颅脑外伤术后昏迷患者下肢深静脉血栓的防治及护理

Prevention and Nursing of Lower Extremity deep Venous Thrombosis in Patients with Coma after Craniocerebral Trauma

目的探讨颅脑外伤术后昏迷患者下肢深静脉血栓(LDVT)患者的防治及护理措施。方法 2013年1月至2015年1月医院颅脑外伤昏迷患者86例,均择期手术治疗,采用随机数字表法将分为对照组和观察组各43例,对照组给予常规护理,观察组给予预见性护理,对比2组干预前后血栓前状态,发放Wells评分LDVT量表和Geneva评分肺栓塞量表,记录LDVT、肺栓塞发生率。结果 2组干预前后抗凝血酶(AT)无差异(P>0.05);观察组干预后纤维蛋白原(Fbg)、血浆纤维蛋白降解产物(FDP)、AT、D二聚体(D-D)、血小板α颗粒膜蛋白-140(GMP-140)改善明显低于对照组(P<0.05);观察组LDVT、肺栓塞发生率为4.65%、0,明显低于对照组(P<0.05)。结论颅脑外伤术后昏迷期间给予预见性护理,可改善血栓前状态,预防LDVT、肺栓塞发生。

Objective To investigate the prevention and nursing measures of lower extremity deep venous thrombosis( LDVT) in patients with coma after craniocerebral trauma. Methods 86 cases of patients with coma after craniocerebral trauma who were admitted in the hospital between January 2013 and January 2015 were treated with elective surgery. All patients were divided into the control group and the observation group by random number table method with 43 cases in each group. The control group was given routine nursing while the observation group was given predictive nursing. Before and after the intervention,the prethrombotic state was compared between the two groups. Wells score of LDVT scale and Geneva score of pulmonary embolism scale were issued. The incidence rates of LDVT and pulmonary embolism were recorded. Results There was no significant difference in antithrombin( AT) between the 2 groups before and after the intervention( P > 0.05); After intervention,fibrinogen( Fbg),plasma fibrinogen degradation products( FDP),AT、D-dimer( D-D)and platelet alpha granule membrant protein-140( GMP-140) in the observation group were improved were significantly lower than those in the control group( P < 0. 05); The Wells score and Geneva score in the observation group after intervention[( 1. 31 ± 0. 44),( 1. 10 ± 0. 34) ]were significantly lower than those in the control group( P < 0. 05); The incidence rates of LDVT and pulmonary embolism in the observation group( 4.65%,0) were significantly lower than those in the control group( P < 0. 05). Conclusion To adopt predictive nursing during coma after craniocerebral trauma surgery can improve prethrombotic state and prevent the occurrence of LDVT and pulmonary embolism.