脊柱骨折术后下肢DVT危险因素及针对性预防护理对策探讨

Risk factors of deep venous thrombosis of lower extremities after surgery for spinal fracture and targeted preventive nursing countermeasures

目的探讨脊柱骨折患者术后发生下肢DVT的危险因素及针对性预防护理对策。方法选取2015年10月—2016年12月于河南省骨科医院脊柱微创外科行手术治疗的60例脊柱骨折患者,根据术后护理方式的不同将其分为对照组和观察组,每组30例。对照组采用常规护理,观察组在对照组基础上给予DVT针对性预防护理。统计两组患者下肢DVT发生情况;比较发生下肢DVT及未发生下肢DVT患者的临床特征,并对影响患者术后发生DVT的危险因素进行Logistic回归分析。结果对照组及观察组发生下肢DVT的患者所占比例分别为40.00%(12/30)、10.00%(3/30),差异有统计学意义(P<0.01);发生下肢DVT组年龄≥60岁、有糖尿病史、有血栓史、手术时间≥2 h、术中出血量≥1000 ml、术中输血量≥600 ml、术后卧床时间≥4 d以及无针对性护理患者所占比例高于未发生下肢DVT组(均P<0.05);Logistic回归分析结果显示,年龄≥60岁、手术时间≥2 h、术后卧床时间≥4 d及无针对性护理是患者术后发生下肢DVT的独立危险因素(OR值分别为2.285、2.077、3.114、3.328;P<0.05)。结论针对性预防护理可有效减少脊柱骨折患者术后下肢DVT的发生,其中年龄≥60岁、手术时间≥2 h、术后卧床时间≥4 d及无针对性护理是影响脊柱骨折患者术后发生下肢DVT的独立危险因素。

Objective To explore the risk factors of postoperative deep venous thrombosis(DVT)of lower extremities in patients with spinal fracture and targeted preventive nursing countermeasures.Methods Totally 60 patients with spinal fracture who underwent surgery in the Department of Minimally Invasive Spine Surgery at Henan Provincial Orthopedic Hospital from October 2015 to December 2016 were selected and divided into the control group and the observation group according to the method of postoperative nursing,with 30 cases in each group.Patients in the control group received routine care,while patients in the observation group received targeted DVT preventive nursing on this basis.The incidence of DVT of lower extremities in the two groups of patients was statistically analyzed.The clinical characteristics were compared between patients with and without DVT of lower extremities,and Logistic regression analysis was performed on the risk factors that affected patients with postoperative DVT.Results The proportion of patients with DVT of lower extremities in the control group and the observation group were 40.00%(12/30)and 10.00%(3/30),respectively,and the difference was statistically significant(P<0.01).The incidence in patients with DVT of lower extremities aged≥60 years,with a history of diabetes,a history of thrombosis,operation time≥2 h,intraoperative blood loss≥1000 ml,intraoperative blood transfusion≥600 ml,postoperative bed time≥4 d,and patients receiving untargeted care were higher than that in patients without DVT of lower extremities(all P<0.05).Logistic regression analysis showed that age≥60 years,operation time≥2 h,postoperative bed time≥4 d and untargeted care were independent risk factors for patients with postoperative DVT of lower extremities(OR=2.285,2.077,3.114,3.328;P<0.05).Conclusions Targeted preventive nursing can effectively reduce the incidence of postoperative DVT of lower extremities in patients with spinal fracture,including age≥60 years,operation time≥2 h,postoperative bed time≥4 d and untargeted care are the independent risk factors for the incidence of postoperative DVT of lower extremities in patients with spinal fracture.