下肢骨折术后深静脉血栓Caprini评估与预见性护理

Predictive nursing based on Caprini risk assessment for deep vein thrombosis after surgical treatment of lower limb frac⁃ tures

摘要:

［目的］ 探索基于 Caprini 风险评估的预见性护理对下肢骨折术后深静脉血栓 （deep venous thrombosis, DVT） 的影响。［方法］2020 年 12 月—2022 年 5 月，90 例下肢骨折患者纳入本研究，采用随机数字表法分为两组， 46 例给予基于 Capri- ni 风险评估的预见性护理，44 例给予常规护理。比较两组临床、检验和超声检查结果 ［结果］ 两组患者均顺利手术，无严重术中并发症。干预组术后 3 d VAS 评分、住院时间、早期发症发生率均显著优于常规组（P<0.05）。检验方面，术后 7 d 干预组 PT 和 aPTT 均显著长于常规组（P<0.05），干预组 PLT 和 Fbg 较常规组下降显著（P<0.05）。两组术后 7 d 的 D-D 较入院时提高显著升高（P<0.05），但术后 7 d 干预组 D-D 水平明显低于常规组（P<0.05）。术后 7 d，干预组的 PIC 和 TAT 均显著低于常规组 （P<0.05）。超声检查方面，术后 3 d DVT 发生率干预组为 4/46 （8.70%），常规组为 11/44 （25.00%）（P=0.002）；下肢静脉血流速度干预组为 （25.26±3.58） cm/s，常规组为 （22.34±2.24） cm/s （P<0.001）。［结论］ 下肢骨折术后采用基于 Caprini 风险评估的预见性护理能改善术后高凝状态，降低血栓分子标志物及 DVT 风险，减少并发症，有利于术后康复。

Abstract:

[Objective] To explore the outcomes of predictive nursing based on Caprini risk assessment for deep venous thrombosis (DVT) after surgical treatment of lower extremity fractures. [Methods] From December 2020 to May 2022, 90 patients with lower extremity fractures were enrolled in this study. They were divided into two groups using random number table method, including 46 patients who were given predictive care (PC) based on Caprini risk assessment and 44 patients who received routine care (RC) . The documents of clinical evaluation, laboratory test and ultrasonic examination were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious intraoperative complications. The PC group was significantly better than the RCl group in terms of VAS score 3 days postoperatively, hospital stay and incidence of early onset complications (P＜0.05) . In terms of laboratory tests, the PC group had significantly longer PT and aPTT, while significantly lower PLT and Fbg than the RC group at 7 days postoperatively (P＜0.05) . In addition, the PC group had significantly lower D-D, PIC and TAT than RC group 7 days postoperatively (P＜0.05) . In terms of ultrasonog- raphy, the incidence of DVT at 3 days after surgery was of 4/46 (8.70%) in the PC group, whereas 11/44 (25.00%) in the RC group (P= 0.002) , with lower limb venous blood stream velocity of (25.26±3.58) cm/s in the PC group than (22.34±2.24) cm/s in the RC group (P＜ 0.001) . [Conclusion] Predictive nursing based on Caprini risk assessment after surgical treatment of lower extremity fractures does relieve postoperative hypercoagulability state, decline thrombotic molecular markers and occurrence of DVT, reduce complications and is benefit to patients' postoperative recovery.