摘要
目的:探讨风险预警护理干预模式在预防机器人辅助泌尿外科手术患者术后并发静脉血栓栓塞症（VTE）的应用价值。方法:回顾性收集2021年7月至2023年4月上海交通大学医学院附属新华医院泌尿外科接受机器人辅助腹腔镜手术治疗的290例患者的临床资料，根据患者在围术期接受的护理干预模式不同进行分组，接受风险预警护理干预模式和常规护理模式的患者分别为观察组（142例）和对照组（148例）。两组均根据Caprini风险评估量表进行VTE风险评估。观察组针对VTE发生机制，依据Caprini风险评估量表结果对患者进行危险度分级并建立多元化VTE风险预警护理干预策略。对照组采用常规护理模式。收集两种护理模式临床指标，包括血栓相关指标（血浆D-二聚体、下肢血管超声检查结果）、VTE总发生率、卧床时间、住院天数、患者满意度情况、上尿路手术与下尿路手术VTE发生率等。结果:观察组术后24 h D-二聚体水平（0.65 mg/L FEU）及术后第3天D-二聚体水平（0.46 mg/L FEU）显著低于对照组对应的D-二聚体水平（24 h：0.90 mg/L FEU，第3天：1.50 mg/L FEU），差异具有统计学意义（P<0.05）。同时术后下肢血管超声结果显示，观察组的VTE总发生率（4.2%）显著低于对照组（14.2%） （P=0.004）。观察组卧床时间[1（1，1.5）d]短于对照组[2.5（2，3）d]（P<0.001）。观察组住院天数[7（5，9）d]比对照组[12（7，14）d]更短（P<0.001）。此外，观察组患者总体满意率（95.8%）高于对照组（83.8%） （P<0.001）。两组间不同手术解剖位置比较，观察组上尿路手术及下尿路手术的VTE发生率分别为2.4%和6.9%，较对照组10.5%和19.4%低（P<0.05）。结论:围手术期VTE风险预警护理干预模式的建立可有效预防机器人辅助泌尿外科手术患者术后静脉血栓栓塞症的发生，提高专科护理质量，具有重要的临床护理价值。
Abstract
Objective:To investigate the application value of the risk warning care model in preventing venous thromboembolism (VTE) in patients undergoing robotic-assisted urological surgery as a postoperative complication.Methods:A retrospective study was conducted by collecting clinic data of 290 patients treated with robotic-assisted surgery in the Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, from July 2021 to April 2023, patients were grouped according to the mode of care they received in the perioperative period. Patients received the risk warning care model was the observation group, and received the conventional care model was the control group, with 142 cases in the observation group and 148 cases in the control group. Both groups were assessed for VTE risk according to the Caprini Risk Assessment Scale. The observation group aimed at the mechanism of VTE occurrence, based on the results of Caprini Risk Assessment Scale to classify the risk of patients and establish a diversified VTE risk warning nursing intervention strategy. Clinical indicators of the two care modes were collected, which included thrombus-related indicators (plasma D-D dimer, ultrasonography of the lower limbs), overall incidence of VTE, bedtime, hospital stay, patient satisfaction status, and incidence of VTE in upper versus lower urinary tract surgery.Results:The postoperative D-dimer levels in the observation group at 24 h (0.65 mg/L FEU) and on the third day (0.46 mg/L FEU) after surgery were significantly lower than the corresponding D-dimer levels in the control group (24 h: 0.90 mg/L FEU, the third day: 1.50 mg/L FEU) (P<0.05). Also postoperative lower limbs ultrasound results showed that the overall incidence of VTE was significantly lower in the observation group (4.2%) than in the control group (14.2%) (P=0.004). And the time in bed in the observation group [1(1, 1.5) d] was less than in the control group [2.5(2, 3) d] (P<0.001), and a shorter hospital stay in the observation group [7(5, 9) d] than in the control group [12(7, 14) d](P<0.001). In addition the overall patient satisfaction rate was higher in the observation group (95.8%) than in the control group (83.8%)(P<0.001). Comparison of different surgical anatomical locations between the two groups, the incidence of VTE was lower in the observation group for upper and lower urinary tract surgery at 2.4% and 6.9%, respectively, compared with 10.5% and 19.4% in the control group (P<0.05).Conclusion:The establishment of a perioperative VTE risk warning care model can effectively prevent the occurrence of postoperative venous thromboembolism in patients undergoing robotic-assisted urologic surgery and improve the quality of specialty care, which has important clinical nursing value.
基金项目
上海交通大学医学院附属新华医院院级临床研究项目(21XHDB06)
万方数据