Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer

BACKGROUND Venous thromboembolism(VTE)is a major cause of unexpected and perioperative in-hospital deaths.It is characterized by high morbidity,high mortality,high misdiagnosis rate,and high missed diagnosis rates.VTE is a common postoperative complication in cancer patients.VTE is preventable,and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality.Presently,there is no uniform standard for the prevention and control of VTE in clinical practice,and hospitals in China lack mature and effective protocols for the assessment,prevention,and treatment of VTE.AIM To explore whether an early warning program could influence the occurrence of deep vein thrombosis(DVT)postoperatively.METHODS This is a comparative retrospective cohort study,which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019.Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented.A venous thromboembolism prevention and control team was established.The outcomes included the occurrence of DVT,the correct rate of VTE assessment,the coagulation indicators,and the mastery of VTE knowledge by the nurses.RESULTS A total of 264 patients were included in this study,with 128 patients in the control group and 136 patients in the early warning group.The occurrence rate of DVT in the early warning group was 6.6%(9/136),compared with 14.1%(18/128)in the control group(P<0.05).The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8%vs 65.6%and 80.2%vs 57.8%in early warning and control groups,respectively(all P<0.001).The independent factors associated with postoperative DVT occurrence were age(OR=1.083,95%CI:1.070-3.265,P=0.032),Hyperlipidemia(OR=1.127,95%CI:1.139-2.564,P=0.042),preoperative high VTE risk(OR=2.131,95%CI:1.085-5.178,P=0.001),time of operation(OR=2.268,95%CI:2.005-5.546,P=0.026)and not adoption of early warning prevention(OR=3.747,95%CI:1.523-6.956,P=0.017).CONCLUSION The early warning strategy was independently associated with the decreasing occurrence of VTE,and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.

Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

The effects of obesity on venous thromboembolism: A review

Obesity has emerged as a global health issue that is associated with wide spectrum of disorders, including coronary artery disease, diabetes mellitus, hypertension, stroke, and venous thromboembolism (VTE). VTE is one of the most common vascular disorders in the United States and Europe and is associated with significant mortality. Although the association between obesity and VTE appears to be moderate, obesity can interact with other environmental or genetic factors and pose a significantly greater risk of VTE among individuals who are obese and who are exposed simultaneously to several other risk factors for VTE. Therefore, identification of potential interactions between obesity and certain VTE risk factors might offer some critical points for VTE interventions and thus minimize VTE morbidity and mortality among patients who are obese. However, current obesity measurements have limitations and can introduce contradictory results in the outcome of obesity. To overcome these limitations, this review proposes several future directions and suggests some avenues for prevention of VTE associated with obesity as well.

The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

Background: Venous thromboembolism (VTE) is a common complication seen during or after hospitalization that manifests as deep venous thrombosis (DVT) and/or pulmonary embolism (PE). PE is considered the commonest preventable cause of death during and/or after hospitalization. Thus, pharmacological and mechanical methods are used to prevent VTE in hospitalized patients. Despite the availability of guidelines for VTE prophylaxis, it is crucial to assess the adherence and adaptation of the institution to these guidelines. Purpose: This study aimed to investigate adherence to the American College of Chest Physicians (ACCP) 2012 VTE prophylaxis guidelines in hospitalized medical patients in a tertiary care hospital in the United Arab Emirates. Methods: An observational prospective design was utilized in this study. To achieve the purpose, primary and secondary end points were identified to be the core of the investigation. The primary end points were: the incidence of bleeding, VTE, and cardiovascular events. While the secondary end points were: dose and indication validity for prophylaxis, VTE and bleeding risk assessments, adverse drug events (ADE) other than bleeding, appropriate monitoring when on low molecular weight heparin (LMWH) and the presence of contraindication at the time of prescribing LMWH. Results: 16 patients (20%) out of the total 80 met one or more of the primary end points. The vast majority of patients (81.25%) developed bleeding, while VTE was seen in one case only during hospitalization. 11 patients (13.75%) received LMWH while a contraindication was present. 15 patients (18.75%) who were prescribed LMWH had an International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score of ≥7. However, 5 out of 13 patients (38.46%) who developed bleeding had a bleeding score of ≥7, and the relationship between bleeding score of ≥7 and the development of bleeding was statistically significant (p = 0.047). When investigating the doses that were utilized, 40% were prescribed an inappropriate dose. Conclusion: Various factors played a role in the inappropriateness of VTE prophylaxis such as;poor adherence to VTE guidelines, inappropriate dosing and monitoring, and not evaluating the bleeding risk. Hence, to be able to achieve effective VTE prophylaxis, these factors need to be addressed through adherence to and adaptation of the ACCP 2012 VTE prophylaxis guidelines.

