全面干预措施对脊柱骨折患者术后下肢深静脉血栓形成的影响

Effect of comprehensive intervention measures on postoperative deep vein thrombosis of the lower extremity in patients with spinal fractures

目的探讨全面干预措施对脊柱骨折患者术后下肢深静脉血栓形成(DVT)的影响。方法收集2018年1月至2021年2月于阜阳市第五人民医院行手术治疗的80例脊柱骨折患者临床资料。按照术后干预措施不同将患者分为对照组(n=35,接受常规干预措施)和观察组(n=45,接受全面干预措施)。比较两组患者术后1 d、干预2周后的下肢静脉最大血流速度、血小板参数[血小板计数(PLT)、血小板平均体积(MPV)、血小板体积分布宽度(PDW)、大血小板比例(P-LCR)]及凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平、血浆D-二聚体(D-D)水平]。比较两组患者干预2周后下肢DVT发生情况。采用36条目健康调查简表(SF-36)评估并比较两组患者术后1 d、干预2周后的生活质量。比较两组患者出院前1 d的满意度。结果观察组患者干预2周后股总静脉、股深静脉、髂外静脉、腘静脉的最大血流速度均高于本组术后1 d及对照组患者,差异均有统计学意义(P<0.05)。干预2周后,观察组患者的PLT、MPV、PDW、P-LCR、PT、APTT、TT、FIB水平、D-D水平均低于对照组患者,差异均有统计学意义(P<0.05)。干预2周后,观察组患者下肢DVT的发生率略低于对照组患者,但差异无统计学意义(P>0.05)。干预2周后,观察组患者SF-36中生理职能、情感职能、生理机能、活力、躯体疼痛、社会功能、精神健康及总体健康维度的评分均高于对照组患者,差异均有统计学意义(P<0.05)。观察组患者关于服务态度、护理针对性、健康教育、舒适度方面的满意度评分均高于对照组患者,差异均有统计学意义(P<0.05)。结论全面干预措施可改善脊柱骨折术后患者的下肢静脉血流,改善凝血功能,降低术后下肢DVT发生风险,提高患者的生活质量及满意度。

Objective To investigate the effect of comprehensive intervention measures on postoperative deep venous thrombosis(DVT)in patients with spinal fractures.Method The clinical data of 80 patients with spinal fractures who underwent surgical treatment in Fuyang Fifth People's Hospital from January 2018 to February 2021 were collected.According to the different postoperative interventions,the patients were divided into the control group(n=35,receiving conventional interventions)and the observation group(n=45,receiving comprehensive interventions).The venous maximum blood flow velocity of the lower extremity,platelet parameters[platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW),platelet-larger cell ratio(P-LCR)],and coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)level,plasma D-dimer(D-D)level]were compared between the two groups 1 day after surgery and 2 weeks after the intervention.The incidence of lower extremity DVT was compared between the two groups after 2 weeks of the intervention.The medical outcomes study 36-item short form health survey(SF-36)was used to evaluate and compare the quality of life of the two groups of patients 1 day after the intervention and 2 weeks after the intervention.The satisfaction of the two groups of patients 1 day before discharge was also compared.Result The maximum blood flow velocity of the common femoral vein,deep femoral vein,external iliac vein,and popliteal vein in the observation group after 2 weeks of intervention were higher than those in the same group 1 day after the operation and the control group,the differences were statistically significant(P<0.05).After 2 weeks of intervention,PLT,MPV,PDW,P-LCR,PT,APTT,TT,the level of FIB,and the level of D-D in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After 2 weeks of intervention,the incidence of lower extremity DVT in the observation group was slightly lower than that in the control group.However,the difference was not statistically significant(P>0.05).After 2 weeks of intervention,the scores of physical function,emotional function,physiological function,vitality,physical pain,social function,mental health,and general health dimensions in SF-36 of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).The satisfaction scores of the patients in the observation group in terms of service attitude,nursing pertinence,health education,and comfort were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Comprehensive intervention measures could improve the venous blood flow of the lower extremities in patients with spinal fractures,improve their coagulation function,reduce the risk of postoperative DVT of the lower extremities,and then improve the quality of life and satisfaction of these patients.