基于Caprini模型风险评估的个体化下肢深静脉血栓干预对重症心肌梗死患者深静脉血栓的发生率及凝血功能的影响

Effects of individualized DVT intervention on the incidence of deep vein thrombosis and coagulation function in patients with severe myocardial infarction based on Caprini model risk assessment

目的探讨基于Caprini模型风险评估的个体化下肢深静脉血栓(deep venous thrombosis,DVT)干预对重症心肌梗死患者深静脉血栓的发生率及凝血功能的影响。方法选取2019年1月至2019年12月期间邢台市第三医院收治的118例重症心肌梗死患者作为研究对象,按照随机数字表法分为对照组和观察组,各59例。对照组采用常规干预,观察组患者在对照组患者的基础上采用基于Caprini模型风险评估的个体化DVT干预。干预前及干预1个月后测量两组患者的血流动力学指标,髂静脉、股静脉、腘静脉的血流速度(Q)和血流量(V),以及凝血功能指标,凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB),干预期间记录两组患者的下肢深静脉血栓(DVT)、肢体疼痛、肢体肿胀及主要不良心血管事件(MACE)发生率,记录两组患者全球急性冠状动脉事件注册评分(GRACE),并分析各危险等级与DVT发生率的关系。结果干预1个月后,观察组患者髂静脉、股静脉和腘静脉的流量(Q)和流速(V)均有显著升高(P<0.05),对照组各项指标显著下降(P<0.05);观察组患者的APTT、PT、TT时间明显高长于对照组,FIB水平更低[(31.49±3.12)比(38.38±4.25),(12.49±1.76)比(15.38±1.99),(19.49±2.79)s比(23.48±2.99)s,(2.79±0.24)g/L比(3.49±0.64)g/L,P<0.05];观察组患者DVT、肢体疼痛、肢体肿胀和MACE的发生率分别为1.69%、3.39%,1.69%和6.78%,显著低于对照组患者(11.86%、10.17%、10.17%和23.73%),差异具有统计学意义(均P<0.05);干预后,观察组的GRACE评分明显低于对照组患者[(82.34±6.25)比(90.36±7.47),P<0.05],GRACE评分危险等级和DVT发生风险呈正相关(r=0.06,P<0.01)。结论采用基于Caprini模型风险评估的个体化DVT干预能显著预防患者DVT的发生,改善不良预后,提高凝血功能,促进血运。该种护理策略具有重要临床应用价值。

Objective To investigate the effects of individualized DVT intervention based on Caprini model risk assessment on the incidence of deep venous thrombosis and coagulation function in patients with severe myocardial infarction. Methods During January 2019 to December 2019, 118 patients with severe myocardial infarction were admitted in Xingtai Third Hospital as the research objects. According to random number table method, they were divided into control group and observation group, 59 cases in each group. The control group was used conventional intervention, while the observation group received individualized DVT intervention based on Caprini model risk assessment on the basis of the control group. Before and 1 month after intervention, the hemodynamic parameters of iliac vein, femoral vein and popliteal venous blood and indicators of coagulation function, such as flow velocity(Q) and volume(V), blood coagulation function index, thrombin time(APTT),prothrombin time(PT), thrombin time(TT) and fibrinogen(FIB) in two groups were measured. During the intervention, the lower extremity deep vein thrombosis(DVT), body pain, limb swelling and the incidence of major adverse cardiac events(MACE) of two groups patients were recorded. The acute coronary event registration global scores(GRACE) of two groups of the patients were taken and the relationship between the risk level and the incidence of DVT was evaluated. Results After 1 month of intervention, the quantity(Q) and velocity(V) of the iliac vein, femoral vein and popliteal vein in the observation group were significantly increased(P<0.05),while the indexes of the control group were significantly decreased(P<0.05). The levels of APTT, PT and TT in the observation group were significantly longer than those in the control group, and the FIB level was lower[(31.49±3.12)vs.(38.38±4.25),(12.49±1.76)vs.(15.38±1.99),(19.49±2.79)s vs.(23.48±2.99)s,(3.49±0.64)g/L vs.(2.79 ± 0.24)g/L,P<0.05]. The incidence of DVT, limb pain, limb swelling and MACE in the observation group were 1.69%, 3.39%, 1.69% and 6.78%, respectively, which were significantly lower than those in the control group [11.86%, 10.17%, 10.17% and 23.73%, respectively, P<0.05]. After intervention, the GRACE score of the observation group was significantly lower than that of the control group [(82.34±6.25) vs.(90.36 ± 7.47),P<0.05], and the risk level of GRACE score was positively correlated with the risk of DVT(r=0.06,P<0.01). Conclusion Individualized DVT intervention based on Caprini model risk assessment could markedly prevent the occurrence of DVT in the patients. This nursing strategy would has have an important clinical application value.