Comparison of prevention and treatment of portal vein thrombosis between proximal splenic vein ligation followed by postoperative transcatheter anticoagulant therapy and systemic anticoagulant therapy in patients with cirrhotic portal hypertension

Aims:Splenectomy combined with pericardial devascularization is one of the important methods to treat hypersplenism,gastrointestinal bleeding,and other complications caused by liver cirrhosis;however,it is accompanied by a high risk of portal vein thrombosis(PVT).This study aimed to explore the preventive and therapeutic effects of proximal splenic vein ligation(PSVL)with postoperative transcatheter anticoagulant therapy(TCAT)on PVT.Methods:This study retrospectively selected 143 patients with liver cirrhosis and portal hypertension,who received splenectomy combined with pericardial devascularization from June 30,2018 to June 30,2021.According to computed tomography photography,within 1 week before the operation,the patients were divided into a prevention group(without preoperative PVT,n=112)and a treatment group(preoperative PVT,n=31).Then,each group was subdivided based on the treatment and prevention measures into PSVL+TCAT(n=70)and systemic anticoagulant therapy(SAT)subgroups(n=73).The preventive and therapeutic effects of PSVL followed by TCAT on PVT were analyzed.Results:The operation time in the PSVL+TCAT subgroups was longer than that in the SAT subgroups(185±76 min vs.161±55 min;p<0.01).There was no difference between the two subgroups in terms of operative bleeding(345±82 mL vs.336±65 mL;p>0.50).There was no operative death,and all patients recovered uneventfully.In the prevention group,procedure-related complications occurred in two patients in the PSVL+TCAT subgroup(3.7%[2/54]),including one patient with slight pancreatitis and one patient with chylous leakage,owing to mobilization of the pancreas.The PVT incidence in the prevention group was significantly different between the two subgroups at postoperative 7th day,3rd month,and 6th month(PSVL+TCAT:0%,11.1%,and 5.6%vs.SAT:39.7%,31.0%,and 20.7%,respectively;all p<0.05).In the treatment group,the thrombus regression rate at postoperative 7th day and disappearance rates at the 3rd month and the 6th month of the PSVL+TCAT subgroup were significantly higher than those in the SAT subgroup after anticoagulant and thrombolysis therapy(PSVL+TCAT:75.0%,68.8%,and 87.5%vs.SAT:20.0%,26.7%,and 40.0%;all p<0.05).Conclusions:PSVL+TCAT reduces the risk of PVT after splenectomy and is safe and effective in treating PVT during surgery for portal hypertension.

