中西医疗法在妇科腹腔镜术深静脉血栓预防中的实证研究

发布时间：2018-11-15 14:29

【摘要】：深静脉血栓(Deep Venous Thrombosis, DVT)是妇科腹腔镜术后常见的并发症,但由于DVT发病隐匿,80%的DVT患者根本无临床表现,我们往往忽略了对妇科手术患者特别是妇科腹腔镜手术患者围术期DVT的预防。目前,如何预防妇科腹腔镜围手术期DVT的发生,国内外尚无统一的规范或标准,在许多医院存在着重视不够或预防过度等问题。本研究利用Autar深静脉风险评估量表,对妇科腹腔镜患者进行DVT风险评估,对中、高危患者进行相应的预防措施,观察妇科腹腔镜术后DVT的发生情况。第一部分：目的讨论和分析Autar量表在妇科腹腔镜手术后预防深静脉血栓(DVT)形成的风险评估中的应用效果。方法利用Autar量表对我院妇科2014年7月到9月行腹腔镜手术的218名患者进行深静脉血栓风险评估,并统计分析患者术后深静脉血栓发生率与Autar评分的相关性。结果所有手术均顺利完成。本组218例中3例(1.4%)发生深静脉血栓,其中术后低危组171例均未发生DVT,中危组31例中1例(3.2%)发生DVT,高危组16例中2例(12.5%)出现DVT,统计学有显著性差异(x 2=16.4,P0.01)。同时,术后Autar量表的风险评分结果与手术后DVT发生率呈正相关性(R2=0.9357,p0.05)。结论Autar量表能够有效的预测妇科腹腔镜手术后DVT发生的风险,有助于针对性的对中高危组患者采取预见性的措施,不仅避免了护理干预的盲目性,还有利于患者的预后。第二部分：目的探讨穴位按摩预防妇科腹腔镜术后不同风险级别DVT发生的效果。方法利用Autar深静脉风险评估量表对2014年10月至2015年1月行妇科腹腔镜手术患者术前一天及术后24h进行评估,选出中度风险组与高度风险组患者作为研究对象,中度风险组72人,高度风险组34人。将中、高风险组患者按照随机原则分别分为对照组和试验组。对照组：常规护理+间歇性肢体气压治疗；试验组：常规护理+穴位按摩(上巨虚、足三里、梁丘、阴市、伏兔)。通过检测患者术前、术后第一天实施间歇性肢体气压治疗或穴位按摩之前、术后第五天红细胞聚集指数和胭窝静脉血流速度及统计术后血栓发生率来评价穴位按摩的效用。结果本组研究中共有4例发生深静脉血栓,其中中、高危组各有2例发生下肢深静脉血栓。在中、高危患者中,与对照组相比,试验组术后第五天红细胞聚集指数明显降低、血流速度明显升高(P0.05)；试验组患者血栓发生率均明显低于对照组(P0.05)。结论对于Autar评估中、高危风险的患者,在给予常规护理的同时辅助穴位按摩有利于预防术后血栓的发生。
[Abstract]:Deep venous thrombosis (Deep Venous Thrombosis, DVT) is a common complication after gynecological laparoscopy. However, because of the occult incidence of DVT, 80% of DVT patients have no clinical manifestations at all. We often overlook the prevention of perioperative DVT in gynecological patients, especially gynecologic laparoscopic surgery. At present, there is no uniform standard or standard on how to prevent the occurrence of DVT during gynecological laparoscopic perioperative period, and there are some problems in many hospitals, such as insufficient attention or prevention. In this study, Autar deep vein risk assessment scale was used to evaluate the risk of DVT in gynecologic laparoscopic patients. The prevention measures were taken to the middle and high risk patients, and the incidence of DVT after gynecologic laparoscopy was observed. Part one: objective to discuss and analyze the application of Autar scale in the risk assessment of (DVT) after laparoscopic gynecologic surgery. Methods Autar scale was used to evaluate the risk of deep venous thrombosis (DVT) in 218 patients undergoing laparoscopic surgery in our hospital from July to September 2014, and the correlation between the incidence of DVT and Autar score was analyzed statistically. Results all the operations were completed successfully. Of the 218 cases, 3 (1.4%) developed deep venous thrombosis, of which 171 cases in the low risk group did not develop DVT,. 1 out of 31 cases (3.2%) developed DVT, in the middle risk group. 2 out of 16 cases (12.5%) in the high-risk group developed DVT,. There was a significant difference between the two groups (x _ 2 ~ (16. 4) P _ (0.01). At the same time, there was a positive correlation between the risk score of postoperative Autar scale and the incidence of DVT after operation (R2 / 0. 9357 / p0. 05). Conclusion Autar scale can effectively predict the risk of DVT after gynecological laparoscopic surgery, and it is helpful to take predictive measures for patients in middle and high risk group, which not only avoids blindness of nursing intervention, but also benefits the prognosis of patients. Part two: objective to investigate the effect of acupoint massage on the prevention of different risk levels of DVT after gynecologic laparoscopy. Methods from October 2014 to January 2015, patients undergoing laparoscopic gynecologic surgery were evaluated with Autar Deep vein risk Assessment scale (Autar). The patients of moderate risk group and high risk group were selected as study subjects, and 72 patients in moderate risk group were selected. High risk group 34. Middle-and high-risk patients were randomly divided into control group and trial group. Control group: routine nursing intermittent limb barometric therapy, test group: routine nursing acupoint massage (Shangjuxu, Zusanli, Liang Qiu, Yin-Shi, Fu rabbit). The effect of acupoint massage was evaluated by measuring the erythrocyte aggregation index and venous blood flow velocity of popliteal fossa and counting the incidence of thrombus before intermittent limb barometric therapy or acupoint massage before and on the first day after operation. Results there were 4 cases of deep venous thrombosis in this study, of which 2 cases in high risk group developed deep venous thrombosis of lower extremity. In the middle and high risk patients, compared with the control group, the erythrocyte aggregation index significantly decreased and the blood flow velocity increased significantly in the test group on the fifth day after operation (P0.05); the incidence of thrombus in the trial group was significantly lower than that in the control group (P0.05). Conclusion for patients with high risk of Autar, routine nursing and acupoint massage are helpful to prevent postoperative thrombosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.71

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