Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Pitfalls and sources of error of color duplex ultrasonography in detecting deep vein thrombosis of proximal lower extremities

Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

Comparison of four clinical scores for the predicting lower limb deep venous thrombosis in Chinese patients

Objective：To evaluate Wells, Kahn, St.Andr 6 and Constans scores for the prediction of deep venous thrombosis in Chinese patients. Methods：One hundred and seventy-two patients, prospectively, blinded referred for evaluation with four clinical-score systems for suspected deep venous thrombosis, were examined by ultrasonography. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores. The difference between areas of the ROC curve for each of the scores was compared with others and reference line. Results：Forty-six of 172 patients had deep venous thrombosis proven by sonography. The sensitivity, specificity, positive predictive value and negative predictive value for Wells score was 91.3%, 57.1%, 43.8% and 94.7%, respectively, for Kahn score; 65.2%, 71.4%, 45.5% and 84.9%, respectively, for St.Andr 6 score; 63%, 38.9%, 27.4% and 74.2% respectively, for Constans score; 95.7%, 34.9%, 34.9% and 95.7% respectively. Area under ROV curve of Constans score was 0.814, which was similar to that of Wells score, then followed by Kahn score and that of St.Andr 6 score was no difference with the reference line. Conclusion：Based on the results of our study, the sensitivity, negative prediction value and area under ROC curve are larger for Constans score and Wells score in Chinese hospitalized patients than that of Kahn score or St.Andr 6 score. Considering the aim of the clinical assessment, Constans score and Wells score are more efficient for Chinese hospitalized patients.

Combined effect of Traditional Chinese Medicine decoction and low-molecular-weight heparin calcium on the postoperative deep venous thrombosis in patients with lower limb fracture

OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Discussion on Prevention and Treatment of Lower Extremity Deep Venous Thrombosis in Orthopedic Perioperative Period from Spleen and Stomach Meridians

Deep venous thrombosis of lower extremity is one of the common complications in orthopedic perioperative period.It is caused by many factors,such as peripheral vein dilation,slow blood flow;long-term immobilization,bed rest and so on.On the one hand,it affects the early postoperative functional exercise and functional recovery,on the other hand,it increases the length of hospital stay and economic burden,increases the pain of patients and even endangers their lives.Effective treatment of traditional Chinese medicine combined with western medicine can play a better role in the prevention and treatment of lower extremity deep venous thrombosis.This study expounds the concept of spleen and stomach meridians in the prevention and treatment of lower extremity deep venous thrombosis,and puts forward some opinions on the dialectical treatment and daily conditioning of lower extremity deep venous thrombosis,hoping to provide ideas for the clinical prevention and treatment of lower extremity deep venous thrombosis in traditional Chinese medicine.

Prevention and Treatment of Deep Vein Thrombosis of the Lower Limbs in Patients with Complications after Orthopedic Trauma Surgery

Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.

基于Caprini量表评估干预措施结合空气波压力治疗仪对乳腺癌术后患者下肢深静脉血栓形成的影响

目的探讨基于Caprini量表评估干预措施结合空气波压力治疗仪对乳腺癌术后患者下肢深静脉血栓(DVT)形成的影响。方法选取2020年3月至2023年9月合肥市第二人民医院收治的80例乳腺癌术后患者,按照入院时间分为两组。入院时间2020年3月至2022年3月为常规组,入院时间2022年4月至2023年9月为干预组,各40例。常规组行基于Caprini量表评估预防护理,干预组在常规组的基础上实施空气波压力治疗仪干预。观察两组DVT发生率,比较两组干预前后世界卫生组织生存质量测定量表简表评分及满意度。结果干预组术后下肢DVT发生率低于常规组,差异有统计学意义(P<0.05)。干预前,两组生理领域、心理领域、环境领域、社会关系领域评分比较,差异无统计学意义(P>0.05);干预后,两组生理领域、心理领域、环境领域、社会关系领域评分高于干预前,且干预组高于常规组,差异有统计学意义(P<0.05)。干预组护理满意度优于常规组,差异有统计学意义(P<0.05)。结论乳腺癌患者术后实施基于Caprini量表评估干预措施结合空气波压力治疗仪干预,可明显提高下肢DVT预防效果,降低下肢DVT发生率,提高生活质量及满意度高。

Upper extremity deep vein thrombosis:An intensivist’s perspective

Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.

Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis

Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.