多学科协作风险管控预防肿瘤病人PICC相关性静脉血栓的效果观察

目的:探讨多学科协作(MDT)风险管控预防肿瘤病人经外周静脉置入中心静脉导管(PICC)相关性静脉血栓的效果。方法:选取2020年6月—2022年6月在本院留置PICC的肿瘤病人190例,采用随机数字表法分为观察组和对照组,各95例。对照组给予常规护理,观察组在对照组基础上给予MDT风险管控护理,比较两组PICC穿刺、维护质量、相关性静脉血栓及腋下静脉最大血流速度(Vmax),平均血流速度(Vmean)情况。结果:观察组PICC一次穿刺成功率、维护质量优良率高于对照组(P<0.05);两组护理后腋下静脉Vmax、Vmean快于护理前,观察组护理后腋下静脉Vmax、Vmean快于对照组(P<0.05);观察组PICC相关性静脉血栓发生率为2.11%,低于对照组的11.58%(P<0.05)。结论:MDT风险管控可提高肿瘤病人PICC穿刺、维护质量,改善腋下静脉循环,有利于改善PICC相关性静脉血栓的预防效果。

吲哚布芬用于预防静脉血栓形成的有效性与安全性的系统评价与Meta分析

目的:评价吲哚布芬在预防静脉血栓形成中的有效性与安全性。方法:在PubMed、Embase、the Cochrane Library、ClinicalTrial.gov、中国知网、万方数据库和中国生物医学文献数据库中检索,纳入吲哚布芬用于预防静脉血栓形成的随机对照试验(干预措施为吲哚布芬单药或联合其他常规用药治疗;对照措施为其他阳性对照药单药或联合其他常规用药治疗),检索时间截至2023年5月。2名评价者按照事先制定的纳入与排除标准筛选文献,提取资料,并对纳入研究的方法学质量进行评价,采用RevMan 5.3软件进行Meta分析。结果:最终纳入15项RCT研究,共2164例患者,其中吲哚布芬组1117例,对照组1047例。有效性结局显示,吲哚布芬在心房颤动(AF)血栓预防、骨科大手术后血栓预防和特发性膜性肾病血栓预防方面有足够的循证证据进行Meta分析,结果均不劣于华法林或其他抗凝血药;在AF合并缺血性心脑血管疾病、肾病综合征和下肢浅静脉曲张术后血栓预防方面,吲哚布芬也具有一定的证据,但尚不足以进行定量分析。安全性结果显示,吲哚布芬在预防AF血栓形成中造成出血(RR=0.18,95%CI=0.09~0.38,P<0.00001)和轻微出血(RR=0.17,95%CI=0.05~0.52,P=0.002)的发生率显著低于华法林,差异均有统计学意义。结论:吲哚布芬在预防静脉血栓形成方面已积累了一定的循证证据,其临床有效性不劣于传统治疗方案,在安全性方面更优。

住院患者下肢深静脉血栓形成预防的现状及其相关因素分析

目的探讨住院患者下肢深静脉血栓形成预防情况及其相关因素。方法收集2019年12月至2022年11月于合肥市第二人民医院住院的86例中高危下肢深静脉血栓患者的临床资料,根据住院期间是否接受下肢深静脉血栓预防干预将其分为预防组(n=46)和未预防组(n=40)。收集患者的一般资料、诊断指标、手术指标、深静脉血栓预防措施实施情况、住院期间发生下肢深静脉血栓的情况、围手术期深静脉血栓风险的评估情况,比较两组患者住院期间下肢深静脉血栓的发生率,分析与下肢深静脉血栓预防相关的影响因素。结果预防组患者中骨科手术比例、使用风险评估工具比例、术后卧床时间≥3 d比例均高于未预防组患者,差异均有统计学意义(P﹤0.05)。预防组患者住院期间下肢肿胀发生率、下肢深静脉血栓发生率均低于未预防组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄≤60岁、未使用风险评估工具、非骨科手术、术后卧床时间﹤3 d均是不进行下肢深静脉血栓预防的独立危险因素(P﹤0.05)。结论临床中仍有部分下肢深静脉血栓形成的高危患者没有进行针对性预防干预,年龄≤60岁、未使用风险评估工具、非骨科手术、术后卧床时间﹤3 d均是不进行下肢深静脉血栓预防的独立危险因素,应引起临床重视,对高危患者均应积极开展深静脉血栓预防。

