護(hù)理干預(yù)預(yù)防骨折下肢深靜脈血栓形成臨床效果分析

董洪鑾

277517山東省滕州市濱湖鎮(zhèn)衛(wèi)生院

護(hù)理干預(yù)預(yù)防骨折下肢深靜脈血栓形成臨床效果分析

董洪鑾

277517山東省滕州市濱湖鎮(zhèn)衛(wèi)生院

目的：探討護(hù)理干預(yù)用于預(yù)防骨折下肢深靜脈血栓的臨床效果。方法：2009年10月-2012年10月收治下肢骨折患者150例，采用隨機(jī)數(shù)字表法分為對(duì)照組和預(yù)防護(hù)理干預(yù)組，各75例，對(duì)照組采用常規(guī)護(hù)理措施；預(yù)防護(hù)理干預(yù)組采用預(yù)防護(hù)理干預(yù)措施；比較兩組患者深靜脈血栓發(fā)生率、護(hù)理滿意度，并分析臨床易患因素。結(jié)果：對(duì)照組和預(yù)防護(hù)理干預(yù)組下肢深靜脈血栓發(fā)生率分別為20.0%和8.0%；預(yù)防護(hù)理干預(yù)組下肢深靜脈血栓發(fā)生率明顯低于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；對(duì)照組和預(yù)防護(hù)理干預(yù)組護(hù)理滿意度分別為78.7%和97.3%；預(yù)防護(hù)理干預(yù)組護(hù)理滿意度明顯高于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；同時(shí)對(duì)照組和預(yù)防護(hù)理干預(yù)組便秘發(fā)生率、早期活動(dòng)率及術(shù)后輸血率等組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：預(yù)防護(hù)理干預(yù)可顯著降低下肢骨折致深靜脈血栓發(fā)生風(fēng)險(xiǎn)，提高護(hù)理滿意度。便秘、早期活動(dòng)及術(shù)后輸血與骨折下肢深靜脈血栓形成關(guān)系密切。

護(hù)理；下肢骨折；深靜脈血栓；預(yù)防；效果

下肢骨折患者術(shù)后易發(fā)生下肢深靜脈血栓，特別多見(jiàn)于多發(fā)創(chuàng)傷者及老年人[1-2]。2009年10月-2012年10月收治下肢骨折患者150例，現(xiàn)報(bào)告如下。

資料與方法

2009年10月-2012年10月收治下肢骨折患者150例，均經(jīng)影像學(xué)檢查確認(rèn)骨折手術(shù)完成后未出現(xiàn)深靜脈血栓。入選患者采用隨機(jī)數(shù)字表法分為對(duì)照組和預(yù)防護(hù)理干預(yù)組，每組75例；對(duì)照組男51例，女24例，年齡20～67歲，平均(43.5±5.8)歲；預(yù)防護(hù)理干預(yù)組男49例，女26例，年齡21～69歲，平均(43.3±5.7)歲；兩組患者年齡、性別及骨折發(fā)生部位等臨床資料方面組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。

方法：對(duì)照組采用下肢骨折術(shù)后常規(guī)護(hù)理干預(yù)措施；干預(yù)組采用下肢骨折術(shù)后下肢深靜脈血栓預(yù)防護(hù)理干預(yù)措施：①詳細(xì)介紹下肢深靜脈血栓發(fā)生機(jī)制，可能誘發(fā)因素，常見(jiàn)臨床癥狀及危害，著重說(shuō)明骨折術(shù)前術(shù)后鍛煉意義，特別是對(duì)于合并有糖尿病、心血管系統(tǒng)疾病等老年患者，更應(yīng)加強(qiáng)與患者及家屬交流，做好健康宣教工作。②制定下肢骨折術(shù)后專門食譜，應(yīng)遵循清淡、易消化、高蛋白、高纖維素及高維生素及低脂原則，但需注意避免維生素K含量高的食物攝入，同時(shí)監(jiān)督患者戒煙限酒。③確保下肢骨折術(shù)后患者絕對(duì)靜臥，每3 h更換體位，密切關(guān)注患者下肢體溫、顏色及動(dòng)脈搏動(dòng)是否正常；如發(fā)現(xiàn)患者下肢出現(xiàn)發(fā)紺等異常，應(yīng)立即保持下肢高于心臟水平面20 cm以上，避免下肢受壓。④指導(dǎo)患者根據(jù)自身情況術(shù)后早期進(jìn)行鍛煉，包括下肢肌肉及關(guān)節(jié)被動(dòng)、主動(dòng)鍛煉，20～25次/d，20 min/次。⑤老年患者因肢體機(jī)能退化，感知能力下降，常無(wú)法正確反應(yīng)肢體改變，故護(hù)理人員應(yīng)當(dāng)密切監(jiān)測(cè)患者下肢改變；對(duì)于合并糖尿病患者還應(yīng)有效控制血糖水平及熱量攝入。