纤维蛋白原/白蛋白比值、Caprini评分、D-二聚体对急性脑梗死后下肢深静脉血栓形成的预测价值

目的 探讨纤维蛋白原/白蛋白比值(FAR)、Caprini评分、D-二聚体(D-D)对急性脑梗死后下肢深静脉血栓(LDVT)形成的预测价值。方法 选取2019年7月至2023年3月在安徽省芜湖市中医医院神经内科住院的急性脑梗死患者122例,根据住院期间双下肢静脉彩超结果将其分为血栓组(42例)和无血栓组(80例),收集两组的基本资料,比较两组FAR、Caprini评分、D-D等指标的差异。建立logistic回归模型分析急性脑梗死后LDVT形成的影响因素,绘制受试者操作曲线比较FAR、Caprini评分、D-D单独及联合对急性脑梗死后LDVT形成的预测价值。结果 血栓组糖尿病患者占比、美国国立卫生研究院卒中量表评分>14分患者占比、格拉斯哥昏迷量表评分>8分患者占比、使用脱水药物>5 d患者占比、Caprini评分及D-D、FAR水平均高于无血栓组,差异有统计学意义(P<0.05)。多因素分析结果显示,Caprini评分(OR=1.803,95%CI:1.173~2.769)、D-D(OR=1.589,95%CI:1.235~2.043)、FAR(OR=1.609,95%CI:1.075~2.408)为急性脑梗死后LDVT形成的独立影响因素(P<0.05)。Caprini评分、FAR、D-D三者联合预测急性脑梗死后LDVT形成的受试者操作曲线下面积高于三者单独预测(P<0.05)。结论 FAR、Caprini评分、D-D与急性脑梗死后LDVT形成有关,可作为LDVT的预测指标,三者联合检测能提高预测效能。

Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

BACKGROUND: Deep venous thrombosis(DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department(ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT.METHODS: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical record.RESULTS: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379(15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT.CONCLUSIONS: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

Caprini评分联合纤维蛋白原水平对下肢骨折患者下肢深静脉血栓的预测价值

目的:探究Caprini评分联合纤维蛋白原(fibrinogen,FIB)水平对下肢骨折患者下肢深静脉血栓(deep vein thrombosis,DVT)的预测价值。方法:以2020年1月1日—2022年9月30日中国人民解放军联勤保障部队第904医院收治的下肢骨折患者作为研究对象,共100例。根据术前下肢深静脉彩色多普勒超声检查结果将研究对象分成DVT组(n=11)和非DVT组(n=89)。比较DVT组和非DVT组FIB水平和Caprini评分;基于模型公式:Y=β_(0)+β_(1)×A+β_(2)×B,构建Caprini评分、FIB回归模型;建立受试者操作特征(ROC)曲线,分析Caprini评分、FIB、Caprini评分联合FIB在下肢骨折患者下肢DVT预测中的应用价值。结果:DVT组的Caprini评分、FIB水平均高于非DVT组(P<0.05)。Caprini评分、FIB的二元logistic回归模型为:Y=-21.556+2.637×FIB+1.997×Caprini评分。经ROC曲线分析,FIB预测下肢DVT的曲线下面积(AUC)为0.908,敏感度为81.82%,特异度为92.13%;Caprini评分预测下肢DVT的AUC为0.939,敏感度为90.91%,特异度为85.39%;Caprini评分联合FIB预测下肢DVT的AUC为0.972,敏感度为100%,特异度为86.52%。结论:发生下肢DVT的下肢骨折患者术前的Caprini评分较高,FIB水平呈现异常增高的情况,Caprini评分联合FIB预测下肢DVT的价值更高。

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

急性下肢深静脉血栓患者置管溶栓前后D-D、F1+2、P-selectin变化及意义

目的 探究急性下肢深静脉血栓形成(DVT)患者置管溶栓前后D-二聚体(D-D)、凝血酶原片段1+2(F1+2)、P选择素(P-selectin)变化及临床意义。方法 选取2020年3月至2022年3月云南省第三人民医院186例急性DVT患者作为研究对象,均行置管溶栓术,术后12个月以门诊形式进行随访,4例失访,共182例完成术后随访。根据术后12个月是否发生血栓后综合征(PTS)分为PTS组(n=27)、非PTS组(n=155),比较2组一般资料及溶栓前后血浆D-D、F1+2、P-selectin表达,Logistic分析PTS发生影响因素,受试者工作特征曲线(ROC)、曲线下面积(AUC)分析血浆D-D、F1+2、P-selectin预测PTS发生价值,采用相对危险度(RR)分析不同血浆D-D、F1+2、P-selectin表达对PTS的影响。结果 PTS组年龄、BMI、静脉通畅评分及溶栓后1周、1个月血浆D-D、F1+2、P-selectin表达高于非PTS组(P <0.05);Logistic显示:BMI及溶栓后1周、1个月血浆D-D、F1+2、P-selectin是急性DVT患者发生PTS的影响因素(P <0.05);ROC曲线,溶栓后1个月血浆D-D、F1+2、P-selectin联合预测PTS效能明显优于溶栓后1周D-D、F1+2、P-selectin联合预测效能;溶栓后1个月血浆D-D、F1+2、P-selectin高表达患者发生PTS风险是低表达的4.211、2.550、3.189倍。结论 急性DVT患者置管溶栓后血浆D-D、F1+2、P-selectin表达升高,其联合预测患者发生PTS具有一定预测效能。