神经外科手术患者静脉血栓栓塞症预防的证据分析

目的评价神经外科手术患者静脉血栓栓塞症(VTE)预防的相关证据,为VTE预防提供理论依据。方法检索美国国立指南库(NGC)、苏格兰院际指南网(SIGN)、英国指南库、加拿大医学会临床实践指南库(CMA)、国际指南协作网(GIN)、英国国家卫生与临床优化研究所(NICE)、加拿大安大略注册护士协会(RNAO)、Cochrane Library、PubMed、CINAHL、Embase、丁香园、医脉通、知网、万方数据库,指南、专家共识、证据总结、最佳临床实践、系统评价,检索时间为建库至2022年7月。纳入文献通过相应的质量评价工具进行评价,同时进行证据提取。结果最终纳入文献21篇,包括9篇临床指南、8篇专家共识和4篇证据总结。从VTE评估、B超检查、机械预防、药物预防、基础预防、术中预防、脑出血患者、脊髓损伤、脑肿瘤等14个方面进行证据总结,形成70条最佳证据。结论医护人员需提高神经外科手术患者VTE的预防意识,在科学的证据指导下,形成科室VTE预防管理规范,使神经外科手术患者VTE发生率减低。

专科-社区医联体模式对居家老龄人员静脉血栓栓塞症的预防效果分析

目的:观察专科-社区医联体模式的开展对居家老龄人员静脉血栓栓塞症(VTE)的预防效果,为预防居家老龄人员发生血栓提供参考方法,以减少居家老龄人员静脉血栓事件的发生。方法:选择2021年9月—2022年12月从呼吸与危重症医学科好转出院回到社区且年龄≥65岁的患者500例,除外因中途退出及失访患者,最终收集到473例患者的完整资料,按随机数字表法分为观察组(239例)和对照组(234例)。观察组由专科-社区医联体医护团队共同参与,给予健康教育、Caprini评分、VTE预防方案的指导及评估;对照组由社区医护团队每月进行常规电话随访。观察两组随访6个月时的VTE相关知识知晓率、VTE发生率以及研究结束时的VTE发生率。结果:观察组随访6个月时的VTE相关知识知晓率明显高于对照组(P<0.05);两组随访6个月时的VTE发生率比较,差异无统计学意义(P>0.05);研究结束时的延续随访观察显示,观察组的VTE发生率低于对照组,差异有统计学意义(P<0.05)。结论:长程的专科-社区医联体管理模式的开展能够减少居家老龄人员静脉血栓事件的发生率。

低分子肝素对肺癌患者术后住院期间下肢深静脉血栓形成的影响

目的探讨低分子肝素对肺癌患者术后住院期间下肢深静脉血栓形成(DVT)的影响。方法收集2020年1月至2023年6月于河北承德医学院附属医院接受外科手术治疗的156例肺癌患者的临床资料,将2021年12月之前未使用低分子肝素预防下肢DVT的患者作为对照组(n=81),将2022年1月开始使用低分子肝素预防下肢DVT的患者作为干预组(n=75)。比较两组患者的手术相关指标、住院期间下肢DVT发生情况、出院之前凝血功能指标及住院期间其他并发症的发生情况。结果两组患者的肿瘤部位、肿瘤分型、手术时间、术中低体温比例、术中出血量、使用呼吸机情况、间歇性气压治疗情况及使用足底静脉泵情况比较,差异均无统计学意义(P﹥0.05)。住院期间共13例患者发生下肢DVT,其中,干预组患者下肢DVT的发生率低于对照组患者,差异有统计学意义(P﹤0.05)。住院期间共有49例患者发生了除下肢DVT之外的其他并发症,两组患者其他并发症的发生率比较,差异无统计学意义(P﹥0.05)。出院之前化验结果显示,两组患者的凝血酶原时间、活化部分凝血活酶时间比较,差异均无统计学意义(P﹥0.05)。结论低分子肝素可有效降低肺癌手术患者住院期间发生下肢DVT的风险,且不会对患者的凝血酶原时间和活化部分凝血活酶时间造成明显的影响,亦不会增加并发症,值得临床推广。

