基于计划行为理论的DVT护理干预模型构建及其在胃肠道肿瘤术后患者中的应用

Construction of deep venous thrombosis nursing intervention model for gastrointestinal cancer patients based on the theory of planned behavior

目的基于计划行为理论构建预防下肢DVT形成的护理干预模型,并探讨其在胃肠道肿瘤术后患者中的应用效果。方法通过方便抽样法,选取2018年1—12月入住浙江省宁波市第一医院胃肠外科的胃肠道肿瘤手术患者163例为研究对象,以2018年1—6月收治的79例患者为对照组,实施常规围手术期DVT预防护理;以2018年7—12月收治的84例患者为观察组,采用以计划行为理论为基础构建的DVT护理干预模型的护理方法。比较两组患者DVT认知问卷得分情况,术后下肢踝泵运动、股四头肌运动、术后24 h内首次下床活动和术后3 d达到行走目标量的依从性,以及术后住院期间发生DVT的例数。结果观察组DVT知识得分高于对照组;观察组术后踝泵运动、股四头肌运动的依从性以及术后24 h内首次下床活动患者比例均高于对照组;两组比较差异均有统计学意义(P<0.05)。观察组术后3 d达到500 m行走目标的完成比例多于对照组,但两组比较差异无统计学意义(P>0.05)。对照组和观察组术后分别有7例、1例患者发生DVT,两组比较差异有统计学意义(P<0.05)。结论基于计划行为理论构建的DVT护理干预模型有助于提高胃肠道肿瘤手术患者的DVT认知水平,提高术后下肢活动及早期下床活动的依从性,降低术后DVT发生率,为胃肠道肿瘤手术患者建立良好的健康行为习惯从而有效预防DVT具有重要意义。

Objective To construct a nursing intervention model based on the theory of planned behavior (TPB), to prevent deep venous thrombosis (DVT) of lower extremities, and to explore its application in patients with gastrointestinal cancer after operation. Methods By convenience sampling, a total of 163 patients admitted in the Department of Gastrointestinal Surgery, Ningbo First Hospital, Zhejiang Province who underwent gastrointestinal surgeries from January to December in 2018 were selected as the research objects in this study. The 79 patients admitted from January to June in 2018 were taken as the control group and the conventional perioperative DVT prevention nursing care was given. The other 84 patients admitted from July to December in 2018 were taken as the observation group and the TPB based DVT nursing intervention model was adopted. The two groups were compared in terms of the patient's scores in cognition about DVT, postoperative ankle pump movement, quadriceps femoris movement, first out-of-bed activity within 24 hours and compliance with walking target volume within 3 days after surgery, as well as the number of cases of DVT during hospitalization after surgery. Results The score of DVT knowledge in the observation group was higher than that in the control group;the compliance of ankle pump movement, quadriceps femoris movement and the proportion of patients getting out of bed for the first time within 24 hours after operation in the observation group were higher than those in the control group;the differences between the two groups were statistically significant (P<0.05). The rate of achieving 500 m walking goal in the observation group was higher than that in the control group 3 days after operation, but there was no significant difference between the two groups (P>0.05). There were 7 cases of DVT in control group and 1 case in observation group after operation, and there was statistically significant difference between the two groups (P<0.05). Conclusions The DVT nursing intervention model based on TPB is helpful to improve the cognitive level of DVT in patients undergoing gastrointestinal cancer surgery, improve the compliance of lower limb activities and early ambulation, and reduce the incidence of DVT after surgery, establish good healthy behavior for patients undergoing gastrointestinal cancer surgery and effectively prevent DVT.