骨科患者静脉血栓栓塞症分级预防方案的构建

doi:10.3761/j.issn.0254-1769.2020.07.006

摘要/Abstract

摘要：

目的基于Caprini风险评估量表,构建骨科住院患者静脉血栓栓塞症（venous thromboembolism,VTE）的分级预防方案,为临床护理人员血栓预防工作提供科学的依据。方法基于循证理念进行VTE预防方案的证据总结,形成初步框架,初拟方案共包括4项一级指标、12项二级指标、49项三级指标;选取23名医生及护理人员作为函询专家,进行2轮专家函询确定分级预防方案。结果本研究纳入7篇指南、3篇专家共识。通过专家函询构建了包括4项一级指标、12项二级指标、39项三级指标在内的VTE分级预防方案,2轮函询专家积极系数均为100%,权威系数为0.863,肯德尔和谐系数为0.111~0.192。结论基于Caprini量表构建的VTE分级预防方案具有科学性,本研究结果可帮助高危科室建立VTE分级预防流程与路径,为临床护士对患者进行VTE预防提供指导依据,保障患者安全。

关键词: 静脉血栓栓塞症, Caprini评估量表, 预防, 循证护理

Abstract:

Objective To construct a hierarchical prevention scheme for venous thromboembolism（VTE） in orthopedic inpatients,so as to provide scientific and practical guidance for VTE prevention of clinical nurses. Methods Firstly,according to the evidence-based concept,researchers summarized the evidence of VTE prevention scheme,and a preliminary framework was formed. The preliminary prevention scheme consisted of 4 first-level indicators,12 second-level indicators,and 49 third-level indicators. Secondly,2 rounds of expert consultations among 23 doctors/nursing experts were conducted to determine the hierarchical prevention scheme. Results A total of 365 guidelines/expert consensuses were retrieved. Removal of duplicates was conducted for 83 articles,and 112 articles were screened out through reading abstracts. After further reading of the full text,7 guidelines and 3 expert consensuses were finally included. The hierarchical prevention scheme for VTE was constructed through expert consultations that included 4 first-level indicators,12 second-level indicators and 39 third-level indicators. The positive coefficients of experts in 2 rounds of consultations were both 100%,the authority coefficient was 0.863,and the coordination coefficients ranged from 0.111 to 0.192. Conclusion The hierarchical prevention scheme for VTE based on the Caprini scale is scientific. The results of this study can help high risk departments to establish the hierarchical prevention process and path for VTE,providing guidance basis for clinical nurses to carry out VTE prevention and improve patient safety.

Key words: Venous Thromboembolism, Caprini Scale, Prophylaxis, Evidence-Based Nursing

陈慧娟, 孔祥燕, 王泠, 谢华晓, 安思兰, 任慧玲, 李硕. 骨科患者静脉血栓栓塞症分级预防方案的构建[J]. 中华护理杂志, 2020, 55(7): 994-1000.

CHEN Huijuan, KONG Xiangyan, WANG Ling, XIE Huaxiao, AN Silan, REN Huiling, LI Shuo. Construction of hierarchical prevention scheme for venous thromboembolism in orthopedic patients in an evidence-based approach[J]. Chinese Journal of Nursing, 2020, 55(7): 994-1000.