重症患者深静脉血栓预防与诊治现状的研究进展

重症患者是深静脉血栓形成的高危人群,血栓脱落可导致肺栓塞,危及患者生命。院内静脉血栓栓塞症是院内非预期死亡的首要原因,也是导致医疗纠纷的主要根源之一,严重威胁患者的生命健康,规范化的静脉血栓栓塞症防治意义重大。本文旨在通过对深静脉血栓栓塞症预防与诊治现状相关研究进展进行综述,以期为重症患者静脉血栓栓塞症防治提供帮助。

院感防控处方制度对中央血管导管置管患者疾病负担的影响

目的了解院感防控处方制度对中央血管导管置管患者疾病负担的影响,优化其管理模式。方法采用整群抽样的方法,选取2022年1月1日至2023年6月30日在成都中医药大学附属第五人民医院住院的599例中央血管导管置管患者为研究对象,根据患者所在病区不同分为试验组(实施院感防控处方制度管理,n=256)与对照组(实施传统模式管理,n=343)。采用倾向评分匹配两组患者的基线资料,使用自制问卷收集两组患者人口学特征、疾病类型、急性生理与慢性健康评分Ⅱ评分、序贯器官衰竭评估评分、院内感染等;同时对两组患者的医务人员按比例抽样观察手卫生时机400次,分析医务人员手卫生执行情况。结果试验组的医疗总费用、实验室诊断费、抗菌药物费、带管时间、抗生素使用时间及院内感染发生率均低于对照组(P<0.05);对照组医务人员手卫生执行率白天高于夜晚(P<0.05),而试验组医务人员手卫生执行率白天与夜晚比较差异无统计学意义(P>0.05);试验组隔离医嘱10 min执行率、多耐防控集束化措施全部落实率高于对照组(P<0.05);试验组院内感染发生率低于对照组(P<0.05)。结论院感防控处方制度实施可减少中央血管导管患者治疗成本,提高医务人员院感防控措施落实成效,减少患者院内感染的发生。

流程化VTE预防质量控制管理在妇科恶性肿瘤患者围术期血栓预防中的应用效果

目的探讨流程化静脉血栓栓塞症(VTE)预防质量控制管理在妇科恶性肿瘤患者围术期血栓预防中的应用效果。方法选取2019年5月至2022年5月我院收治的70例妇科恶性肿瘤患者,按照干预方案不同将其分为对照组和研究组,各35例。对照组给予常规管理,研究组开展流程化VTE预防质量控制管理。比较两组的下肢静脉血流速度、疼痛评分、下肢静脉血栓发生情况、凝血功能指标及知信行(KAP)评分。结果干预前,两组的下肢静脉血流速度及视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);干预后,研究组的下肢静脉血流速度大于对照组,VAS评分低于对照组,差异具有统计学意义(P<0.05)。研究组的下肢静脉血栓发生率低于对照组,差异具有统计学意义(P<0.05)。干预前,两组的凝血酶原时间、纤维蛋白原、D-二聚体水平及血小板计数比较,差异无统计学意义(P>0.05);干预后,研究组的凝血酶原时间长于对照组,纤维蛋白原、D-二聚体水平及血小板计数低于对照组,差异具有统计学意义(P<0.05)。研究组的KAP各维度评分高于对照组,差异具有统计学意义(P<0.05)。结论流程化VTE预防质量控制在妇科恶性肿瘤患者围手术期中的应用效果显著,能够改善凝血功能,加速下肢静脉血流速度,缓解疼痛,并提高患者的知信行水平,值得临床推广和应用。

