全流程干预对脑外科手术重症患者住院期间下肢深静脉血栓的预防价值

Value of whole process intervention in the prevention of lower extremity deep vein thrombosis in severe patients undergoing brain surgery during hospitalization

目的探讨全流程干预对脑外科手术重症患者住院期间下肢深静脉血栓(DVT)的预防价值。方法收集2021年1月至2022年12月于南京医科大学第一附属医院(江苏省人民医院)住院并接受手术治疗的146例脑外科手术重症患者的临床资料,并根据住院期间是否接受了预防下肢DVT的全流程干预措施将患者分为干预组(n=69)和对照组(n=77)。主要观察终点为住院期间患者下肢DVT的发生率,次要终点为患者脑外科专科信息以及住院期间的D-二聚体水平、并发症发生率、病死率和国际标准化比值。结果两组患者疾病类型、清醒的比例和接受开颅手术的比例比较,差异均无统计学意义(P>0.05)。干预组患者术中发生低体温的比例低于对照组患者,术后使用低分子量肝素的比例高于对照组患者,差异均有统计学意义(P<0.05)。住院期间,干预组患者下肢DVT的发生率、D-二聚体水平均低于对照组患者,差异均有统计学意义(P<0.05)。两组患者住院期间并发症的发生率、病死率和国际标准化比值比较,差异均无统计学意义(P>0.05)。结论全流程干预可明显降低脑外科手术重症患者住院期间下肢DVT的发生率,同时没有增加住院期间并发症的发生率和病死率。

Objective To analyze the value of whole process intervention in the prevention of lower extremity deep vein thrombosis(DVT)in severe patients undergoing brain surgery during hospitalization.Method The clinical data of 146 patients of severe patients undergoing brain surgery who were hospitalized and received surgical treatment in the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital)from January 2021 to December 2022 were collected.According to whether they received the whole process intervention aimed at preventing lower extremity DVT,the patients were divided into the intervention group of 69 cases and the control group of 77 cases. The primary endpoint of this study was the incidence of lower extremity DVT during hospitalization, while secondary endpoints were the brain surgery specialty information, D-dimer level, incidence of complications, mortality rate and international normalized ratio during hospitalization. Result There were no statistically significant differences between the two groups of patients in terms of disease type, proportion of conscious patients, and proportion of patients undergoing craniotomy surgery (P>0.05). The proportion of patients in the intervention group who experienced hypothermia during surgery was lower than that in the control group, and the proportion of postoperative use of low molecular weight heparin was higher than that in the control group, all the differences above were statistically significant (P<0.05). During the hospitalization, the incidence rate of lower extremity DVT and D-dimer level in the intervention group were lower than those in the control group, and the difference were statistically significant (P<0.05). There were no statistically differences in the incidence of complications, mortality rate and international normalized ratio during hospitalization between the two groups of patients (P>0.05). Conclusion Whole process intervention can significantly reduce the incidence of lower extremity DVT during hospitalization in severe patients undergoing brain surgery, without increasing the incidence of complications and mortality during hospitalization.