图/表 2

参考文献 29

[1]	Kahn SR, Morrison DR, Cohen JM , et al. Interventions for im-plementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism[J]. Cochrane Database Syst Rev, 2013,7:CD008201. URL PMID
[2]	袁越, 王洋, 张淑香 . Caprini风险评估模型在预防静脉血栓栓塞症中的初步应用[J]. 中国实用护理杂志, 2016,32(18):1365-1368.
[3]	陈慧娟, 孔祥燕 . 护士在静脉血栓栓塞预防中的角色与作用[J]. 中国实用护理杂志, 2018,34(31):2468-2472.
[4]	王晓猛, 牛映祯, 纪刚 , 等. 《中国骨科大手术静脉血栓栓塞症预防指南》的解读[J]. 中华骨科杂志, 2017,37(10):636-640.
[5]	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志, 2016,36(2):65-71. DOI URL
[6]	龙建云, 黄昌拼, 刘永昌 , 等. 下肢深静脉血栓形成及其预防策略[J]. 中华全科医师杂志, 2019,18(10):965-969.
[7]	Excellence NIFH. Venous thromboembolism in over 16s reducing the risk of hospital acquired deep vein thrombosis or pulmonary embolism[EB/OL]( 2018-03-21)[2019-06-10]. https://www.nice.org.uk/search?q=venous+thromboembolism+in+over+16s+reducing+the+risk+of+hospital+acquired+deep+vein+thrombosis+or+pulmonary+embolism.
[8]	Link T . Guideline implementation:prevention of venous thrombo-embolism[J]. AORN Journal, 2018,107(6):737-748. DOI URL
[9]	Treasure T, Hill J . NICE guidance on reducing the risk of venous thromboembolism in patients admitted to hospital[J]. J R Soc Med, 2010,103(6):210-212. DOI URL PMID
[10]	杨雄刚, 胡永成, 赵立明 . 老年骨科患者血栓预防的研究现状[J]. 中华老年骨科与康复电子杂志, 2018,4(2):65-69.
[11]	杨柯君 . 《抗血小板治疗中国专家共识》发表[J]. 上海医药, 2013,34(14):4.
[12]	复旦大学附属中山医院围手术期处理多学科团队. 普外科病人围手术期血栓预防——中山共识(2)[J]. 中国实用外科杂志, 2013,33(11):946-948.
[13]	Randelli F, Romanini E, Biggi F , et al. Ⅱ Italian intersociety consensus statement on antithrombotic prophylaxis in orthopa-edics and traumatology:arthroscopy,traumatology,leg immobili-zation,minor orthopaedic procedures and spine surgery[J]. J Orthop Traumatol, 2013,14(1):1-13. URL PMID
[14]	中华心血管病杂志编辑委员会, 中华医学会心血管病学分会. 抗血小板治疗中国专家共识[J]. 中华心血管病杂志, 2013,41(3):183-194.
[15]	Holbrook A, Schulman S, Witt DM , et al. Evidence-based mana-gement of anticoagulant therapy:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012,141(2 Suppl):e152S. DOI URL PMID
[16]	马娜, 张成欢, 曹青刚 , 等. 骨科深静脉血栓形成物理预防实施现状调查[J]. 护理学杂志, 2019,34(1):27-31.
[17]	谢煜, 任冰, 刘云 . 间歇性充气加压装置预防骨科大手术患者深静脉血栓的研究进展[J]. 中华护理杂志, 2016,51(6):667-670.
[18]	Treasure T, Hill J . NICE guidance on reducing the risk of venous thromboembolism in patients admitted to hospital[J]. J R Soc Med, 2010,103(6):210-212.
[19]	李海燕, 植艳茹, 张玲娟 , 等. 静脉血栓栓塞症物理预防措施的研究进展[J]. 护理研究, 2019,33(20):3535-3539.
[20]	谢萍, 张灿, 王静 . 健康教育对急性胰腺炎患者心理状况和健康行为能力的影响[J]. 中华护理教育, 2015,12(11):852-857.
[21]	Tang X, Sun B, Yang Y , et al. A survey of the knowledge of venous thromboembolism prophylaxis among the medical staff of intensive care units in North China[J]. PLoS One, 2015,10(9):e139162.
[22]	王晓杰, 徐园, 陈亚萍 , 等. 护士静脉血栓栓塞症知识的多中心调查[J]. 中华护理杂志, 2017,52(12):1500-1504.
[23]	姜英, 张纳, 汤海祥 , 等. 外科护士预防术后患者下肢深静脉血栓形成的知信行调查[J]. 中国护理管理, 2014,14(10):1086-1089.
[24]	Streiff MB, Lau BD, Hobson DB , et al. The Johns Hopkins venous thromboembolism collaborative:multidisciplinary team approach to achieve perfect prophylaxis[J]. Journal of Hospital Medicine, 2016,11:S8-S14. URL PMID
[25]	王慧颖, 崔玉洁, 朱迎 , 等. 静脉血栓预防管理系统的设计与应用[J]. 护理学杂志, 2017,32(22):1-4.
[26]	米元元, 陈婷, 周英凤 , 等. 脊柱外科术后患者深静脉血栓预防及管理的最佳证据总结[J]. 中华护理杂志, 2019,54(2):288-294.
[27]	Hill J, Treasure T . Reducing the risk of venous thromboembolism(deep vein thrombosis and pulmonary embolism)in patients admitted to hospital:summary of the NICE guideline[J]. Heart, 2010,96(11):879-882. URL PMID
[28]	Findlay J, Keogh M, Cooper L . Venous thromboembolism prophylaxis:the role of the nurse[J]. Br J Nurs, 2010,19(16):1028-1032. DOI URL PMID
[29]	Zhai Z, Zhai J, Kan Q , et al. VTE risk profiles and prophylaxis in medical and surgical inpatients[J]. Chest, 2019,155(1):114-122. URL PMID