外科手术患者术中深静脉血栓预防的最佳证据总结

目的检索、评价并整合外科手术患者术中深静脉血栓(DVT)预防的最佳证据,为手术室临床护理实践提供参考。方法根据PIPOST模型确立循证护理问题,按照证据的“6S”金字塔模型,自上而下系统检索美国国立指南库、国际指南协作网、苏格兰院际指南网、医脉通、Cochrane Library、JBI循证资源数据库、美国胸科医师协会、美国血液协会、美国围手术期注册护士协会、欧洲麻醉学会、加拿大安大略注册护士协会、英国国家健康和护理卓越研究所、PubMed、Web of Science核心合集数据库、Medline、中国知网、中国生物医学文献数据库、维普网、万方数据知识服务平台等数据库中关于手术室患者术中预防DVT的所有证据,包括临床决策、指南、专家共识、证据总结、系统评价及meta分析,检索时间为2012年1月至2023年12月,对符合标准的文献进行质量评价、证据提取和分级。结果研究共纳入12篇文献,其中包括指南5篇、专家共识4篇、系统评价1篇、证据总结2篇,从多学科团队协作、术前评估、术中麻醉管理、术中基础预防、专科预防、术中机械预防、术中药物预防、监测与交接8个方面,总结、归纳出28条最佳证据。结论外科手术患者术中DVT的预防需要多学科共同协作,证据应用过程中需要结合科室和患者的具体情况,审慎地将证据应用于临床,降低患者术中DVT发生率,提升临床护理质量。

信息化管理在院内静脉血栓栓塞症防控中的实施效果评价

目的探讨采用信息化管理对提高静脉血栓栓塞症(VTE)防控内涵质量的效果。方法随机抽取自贡市第四人民医院骨科、呼吸内科、妇产科、心血管内科信息化管理前(2020年1月1日至7月31日)及信息化管理后(2021年1月1日至7月31日)的病案各216份,分别设为信息化管理前组、信息化管理后组,统计两组VTE风险评估质控指标、诊断质控指标、预防质控指标和结局质控指标。结果信息化管理后VTE风险评估质量明显提高,VTE风险评估率、评估及时率、评估准确率、动态评估率分别为95.37%、91.75%、92.72%、76.21%,均显著高于信息化管理前的74.54%、57.76%、81.99%、19.25%,差异有统计学意义(P<0.05)。检查检验方面,信息化管理后VTE风险检查检验率、D-二聚体检测率、静脉超声检查率分别为93.98%、98.03%、87.97%,与信息化管理前的64.81%、82.86%、76.99%相比均有明显改善,差异有统计学意义(P<0.05)。预防管理方面,信息化管理后中高风险患者预防措施执行率为87.96%,较信息化管理前的59.72%有显著改善,差异有统计学意义(P<0.05)。结局指标方面,信息化管理后医院相关性VTE发生率为0,明显低于信息化管理前的1.85%,差异有统计学意义(P<0.05)。结论信息化管理能明显提高VTE防控内涵质量,对于进一步保障医疗安全具有一定的现实意义。

集束化护理预防宫颈癌术后下肢深静脉血栓的效果评价

目的 观察宫颈癌患者术后应用集束化护理干预对下肢深静脉血栓形成的预防效果。方法 选择妇科2020年2月至2021年2月收治入院的宫颈癌根治术患者100例,遵循自愿参与及同意知情原则,数字随机表法分为常规组(常规护理)和研究组(集束化护理干预),每组50例。结果 研究组术后下肢深静脉血栓形成率低于常规组(P<0.05);研究组ADL评分高于常规组,SDS抑郁心态评分以及SAS焦虑心态评分显著低于常规组(P<0.05);研究组住院时间短于常规组,疾病认知评分、满意度高于常规组(P<0.05)。结论 实施集束化护理干预措施,能更好加深患者对疾病的认识,使其自觉规避不良行为,减少术后并发症的发生,减轻负性情绪,缩短住院时间,改善生活质量,赢得患者满意。