柚皮素抑制cGAS-STING通路活化对大鼠下肢深静脉血栓形成的影响

【目的】探讨柚皮素抗大鼠下肢深静脉血栓形成机制。【方法】将60只大鼠随机分为6组,即假手术组,模型组,柚皮素低、中、高剂量组和柚皮素高剂量+STING激动剂2.5己酮可可碱(DMXAA)组,每组10只。检测各组大鼠凝血指标[D-二聚体(D-dimer)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)],炎症指标[白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]及氧化应激指标[丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)];苏木素-伊红(HE)染色法检测静脉血栓形成;检测血栓湿质量和干质量;透射电镜检测静脉血栓超微结构;Western Blot法检测静脉血栓组织中环鸟苷酸-腺苷酸合成酶(c GAS)、干扰素基因刺激因子(STING)蛋白表达。【结果】(1)与假手术组比较,模型组大鼠D-dimer水平,IL-1β、IL-6、TNF-α水平,MDA含量,血栓湿质量和干质量增加,TT、APTT、PT,SOD活性和GSH-Px活性降低(均P<0.05);与模型组比较,柚皮素低、中、高剂量组大鼠D-dimer水平,IL-1β、IL-6、TNF-α水平,MDA含量,血栓湿质量和干质量降低,TT、APTT、PT,SOD活性和GSH-Px活性增加(均P<0.05),且呈剂量依赖性;与柚皮素高剂量组比较,柚皮素高剂量+DMXAA组大鼠D-dimer水平,IL-1β、IL-6、TNF-α水平,MDA含量,血栓湿质量和干质量升高,TT、APTT、PT,SOD活性和GSH-Px活性降低(均P<0.05)。(2)与假手术组比较,模型组大鼠静脉血栓组织中cGAS、STING蛋白表达水平升高(P<0.05);与模型组比较,柚皮素低、中、高剂量组大鼠静脉血栓组织中cGAS、STING蛋白表达水平均显著降低(P<0.05);柚皮素高剂量+DMXAA组大鼠cGAS、STING蛋白表达水平显著高于柚皮素高剂量组(P<0.05)。【结论】柚皮素可通过抑制cGAS/STING信号通路活化,抑制炎症、氧化应激反应,从而缓解下肢深静脉血栓形成。

血栓弹力图与凝血因子Ⅴ、Serpine1对创伤性骨折患者术后下肢深静脉血栓的预测价值分析

目的探讨血栓弹力图(thrombelastography,TEG)与人纤溶酶原激活物抑制剂1(human plasminogen activator inhibitor-1,Serpine1)对创伤性骨折患者术后下肢深静脉血栓的预测价值。方法选取2019年10月至2021年10月于杭州整形医院就诊的疑似下肢深静脉血栓的创伤性骨折术后患者272例,以超声造影检查诊断为“金标准”,将确诊为下肢深静脉血栓的200例患者设为研究组,72例非下肢深静脉血栓患者设为对照组,两组患者均行TEG检查,检测两组的凝血因子Ⅴ、Serpine1水平。结果与对照组比较,研究组的TEG参数凝固时间(solidification time,K)、反应时间(reaction time,R)降低,最大幅度(maximum magnitude,MA)、凝固角(solidification angle,α)升高,且研究组重度患者的K、R较低,MA、α、凝血因子Ⅴ、Serpine1水平较高(P<0.05)。K、R、MA、α、凝血因子Ⅴ、Serpine1与研究组轻度、重度严重程度相关,且K、R、MA、α与凝血因子Ⅴ、Serpine1相关。K、R、MA、α、凝血因子Ⅴ、Serpine1联合检测对创伤性骨折患者术后下肢深静脉血栓的预测价值较高。结论TEG联合凝血因子Ⅴ、Serpine1对创伤性骨折患者术后下肢深静脉血栓有较高的预测价值,具有一定的临床价值。

基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后患者下肢深静脉血栓形成的影响

目的:探讨基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后患者下肢深静脉血栓形成(deep venous thrombosis,DVT)的影响。方法:选取2020年3月至2022年2月北京积水潭医院收治并施行手术治疗的186例老年髋部骨折患者为研究对象。根据随机数字表法将患者随机分为对照组与观察组,每组各93例。比较2组患者DVT发生率、血栓最大宽度及DVT相关知识知晓情况;比较2组患者术前、术后3、5 d及出院时D-二聚体值、双下肢大腿周径差值,并记录干预期间其他并发症情况。结果:观察组患者DVT发生率为4.30%,低于对照组的12.90%(P<0.05)。观察组患者血栓最大宽度低于对照组(P<0.05)。出院时,观察组患者预防DVT相关知识知晓问卷总分及各维度评分均高于对照组(均P<0.05)。术后,随着时间推移,2组患者D-二聚体值随之下降,且观察组各时间点D-二聚体值均低于对照组(均P<0.05)。术后3 d,2组患者双下肢大腿周径差值均较术前上升,之后2组患者双下肢大腿周径差值随时间推移下降,且观察组患者各时间点双下肢大腿周径差值均低于对照组(均P<0.05)。观察组患者其他并发症发生率为6.5%,显著低于对照组的18.3%(P<0.05)。结论:基于Caprini风险评估模型的个性化预防护理对老年髋部骨折术后下肢DVT的预防效果较好,能明显减少DVT。