【摘要】：深靜脈血栓(Deep Venous Thrombosis, DVT)是婦科腹腔鏡術(shù)后常見的并發(fā)癥,但由于DVT發(fā)病隱匿,80%的DVT患者根本無臨床表現(xiàn),我們往往忽略了對婦科手術(shù)患者特別是婦科腹腔鏡手術(shù)患者圍術(shù)期DVT的預防。目前,如何預防婦科腹腔鏡圍手術(shù)期DVT的發(fā)生,國內(nèi)外尚無統(tǒng)一的規(guī)范或標準,在許多醫(yī)院存在著重視不夠或預防過度等問題。本研究利用Autar深靜脈風險評估量表,對婦科腹腔鏡患者進行DVT風險評估,對中、高危患者進行相應的預防措施,觀察婦科腹腔鏡術(shù)后DVT的發(fā)生情況。第一部分：目的討論和分析Autar量表在婦科腹腔鏡手術(shù)后預防深靜脈血栓(DVT)形成的風險評估中的應用效果。方法利用Autar量表對我院婦科2014年7月到9月行腹腔鏡手術(shù)的218名患者進行深靜脈血栓風險評估,并統(tǒng)計分析患者術(shù)后深靜脈血栓發(fā)生率與Autar評分的相關(guān)性。結(jié)果所有手術(shù)均順利完成。本組218例中3例(1.4%)發(fā)生深靜脈血栓,其中術(shù)后低危組171例均未發(fā)生DVT,中危組31例中1例(3.2%)發(fā)生DVT,高危組16例中2例(12.5%)出現(xiàn)DVT,統(tǒng)計學有顯著性差異(x 2=16.4,P0.01)。同時,術(shù)后Autar量表的風險評分結(jié)果與手術(shù)后DVT發(fā)生率呈正相關(guān)性(R2=0.9357,p0.05)。結(jié)論Autar量表能夠有效的預測婦科腹腔鏡手術(shù)后DVT發(fā)生的風險,有助于針對性的對中高危組患者采取預見性的措施,不僅避免了護理干預的盲目性,還有利于患者的預后。第二部分：目的探討穴位按摩預防婦科腹腔鏡術(shù)后不同風險級別DVT發(fā)生的效果。方法利用Autar深靜脈風險評估量表對2014年10月至2015年1月行婦科腹腔鏡手術(shù)患者術(shù)前一天及術(shù)后24h進行評估,選出中度風險組與高度風險組患者作為研究對象,中度風險組72人,高度風險組34人。將中、高風險組患者按照隨機原則分別分為對照組和試驗組。對照組：常規(guī)護理+間歇性肢體氣壓治療；試驗組：常規(guī)護理+穴位按摩(上巨虛、足三里、梁丘、陰市、伏兔)。通過檢測患者術(shù)前、術(shù)后第一天實施間歇性肢體氣壓治療或穴位按摩之前、術(shù)后第五天紅細胞聚集指數(shù)和胭窩靜脈血流速度及統(tǒng)計術(shù)后血栓發(fā)生率來評價穴位按摩的效用。結(jié)果本組研究中共有4例發(fā)生深靜脈血栓,其中中、高危組各有2例發(fā)生下肢深靜脈血栓。在中、高�；颊咧�,與對照組相比,試驗組術(shù)后第五天紅細胞聚集指數(shù)明顯降低、血流速度明顯升高(P0.05)；試驗組患者血栓發(fā)生率均明顯低于對照組(P0.05)。結(jié)論對于Autar評估中、高危風險的患者,在給予常規(guī)護理的同時輔助穴位按摩有利于預防術(shù)后血栓的發(fā)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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R473.71

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