结直肠癌术后并发静脉血栓栓塞症的危险因素及其预防情况

目的探讨结直肠癌(CRC)患者术后并发静脉血栓栓塞症(VTE)的危险因素及其预防情况。方法收集2022年1—12月于首都医科大学附属北京友谊医院行CRC根治术治疗的93例患者的临床资料,按照是否发生VTE将其分为VTE组(n=17)和非VTE组(n=76),收集CRC患者的相关指标,分析CRC患者术后发生VTE的危险因素及其预防情况。结果单因素分析结果显示,年龄、冠心病、高脂血症、术后D-二聚体水平均是CRC患者术后发生VTE的影响因素(P﹤0.05)。多因素分析结果显示,冠心病、术后D-二聚体≥2.5μg/ml均是CRC患者术后发生VTE的独立危险因素(P﹤0.05)。Caprini评分高危患者中,任何预防措施率为75.56%(68/90),规范预防措施率为27.78%(25/90);Caprini评分中危患者中,任何预防措施率为100%(3/3),规范预防措施率为0。93例CRC患者中,围手术期任何预防措施率为76.34%(71/93),规范预防措施率仅为26.88%(25/93),差异有统计学意义(P﹤0.05)。VTE组患者术前预防及术后规范预防比例均低于非VTE组患者,但差异均无统计学意义(P﹥0.05)。结论多数CRC患者在围手术期均未得到规范的血栓预防管理,临床上动态监测D-二聚体可能有助于判断患者VTE发生风险的变化情况,从而判断预防措施的效果。

成人创伤性脑损伤患者静脉血栓栓塞症预防的最佳证据总结

目的检索、提取和汇总成人创伤性脑损伤患者静脉血栓栓塞症(VTE)预防的最佳证据,为临床实践提供循证依据。方法系统检索中英文数据库、国内外相关指南及专业学会或协会网站中成人创伤性脑损伤患者VTE预防的相关文献。由两名研究人员独立筛选文献、评价文献质量并提取证据。结果共纳入22篇文献,包括3篇临床决策、8篇专家共识、11篇指南。汇总形成评估、筛查、基础预防、机械预防、药物预防、下腔静脉过滤器应用等6个方面共29条证据。结论临床医护人员应结合患者的病情及实际需求,充分考虑证据的可行性和适用性,同时可以选择合适的证据转化模式,并建立相应的审查指标或评价方法,以规范成人创伤性脑损伤患者VTE防治流程。

胫骨高位截骨术后静脉血栓栓塞的危险因素分析

目的探讨胫骨高位截骨术后患者下肢深静脉血栓栓塞(deep venous thromboembolism,DVT)的发生率及相关危险因素。方法回顾性地收集2017年1月至2022年12月期间于河北省优抚医院骨科接受胫骨高位截骨术(high tibial osteotomy,HTO)的患者资料。以术后是否发生DVT进行分组,并对与DVT发生可能相关的因素进行统计学分析,先采用单因素分析筛选危险因素,再采用多因素Logistic回归分析确定主要的危险因素。结果140例患者被纳入该研究,HTO术后DVT的发生率为18.6%。单因素结果显示,BMI、围手术期血红蛋白差、输血、纤维蛋白原水平、D-二聚体水平、红细胞比容,术前、术后VAS评分,术前膝关节损伤和骨关节炎结果评分(knee injury and osteoarthritis outcome score,KOOS)疼痛和术前KOOS日常活动是DVT发生的危险因素。Logistic回归分析表明,BMI(OR=1.776,P=0.001)、红细胞比容(OR=5.171,P=0.040)、纤维蛋白原(OR=3.383,P=0.013)、D-二聚体水平(OR=1.015,P<0.001)是DVT发生的独立危险因素。结论HTO术后静脉血栓栓塞发生率较高,针对肥胖、术中出血较多和术后纤维蛋白原和D-二聚体较高的患者,建议采取相应预防措施,降低术后DVT的发生率。