觀察指標(biāo)：記錄患者骨折術(shù)后下肢深靜脈血栓發(fā)生例數(shù)、便秘例數(shù)、早起下床活動(dòng)例數(shù)及術(shù)后輸血例數(shù)；采用本院自擬骨科護(hù)理滿意度調(diào)查問(wèn)卷進(jìn)行護(hù)理質(zhì)量評(píng)價(jià)，滿分100分，問(wèn)卷回收率100.0%。

統(tǒng)計(jì)學(xué)方處理：本次研究統(tǒng)計(jì)學(xué)處理采用SPSS 15.0軟件，其中計(jì)數(shù)資料采用χ2檢驗(yàn)；P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。

結(jié)果

兩組患者下肢深靜脈血栓發(fā)生率比較：對(duì)照組和預(yù)防護(hù)理干預(yù)組患者中發(fā)生下肢深靜脈血栓分別為15例和6例；下肢深靜脈血栓發(fā)生率分別為20.0%和8.0%；預(yù)防護(hù)理干預(yù)組患者下肢深靜脈血栓發(fā)生率明顯低于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)，見(jiàn)表1。

兩組患者護(hù)理滿意度比較：對(duì)照組和預(yù)防護(hù)理干預(yù)組患者護(hù)理滿意例數(shù)分別為59例和73例；護(hù)理滿意度分別為78.7%和97.3%；預(yù)防護(hù)理干預(yù)組患者護(hù)理滿意度明顯高于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)，見(jiàn)表2。

兩組患者深靜脈血栓易患因素分析：對(duì)照組患者便秘發(fā)生率、早期活動(dòng)率及術(shù)后輸血率分別為30.7%、38.5%、25.3%；預(yù)防護(hù)理干預(yù)組患者便秘發(fā)生率、早期活動(dòng)率及術(shù)后輸血率分別為9.3%、97.3%，8.0%；對(duì)照組和預(yù)防護(hù)理干預(yù)組患者術(shù)后輸血率分別為26.2%、7.7%；對(duì)照組和預(yù)防護(hù)理干預(yù)組患者便秘發(fā)生率、早期活動(dòng)率及術(shù)后輸血率等組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)，見(jiàn)表3。

表1 兩組患者下肢深靜脈血栓發(fā)生率比較(例)

表2 兩組患者護(hù)理滿意度比較

表3 兩組患者深靜脈血栓易患因素分析[例(%)]

討論

已有研究顯示，下肢骨折術(shù)后下肢深靜脈血栓發(fā)生與骨折部位血管內(nèi)膜損傷，創(chuàng)傷誘發(fā)機(jī)體凝血系統(tǒng)激活及炎性介質(zhì)釋放及術(shù)后長(zhǎng)期臥床休息等密切相關(guān)。

本次研究顯示，對(duì)照組和預(yù)防護(hù)理干預(yù)組患者下肢深靜脈血栓發(fā)生率分別為20.0%、8.0%；預(yù)防護(hù)理干預(yù)組患者下肢深靜脈血栓發(fā)生率明顯低于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；對(duì)照組和預(yù)防護(hù)理干預(yù)組患護(hù)理滿意度分別為78.7%、97.3%；預(yù)防護(hù)理干預(yù)組患者護(hù)理滿意度明顯高于對(duì)照組。

總之，預(yù)防護(hù)理干預(yù)可顯著降低下肢骨折致深靜脈血栓發(fā)生的風(fēng)險(xiǎn)。

[1]邱貴興,戴戎,楊慶明,等.預(yù)防骨科大手術(shù)后深靜脈血栓形成的專家建議[J].中華骨科雜志,2005,34(2):636-640.

