以循证为基础的集束化护理对预防髋关节置换术后患者DVT的研究

发布时间：2018-01-14 03:24

本文关键词：以循证为基础的集束化护理对预防髋关节置换术后患者DVT的研究　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探究以循证为基础的集束化护理,对预防髋关节置换术后患者深静脉血栓形成的疗效,为丰富临床护理人员护理髋关节置换术后患者,提供一种科学有效的方法。本研究是循证医学在护理学领域的探索性应用,建立规范的临床护理工作模式,指导护理人员提升护理服务质量,提高患者满意度。方法将90例实施髋关节置换术的患者按照基线资料匹配入组,平均分为对照组(45例)和干预组(45例),对照组给予目前临床预防DVT的一般护理,干预组给予以循证为基础的集束化护理,然后观察两组患者护理的临床疗效。在术前及术后9天内观察两组患者静脉血栓、Homan征、Neuhof征发生率;并测量两组踝上5cm、髌下10cm、髌上15cm肢体体表温度;测量两组患者踝上5cm、髌上15cm肢体周径;术前及术后第1天、4天、7天抽血化验检测D-二聚体和同型半胱氨酸(Hcy)水平;术前及术后第1天、第7天进行彩色多普勒检查,检测股静脉峰值流速及平均流速。数据处理用SPSS16.0统计软件包,对于计量资料,用均数±标准差(sx±)表示;两组间资料服从正态分布及方差齐,两组间均数比较用t检验;计数资料比较用Pearson卡方检验或校正卡方检验,P0.05差异具有统计学意义。结果1.干预组术后0例血栓,对照组有6例,干预组显著小于对照组(P0.05);干预组Homan征(+)发生率为28.89%,Neuhof征(+)发生率为22.22%,与对照组比较差异均具有统计学意义(X2=4.630,P0.05;X2=5.954,P0.05)。2.两组踝上5cm、髌下10cm、髌上15cm肢体体表温度比较。术前两组踝上5cm、髌下10cm、髌上15cm体表温度相比差异均无统计学意义(P0.05);踝上5cm肢体体表温度术后2-4天干预组显著低于对照组(P0.05),髌下10cm、髌上15cm肢体体表温度术后1-4天干预组显著低于对照组(P0.05)。3.两组踝上5cm、髌上15cm肢体周径比较。术前两组踝上5cm、髌上15cm肢体周径比较差异均无统计学意义(P0.05);术后两组踝上5cm肢体周径比较差异无统计学意义(P0.05);术后两组髌上15cm肢体周径在第3-5天均增加,干预组显著低于对照组,差异具有统计学意义(P0.05)。4.两组血浆DD及Hcy水平比较。术前两组DD及Hcy水平比较差异均无统计学意义(P0.05);术后第1天两组DD及Hcy水平均升高,两组比较差异均无统计学意义(P0.05);术后第4天两组DD及Hcy水平均升高,两组比较差异均具有统计学意义(P0.05)。5.两组股静脉彩超峰值流速及平均流速比较。术前两组比较差异均无统计学意义(P0.05);术后第7天两组较术前均有明显升高,且干预组升高程度更明显,两组比较差异均具有统计学意义(P0.05)。结论以循证为基础的集束化护理干预措施能有效预防和减少髋关节置换术后患者深静脉血栓的发生率,提高临床治疗疗效,具有重要的临床应用价值。
[Abstract]:Objective to explore the effect of evidence-based cluster nursing on the prevention of deep venous thrombosis after hip arthroplasty, so as to enrich the nursing care of the patients after hip replacement. This study is an exploratory application of evidence-based medicine in the field of nursing to establish a standardized clinical nursing work model to guide nurses to improve the quality of nursing services. Methods 90 patients undergoing hip arthroplasty were matched according to baseline data and divided into control group (45 cases) and intervention group (45 cases). The control group was given general nursing care for current clinical prevention of DVT, while the intervention group was given cluster nursing based on evidence. Then we observed the clinical effect of nursing care in two groups, and observed the incidence of Neuhof sign of venous thrombosis in both groups before operation and 9 days after operation. The body surface temperature of upper malleolus 5 cm, subpatellar 10 cm and suprapatellar 15 cm were measured in both groups. The circumference of upper malleolus 5 cm and suprapatellar 15 cm were measured in both groups. The levels of D- dimer and homocysteine were detected by blood sampling before and after operation on day 4 and day 7. The peak velocity and mean velocity of femoral vein were detected by color Doppler imaging before operation and on day 1 and day 7 after operation. The data were processed by SPSS16.0 statistical software package. It is expressed as mean 卤standard deviation (sx 卤); The data between the two groups were matched by normal distribution and variance. T test was used to compare the mean between the two groups. The count data were compared with Pearson chi-square test or corrected chi-square test (P0.05). Results 1. There were 0 cases of thrombus in the intervention group and 6 cases in the control group. 2. The intervention group was significantly smaller than the control group (P 0.05). The incidence of Homan sign in the intervention group was 28.89 and the incidence of Neuhof sign was 22.22. The difference was statistically significant compared with the control group. P0.05; The body surface temperature of the two groups was 5 cm above the ankle, 10 cm below the patella, and 15 cm above the patella. Before operation, the body surface temperature of the upper malleolus and the subpatellar were 5 cm and 10 cm respectively in the two groups. There was no significant difference in the body surface temperature of 15 cm above the patella between the two groups (P 0.05). The body surface temperature of the upper malleolus 5 cm was significantly lower in the intervention group than that in the control group at 2 to 4 days after operation (P 0.05) and 10 cm below the patella. The body surface temperature of the upper patellar 15cm limb was significantly lower in the intervention group than that in the control group at 1-4 days postoperatively (P 0.05). The circumference of the upper malleolus and the supracrapatellar 15 cm were compared between the two groups. The upper malleolus of the two groups was 5cm before operation. There was no significant difference in the circumference of the upper patellar 15cm limb between the two groups (P 0.05). There was no significant difference in the circumference of the upper malleolus 5 cm after operation between the two groups (P 0.05). The circumference of the upper patellar 15cm limb in the two groups increased on the 3-5 days after operation, which was significantly lower in the intervention group than that in the control group. There were significant differences in DD and Hcy levels between the two groups. There was no significant difference in DD and Hcy levels between the two groups before operation (P 0.05). On the first day after operation, the levels of DD and Hcy increased in both groups, and there was no significant difference between the two groups (P 0.05). On the 4th day after operation, the levels of DD and Hcy increased in both groups. The difference between the two groups was statistically significant (P 0.05). The peak velocity and mean velocity of femoral vein color Doppler ultrasound were compared between the two groups. There was no significant difference between the two groups before operation (P 0.05). On the 7th day after operation, both groups were significantly higher than those before operation, and the degree of increase was more obvious in the intervention group. Conclusion the cluster nursing intervention based on evidence can effectively prevent and reduce the incidence of deep venous thrombosis after hip arthroplasty. It has important clinical application value to improve the curative effect of clinical treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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