發(fā)布時(shí)間：2018-01-14 03:24

  本文關(guān)鍵詞：以循證為基礎(chǔ)的集束化護(hù)理對(duì)預(yù)防髖關(guān)節(jié)置換術(shù)后患者DVT的研究　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 髖關(guān)節(jié)置換 深靜脈血栓 循證護(hù)理 集束化護(hù)理

【摘要】：目的探究以循證為基礎(chǔ)的集束化護(hù)理,對(duì)預(yù)防髖關(guān)節(jié)置換術(shù)后患者深靜脈血栓形成的療效,為豐富臨床護(hù)理人員護(hù)理髖關(guān)節(jié)置換術(shù)后患者,提供一種科學(xué)有效的方法。本研究是循證醫(yī)學(xué)在護(hù)理學(xué)領(lǐng)域的探索性應(yīng)用,建立規(guī)范的臨床護(hù)理工作模式,指導(dǎo)護(hù)理人員提升護(hù)理服務(wù)質(zhì)量,提高患者滿意度。方法將90例實(shí)施髖關(guān)節(jié)置換術(shù)的患者按照基線資料匹配入組,平均分為對(duì)照組(45例)和干預(yù)組(45例),對(duì)照組給予目前臨床預(yù)防DVT的一般護(hù)理,干預(yù)組給予以循證為基礎(chǔ)的集束化護(hù)理,然后觀察兩組患者護(hù)理的臨床療效。在術(shù)前及術(shù)后9天內(nèi)觀察兩組患者靜脈血栓、Homan征、Neuhof征發(fā)生率;并測(cè)量?jī)山M踝上5cm、髕下10cm、髕上15cm肢體體表溫度;測(cè)量?jī)山M患者踝上5cm、髕上15cm肢體周徑;術(shù)前及術(shù)后第1天、4天、7天抽血化驗(yàn)檢測(cè)D-二聚體和同型半胱氨酸(Hcy)水平;術(shù)前及術(shù)后第1天、第7天進(jìn)行彩色多普勒檢查,檢測(cè)股靜脈峰值流速及平均流速。數(shù)據(jù)處理用SPSS16.0統(tǒng)計(jì)軟件包,對(duì)于計(jì)量資料,用均數(shù)±標(biāo)準(zhǔn)差(sx±)表示;兩組間資料服從正態(tài)分布及方差齊,兩組間均數(shù)比較用t檢驗(yàn);計(jì)數(shù)資料比較用Pearson卡方檢驗(yàn)或校正卡方檢驗(yàn),P0.05差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.干預(yù)組術(shù)后0例血栓,對(duì)照組有6例,干預(yù)組顯著小于對(duì)照組(P0.05);干預(yù)組Homan征(+)發(fā)生率為28.89%,Neuhof征(+)發(fā)生率為22.22%,與對(duì)照組比較差異均具有統(tǒng)計(jì)學(xué)意義(X2=4.630,P0.05;X2=5.954,P0.05)。2.兩組踝上5cm、髕下10cm、髕上15cm肢體體表溫度比較。術(shù)前兩組踝上5cm、髕下10cm、髕上15cm體表溫度相比差異均無統(tǒng)計(jì)學(xué)意義(P0.05);踝上5cm肢體體表溫度術(shù)后2-4天干預(yù)組顯著低于對(duì)照組(P0.05),髕下10cm、髕上15cm肢體體表溫度術(shù)后1-4天干預(yù)組顯著低于對(duì)照組(P0.05)。3.兩組踝上5cm、髕上15cm肢體周徑比較。術(shù)前兩組踝上5cm、髕上15cm肢體周徑比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后兩組踝上5cm肢體周徑比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后兩組髕上15cm肢體周徑在第3-5天均增加,干預(yù)組顯著低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組血漿DD及Hcy水平比較。術(shù)前兩組DD及Hcy水平比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后第1天兩組DD及Hcy水平均升高,兩組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后第4天兩組DD及Hcy水平均升高,兩組比較差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.兩組股靜脈彩超峰值流速及平均流速比較。術(shù)前兩組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后第7天兩組較術(shù)前均有明顯升高,且干預(yù)組升高程度更明顯,兩組比較差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論以循證為基礎(chǔ)的集束化護(hù)理干預(yù)措施能有效預(yù)防和減少髖關(guān)節(jié)置換術(shù)后患者深靜脈血栓的發(fā)生率,提高臨床治療療效,具有重要的臨床應(yīng)用價(jià)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 鹵standard deviation (sx 鹵); 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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6

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