Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute ill...Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.展开更多
The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis.Venous ultrasound(VU)is a sensitive and rapidly performed test in cases...The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis.Venous ultrasound(VU)is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis.Various protocols have been proposed for its execution,such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area.The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe.Initially,the thrombus is hypoechogenic and adherent to the vessel;later,it tends to organize and recanalize.Usually,in the early stages,the risk of embolism is higher.The role of studying the iliac axis and calf veins is still uncertain.VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.展开更多
目的 研究健康服务领域研究成果应用的行动促进框架(promoting action on research implementation in health service,i-PARIHS)概念下的集束化护理在ICU重症患者中对深静脉血栓及匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,P...目的 研究健康服务领域研究成果应用的行动促进框架(promoting action on research implementation in health service,i-PARIHS)概念下的集束化护理在ICU重症患者中对深静脉血栓及匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分的价值。方法 随机选取2022年3月—2023年3月福州市第一医院接收的100例ICU重症患者,按照随机数表法分为研究组与对比组,每组50例。对比组实施传统护理,研究组实施i-PARIHS概念框架下的集束化护理,比较两组深静脉血栓出现率与护理前后的PSQI评分、下肢静脉(股静脉、腘静脉)血流速度及总满意率。结果 研究组深静脉血栓出现率为8.00%,与对比组的12.00%比较,差异有统计学意义(χ^(2)=0.444,P>0.05);护理后,两组睡眠质量、入睡时间、睡眠障碍、睡眠时间评分均降低,且研究组各项评分低于对比组,差异有统计学意义(P<0.05);护理后,两组下肢股静脉、腘静脉血流速度均提升,且研究组速度快于对比组,差异有统计学意义(P<0.05);研究组总满意率高于对比组,差异有统计学意义(P<0.05)。结论 i-PARIHS概念框架下的集束化护理在ICU重症患者中对深静脉血栓起到预防作用,加快下肢静脉血液流动,同时改善睡眠情况,获得高满意率。展开更多
文摘Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.
文摘The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis.Venous ultrasound(VU)is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis.Various protocols have been proposed for its execution,such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area.The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe.Initially,the thrombus is hypoechogenic and adherent to the vessel;later,it tends to organize and recanalize.Usually,in the early stages,the risk of embolism is higher.The role of studying the iliac axis and calf veins is still uncertain.VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.
文摘目的 研究健康服务领域研究成果应用的行动促进框架(promoting action on research implementation in health service,i-PARIHS)概念下的集束化护理在ICU重症患者中对深静脉血栓及匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分的价值。方法 随机选取2022年3月—2023年3月福州市第一医院接收的100例ICU重症患者,按照随机数表法分为研究组与对比组,每组50例。对比组实施传统护理,研究组实施i-PARIHS概念框架下的集束化护理,比较两组深静脉血栓出现率与护理前后的PSQI评分、下肢静脉(股静脉、腘静脉)血流速度及总满意率。结果 研究组深静脉血栓出现率为8.00%,与对比组的12.00%比较,差异有统计学意义(χ^(2)=0.444,P>0.05);护理后,两组睡眠质量、入睡时间、睡眠障碍、睡眠时间评分均降低,且研究组各项评分低于对比组,差异有统计学意义(P<0.05);护理后,两组下肢股静脉、腘静脉血流速度均提升,且研究组速度快于对比组,差异有统计学意义(P<0.05);研究组总满意率高于对比组,差异有统计学意义(P<0.05)。结论 i-PARIHS概念框架下的集束化护理在ICU重症患者中对深静脉血栓起到预防作用,加快下肢静脉血液流动,同时改善睡眠情况,获得高满意率。
