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        基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理預(yù)防腹腔鏡膽囊切除術(shù)后靜脈血栓栓塞癥的臨床研究

        2020-11-09 09:08:49高玲李炳芹張承麗王玉濤
        中國醫(yī)學(xué)創(chuàng)新 2020年23期
        關(guān)鍵詞:腹腔鏡膽囊切除術(shù)

        高玲 李炳芹 張承麗 王玉濤

        【摘要】 目的:探討基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理預(yù)防腹腔鏡膽囊切除術(shù)后靜脈血栓栓塞癥的效果。方法:選取2014年10月-2018年12月于濟(jì)南市中醫(yī)醫(yī)院與利津縣明集中心衛(wèi)生院進(jìn)行腹腔鏡膽囊切除術(shù)(laparoscopic cholecystectomy,LC)治療的患者186例,按護(hù)理方法不同分為對照組(n=90)與觀察組(n=96)。對照組給予常規(guī)護(hù)理,觀察組給予基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理。比較兩組術(shù)后Wells評分分級、VTE發(fā)生情況及對VTE相關(guān)知識的掌握情況。結(jié)果:對照組高危險度者比例高于觀察組(P<0.05)。觀察組VTE發(fā)生率為1.04%低于對照組的6.67%(P<0.05)。觀察組VTE相關(guān)知識掌握評分高于對照組(P<0.05)。結(jié)論:基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理措施能夠有效提高患者及家屬對VTE危害和預(yù)防方法相關(guān)知識的掌握度,降低LC術(shù)后患者VTE發(fā)病風(fēng)險。

        【關(guān)鍵詞】 腹腔鏡膽囊切除術(shù) 靜脈血栓栓塞癥 Wells評分 網(wǎng)絡(luò)宣教

        [Abstract] Objective: To investigate the effect of grading nursing based on the Wells score and network education in preventing venous thromboembolism after laparoscopic cholecystectomy. Method: A total of 186 patients treated with laparoscopic cholecystectomy (LC) in Jinan Municipal Hospital of Traditional Chinese Medicine and Mingji Central Hospital of Lijin County in Dongying from October 2014 to December 2018 were selected. According to different nursing methods, they were divided into control group (n=90) and observation group (n=96). The control group was given routine nursing, while the observation group was given grading nursing based on the Wells score and network education. The Wells score grading, VTE occurrence and mastery of VTE related knowledge were compared between the two groups. Result: The proportion of high risk patients in the control group was higher than that in the observation group (P<0.05). The incidence of VTE in the observation group was 1.04% lower than 6.67% in the control group (P<0.05). The mastery of VTE related knowledge scores in the observation group was higher than that in the control group (P<0.05). Conclusion: The grading nursing based on the Wells score and network education can effectively improve the knowledge of VTE hazards and prevention methods of patients and their families, and reduce the risk of VTE in patients after LC.

        [Key words] Laparoscopic cholecystectomy Venous thromboembolism Wells score Network education

        First-authors address: Mingji Central Hospital of Lijin County in Dongying, Lijin 257400, China

        doi:10.3969/j.issn.1674-4985.2020.23.027

        靜脈血栓栓塞癥(venous thromboembolism,VTE)是常見的血管疾病,主要包括深靜脈血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)[1]。主要表現(xiàn)為靜脈血液不正常凝結(jié)成塊,部分或完全堵塞靜脈管腔,導(dǎo)致靜脈血液回流障礙,誘發(fā)肢體腫脹、淺靜脈擴(kuò)張、皮膚溫度升高等癥狀,嚴(yán)重者可致人死亡。手術(shù)創(chuàng)傷、麻醉、臥床、惡性腫瘤等是VTE的高危因素。隨著腹腔鏡技術(shù)的快速發(fā)展和培訓(xùn)進(jìn)修學(xué)習(xí)的日益便捷,腹腔鏡膽囊切除術(shù)(laparoscopic cholecystectomy,LC)迅速在各級醫(yī)療機(jī)構(gòu)普及。由于腹腔鏡手術(shù)體位、麻醉、CO2氣腹等多種應(yīng)激因素影響,術(shù)后患者VTE的預(yù)防成為外科醫(yī)務(wù)人員關(guān)注的重點問題[2]。本研究對186例行LC治療的患者臨床資料進(jìn)行回顧性分析,探討基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理預(yù)防腹腔鏡膽囊切除術(shù)后VTE的效果,旨在探索更為安全、有效的預(yù)防VTE的護(hù)理方法。

        Wells評分表于1995年由Wells教授等人編制,包含了10個條目,根據(jù)累計得分將患者發(fā)生VTE風(fēng)險分為3個等級,因其對VTE預(yù)測的有效性而廣泛應(yīng)用于臨床[9-11]。Wells評分級可以協(xié)助醫(yī)務(wù)工作者快速制定分級護(hù)理干預(yù)措施,降低VTE的風(fēng)險,或在確診VTE后,及早采取相應(yīng)的措施,降低VTE遠(yuǎn)期并發(fā)癥發(fā)生率[12-14]。在LC術(shù)后患者中應(yīng)用Wells評分分級作為預(yù)防VTE護(hù)理措施的指導(dǎo)原則,是護(hù)理模式的一種新的嘗試。

