of DVT after gynecologic laparoscopic surgery.