[2]李萍.下肢骨折260例深靜脈血栓形成的預(yù)防和護(hù)理[J].齊魯護(hù)理雜志,2007,13(24): 4748.

表1 兩組患兒的臨床療效比較[例(%)]

討論

手足口病是嬰幼兒及學(xué)齡期兒童常見(jiàn)疾病，臨床表現(xiàn)主要為發(fā)病初期口痛、發(fā)熱、口腔黏膜出現(xiàn)皰疹或潰瘍，重癥患兒還可并發(fā)嗜睡、精神差等中樞神經(jīng)系統(tǒng)疾病[4-5]。有效的護(hù)理是提高治愈率、促進(jìn)患兒康復(fù)的重要手段之一?；純河捎诩膊?、環(huán)境等的影響可存在不良心理，因此護(hù)理過(guò)程中，應(yīng)加強(qiáng)患兒及家屬的心理護(hù)理，并對(duì)家屬進(jìn)行適當(dāng)?shù)慕】到逃?，促使其積極配合治療。手足口病患兒手足、臀部、腿部等皮膚可出現(xiàn)斑丘疹或皰疹，皰疹破裂后小兒易抓破裂部位，增加感染的幾率，因此應(yīng)注意保護(hù)皮膚的清潔，此外還應(yīng)加強(qiáng)患兒的口腔及飲食護(hù)理，促進(jìn)口腔潰瘍愈合。我院在對(duì)手足口病患兒護(hù)理時(shí)給予以上綜合護(hù)理干預(yù)措施，結(jié)果顯示觀察組臨床總有效率明顯高于對(duì)照組，且家屬護(hù)理滿意度高于對(duì)照組。表明綜合護(hù)理干預(yù)可提高小兒手足口病的治療效果，促進(jìn)患兒早日康復(fù)，且有利于提高護(hù)理滿意度。

參考文獻(xiàn)

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[2]陳曉霞.嬰幼兒手足口病住院期的心理護(hù)理體會(huì)[J].臨床合理用藥雜志,2014,7(7):37.

[3]孔垂蘭.小兒手足口病的發(fā)病特點(diǎn)以及護(hù)理進(jìn)展[J].醫(yī)學(xué)信息,2014,1(5):187.

[4]賀麗.小兒手足口病的臨床護(hù)理觀察[J].中國(guó)現(xiàn)代藥物應(yīng)用,2014,4(8):201-202.

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Clinical effect analysis of nursing intervention in preventing fracture lower limb deep vein thrombosis

Dong Hongluan
Binhu Town Health Center of Tengzhou City,Shandong Province 277517

Objective:To explore the clinical effect of nursing intervention in preventing fracture lower limb deep vein thrombosis. Methods:150 patients with lower limb fracture were selected from October 2009 to October 2012.Using the random number table method,they were divided into the control group and the preventive nursing intervention group with 75 cases in each.The control group was given routine nursing measures,and the preventive nursing intervention group was given preventive nursing intervention measures.The incidence rate of deep vein thrombosis,nursing satisfaction of two groups were compared,and the clinical risk factors were analyzed.Results:The incidence rate of deep vein thrombosis in the control group and the preventive nursing intervention group were respectively 20.0%and 8.0%.The incidence rate of deep vein thrombosis in the preventive nursing intervention group was significantly lower that of than control group,and the difference between groups was statistically significant(P＜0.05).The nursing satisfaction of the control group and the preventive nursing intervention group were respectively 78.7%and 97.3%.The nursing satisfaction of the preventive nursing intervention group was significantly higher than that of the control group,and the differences between groups was statistically significant(P＜0.05).The incidence rate of constipation,early activity rate and postoperative blood transfusion rate of the control group and the preventive nursing intervention group were compared,and the differences between groups was statistically significant(P＜0.05).Conclusion:Preventive nursing intervention can significantly reduce the risk of deep vein thrombosis caused by lower extremity fracture and improve nursing satisfaction.The constipation,early activity rate and postoperative blood transfusion rate have close relation with fracture lower limb deep vein thrombosis.

Nursing;Lower limb fracture;Deep vein thrombosis;Prevention;Effect

10.3969/j.issn.1007-614x.2015.5.82