        護(hù)理宣教在診療過程中意義重大。趙飛燕等[15]研究發(fā)現(xiàn),患者的文化程度、是否接受宣教等因素顯著影響患者的抗凝藥物服藥依從性。隨著移動通信技術(shù)的發(fā)展,人們獲取信息的方式也越來越便捷、多樣。網(wǎng)絡(luò)宣教是一種新型宣教方式,借助網(wǎng)絡(luò)和移動智能設(shè)備,護(hù)理人員可以及時、全面、形象地開展宣教工作,不必拘泥于時間地點,患者及家屬也可反復(fù)學(xué)習(xí),生動的教學(xué)內(nèi)容也更有助于受眾理解[16-17]。本研究結(jié)果顯示,觀察組VTE相關(guān)知識知識掌握評分高于對照組(P<0.05)。表明接受網(wǎng)絡(luò)宣教的患者及家屬更容易掌握VTE相關(guān)知識。

        綜上所述,基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理能夠有效提高患者及家屬對VTE危害和預(yù)防方法的認(rèn)知度,降低LC術(shù)后患者VTE發(fā)病風(fēng)險。本研究尚存在不足之處,如隨訪時間較短,對于遲發(fā)性VTE缺乏隨訪數(shù)據(jù)等,無法評價基于Wells評分和網(wǎng)絡(luò)宣教的分級護(hù)理對VTE的遠(yuǎn)期預(yù)防效果。更全面、準(zhǔn)確、有效地VTE預(yù)防護(hù)理措施有待臨床工作者進(jìn)一步探尋。

        參考文獻(xiàn)

        [1] Kunutsor S K,M?kikallio T H,Seidu S,et al.Physical activity and risk of venous thromboembolism:systematic review and meta-analysis of prospective cohort studies[J].Eur J Epidemiol,2019,34(11):431-442.

        [2] Stein P D,Matta F,Sabra M J.Pulmonary embolism and deep venous thrombosis following laparoscopic cholecystectomy[J].Clin Appl Thromb Hemost,2014,20(3):233-237.

        [3]邱燕碧,羅秀霞,羅志蘭.婦產(chǎn)科術(shù)后預(yù)防深靜脈血栓栓塞癥護(hù)理的臨床研究[J].中國醫(yī)學(xué)創(chuàng)新,2016,13(13):86-89.

        [4] Maíllo C L,Martín E,López J,et al.Effect of pneumoperitoneum on venous hemodynamics during laparoscopic cholecystectomy.Influence of patients age and time of surgery[J].Med Clin(Barc),2003,120(9):330-334.

        [5] Gundogdu R H,Oduncu M,Bozkirli B O,et al.Does thromboprophylaxis cause bleeding after laparoscopic cholecystectomy?[J].Bratisl Lek Listy,2017,118(3):156-159.

        [6] Henry M L,Abdul-Sultan A,Walker A J,et al.Duration and Magnitude of Postoperative Risk of Venous Thromboembolism after Cholecystectomy:A Population-Based Cohort Study[J].Dig Surg,2019,37(1):1-7.

        [7] Milic D J,Pejcic V D,Zivic S S,et al.Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy[J].Surg Endosc,2007,21(9):1588-1592.

        [8]溫薇,曾國華,余芳,等.分級預(yù)防護(hù)理在骨科大手術(shù)患者深靜脈血栓形成中的應(yīng)用效果[J].中國醫(yī)學(xué)創(chuàng)新,2019,16(36):105-108.

        [9] Wells P S,Hirsh J,Anderson D R,et al.Accuracy of clinical assessment of deep-vein thrombosis[J].Lancet,1995,345(8961):1326-1330.

        [10] Wells P S,Ginsberg J S,Anderson D R,et al.Use of a clinical model for safe management of patients with suspected pulmonary embolism[J].Ann Intern Med,1998,129(12):997-1005.

        [11] van Es N,Kraaijpoel N,Klok F A,et al.The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism:an individual patient data meta-analysis[J].J Thromb Haemost,2017,15(4):678-684.

        [12] Modi S,Deisler R,Gozel K, et al.Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients[J].World J Emerg Surg,2016,11(1):24.

        [13] Gaitini D,Khoury R,Israelit S, et al.Sparing ultrasound in emergency department patients with suspected deep vein thrombosis by using clinical scores and D-dimer testing[J].J Clin Ultrasound,2016,44(4):231-239.

        [14]阮小貞,何琳.Wells量表和修正的Geneva評分對肺栓塞的預(yù)測價值分析[J].中國醫(yī)學(xué)創(chuàng)新,2018,15(24):106-109.

        [15]趙飛燕,崔英,肖樹芹.肺血栓栓塞癥患者華法林抗凝治療的知識、態(tài)度及行為的調(diào)查分析[J].中華護(hù)理雜志,2016,51(12):1451-1455.

        [16]汪小冬,徐鶯,何艷娟,等.提升動靜脈內(nèi)瘺患者功能鍛煉執(zhí)行率的品管圈實踐[J].護(hù)理學(xué)報,2016,23(15):9-11.

        [17]吁佳,楊菊蓮.微信平臺健康教育對口服阿片類鎮(zhèn)痛藥物中晚期癌痛患者自我效能感和治療依從性的影響[J].中國醫(yī)學(xué)創(chuàng)新,2019,16(12):150-153.

        (收稿日期:2020-01-19) (本文編輯:田婧)

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