血栓弹力图指导预防腹腔镜结直肠肿瘤患者术后下肢深静脉血栓形成的应用研究

Prevention of postoperative deep venous thrombosis in patients with laparoscopic colorectal surgery with the assistance of thromboelastography monitoring

目的:探讨血栓弹力图指导预防腹腔镜结直肠手术患者术后下肢深静脉血栓形成(LDVT)的综合干预措施,以降低DVT发生率。方法:收集2018年1月至2018年12月接受腹腔镜结直肠手术的100例患者,术后患者返回病房后即采用VTE风险因素评估表(Caprini评分);评分≥2分的中高危DVT患者,进一步采用TEG监测,并采取主动与被动物理干预措施,采取下肢压力梯度治疗仪及不同的物理运动治疗,包括踝关节背伸、跖屈活动、双下肢足泵运动,床上活动使用卧床患者功能锻炼器进行,同时予以适当的药物干预。结果:与干预前相比,干预后48 h、1周、2周,患者TEG参数R值、MA值改善差异有统计学意义(P<0.05);高凝患者数量减少(P<0.05)。干预后2周,仅1例患者发生下肢深静脉血栓,发生率为1.02%。结论:采用血栓弹力图联合Caprini评分系统对腹腔镜结直肠手术后患者LDVT筛查具有积极的指导作用,采取积极有效的综合护理及药物干预措施,可有效改善凝血功能、降低术后下肢深静脉血栓的发生。

Objective:To investigate preventive measures of postoperative deep venous thrombosis(DVT) with the assistance of thromboelastography in patients with laparoscopic colorectal surgery,in order to reduce the incidence of DVT.Methods:One hundred patients who underwent laparoscopic colorectal surgery from Jan.2018 to Dec.2018 were recruited in this study.The patients were immediately assessed by using the Caprini assessment form when returned to the ward after operation.The patients with a Caprini score ≥2 were screened by TEG for coagulation abnormalities and received comprehensive prevention and nursing interventions.All patients received intermittent compression at lower limbs by using the pneumatic compression systems and appropriate drug therapy,and also were instructed to do active and passive exercises,including ankle dorsiflexion and rotation,plantar flexion activities and foot pump exercises.Results:The R and MA values of thromboelastography were obviously improved after 48 h,1 week,and 2 weeks intervention compared with pretreatment(P<0.05).At the same time,the proportions of high risk patients declined significantly(P<0.05).One patient developed DVT with the incidence rate of 1.02% after intervention for 2 weeks.Conclusions:Thromboelastography combined with Caprini assessment form plays a positive role in DVT screening for patients with colorectal surgery.Comprehensive nursing prevention and medicine interventions can improve blood coagulation function and reduce the incidence of postoperative DVT.