肝胆胰外科恶性肿瘤手术患者术后下肢深静脉血栓形成危险因素及其护理对策

Risk factors and nursing countermeasures of deep venous thrombosis of lower extremities in patients with hepatobiliary and pancreatic surgery for malignant tumors

目的探讨肝胆胰外科恶性肿瘤手术患者术后下肢深静脉血栓(DVT)形成危险因素及其护理对策。方法选取2018年5月至2019年7月鄂东医疗集团黄石市中心医院收治的肝胆胰腺外科恶性肿瘤患者90例为研究对象。通过问卷调查的方式,统计患者基本资料及术后DVT形成情况。通过单因素分析影响肝胆胰外科恶性肿瘤手术患者术后下肢DVT形成的相关危险因素,通过多因素Logistic回归分析影响肝胆胰外科恶性肿瘤手术患者术后下肢DVT形成的独立危险因素。结果该院收治的90例肝胆胰外科恶性肿瘤患者中,共有11例患者术后发生DVT,占比12.22%,其中9例患者血栓累及左下肢,占比81.82%,1例患者血栓累及右下肢,占比9.09%,1例患者血栓累及双侧下肢,占比9.09%;单因素分析结果显示,年龄、糖尿病、高血压、肿瘤类型、肿瘤分期、手术方式、术后卧床时间、联合放化疗、抗凝治疗及非计划重返ICU是影响患者术后下肢DVT形成的相关因素(P<0.05);多因素分析结果显示,年龄、肿瘤类型、联合化疗及非计划重返ICU是影响患者术后DVT形成的独立危险因素(OR>1,P<0.05)。结论年龄、肿瘤类型、联合化疗及非计划重返ICU是影响患者术后DVT形成的独立危险因素。提示应针对以上危险因素,制定针对性护理对策,以预防或降低肝胆胰外科恶性肿瘤患者术后下肢DVT的形成。

Objective To explore the risk factors and nursing countermeasures of deep venous thrombosis(DVT)of lower extremities in patients undergoing hepatobiliary and pancreatic surgery for malignant tumors.Methods A total of 90 patients with hepatobiliary pancreatic surgery malignant tumors admitted this hospital from May 2018 to July 2019 were selected as the research objects.By means of questionnaire survey,the basic information of patients and postoperative deep vein thrombosis were counted.The risk factors for DVT in lower limbs after hepatobiliary and pancreatic surgery for malignant tumor were analyzed by univariate analysis,and the independent risk factors for DVT in lower limbs after hepatobiliary and pancreatic surgery for malignant tumor were analyzed by multivariate Logistic regression analysis.Results Among 90 patients with malignant tumor in hepatobiliary and pancreatic surgery,11 patients developed DVT after operation,accounting for 12.22%.Among them,thrombus involved left lower limb in 9 patients(81.82%),right lower limb in 1 patient(9.09%),and bilateral lower limb in 1 patient(9.09%).Univariate analysis showed that age,diabetes,hypertension,tumor type,tumor stage,surgical method,postoperative bed time,combined chemoradiotherapy,anticoagulant therapy and unplanned return to ICU were the related factors influencing postoperative DVT of lower extremity(P<0.05).Multivariate analysis showed that age,tumor type,combination chemotherapy,and unplanned return to ICU were independent risk factors for postoperative DVT(OR>1,P<0.05).Conclusions Age,tumor type,combination chemotherapy,and unplanned return to ICU were independent risk factors for postoperative DVT.It is suggested that nursing countermeasures should be formulated according to the above risk factors to prevent or reduce the formation of DVT of lower limbs in patients with hepatobiliary and pancreatic cancer after surgery.