老年髋部骨折患者下肢深静脉血栓预防护理研究

Systematic Nursing Prevention of Lower Extremity Deep Vein Thrombosis in Elderly Patients with Hip Fracture

摘要: 目的：探讨系统性多模式护理干预对老年髋部骨折患者术后下肢深静脉血栓(DVT)形成的预防效果及安全性。方法：采用前瞻性队列研究设计，纳入2022年1月~2023年10月收治的200例老年髋部骨折手术患者，经随机数字表法分配至干预组与对照组，每组各100例。对照组实施骨科常规护理干预，包括基础生命体征监测、伤口护理及术后常规抗凝治疗。干预组在常规护理基础上实施系统性DVT预防专项护理，主要涵盖分级压力治疗、间歇充气加压装置(IPC)应用、踝泵运动指导、个体化抗凝药物管理、早期康复介入及DVT风险动态评估。使用彩色多普勒超声于术前、术后第3、7、14天实施DVT筛查；每周检测凝血功能指标(D-二聚体、PT、APTT)；详细记录术后出血事件、肺栓塞发生率及患者出院时功能独立量表(FIM)评分。结果：术后14天DVT总发生率干预组(4.0%)显著低于对照组(15.0%)，组间差异存在统计学意义(χ² = 7.821, P < 0.01)。干预组术后第7天D-二聚体峰值水平(1.35 ± 0.42 mg/L FEU)明显低于对照组(2.28 ± 0.58 mg/L FEU) (t = 12.637, P < 0.001)。两组在术后出血事件(干预组3例vs对照组2例)及症状性肺栓塞发生率(均为0例)上无显著统计学差异(P > 0.05)。干预组患者术后首次下床时间(3.2 ± 0.9天)早于对照组(5.7 ± 1.4天) (t = 15.294, P < 0.001)，且出院时FIM评分(92.4 ± 7.3分)高于对照组(85.1 ± 8.6分) (t = 6.831, P < 0.001)。结论：系统性多模式预防护理策略能够有效降低老年髋部骨折患者术后DVT发生率，优化凝血功能恢复进程，促进术后康复并提升功能独立性。该模式安全可行，具有临床推广价值。

Abstract: Objective: To investigate the preventive effect and safety of systematic multi-mode nursing intervention on postoperative deep vein thrombosis (DVT) in elderly patients with hip fractures. Methods: A prospective cohort study was conducted, and 200 elderly patients with hip fracture surgery admitted from January 2022 to October 2023 were enrolled and randomly divided into intervention group and control group by random number table method, with 100 cases in each group. The control group received routine orthopedic nursing interventions, including basic vital signs monitoring, wound care and routine postoperative anticoagulant therapy. On the basis of routine nursing, the intervention group implemented systematic special nursing for DVT prevention, mainly including graded pressure therapy, application of intermittent pneumatic compression (IPC) device, ankle pump exercise guidance, individualized anticoagulant drug management, early rehabilitation intervention and dynamic assessment of DVT risk. Color Doppler ultrasound was used to screen DVT before operation and on the 3rd, 7th and 14th days after operation; coagulation function indicators (D-dimer, PT, APTT) were detected weekly; postoperative bleeding events, incidence of pulmonary embolism and Functional Independence Measure (FIM) scores at discharge were recorded in detail. Results: The total incidence of DVT in the intervention group (4.0%) was significantly lower than that in the control group (15.0%) at 14 days after operation, and the difference between groups was statistically significant (χ² = 7.821, P < 0.01). The peak level of D-dimer on the 7th day after operation in the intervention group (1.35 ± 0.42 mg/L FEU) was significantly lower than that in the control group (2.28 ± 0.58 mg/L FEU) (t = 12.63, P < 0.001). There were no significant statistical differences in postoperative bleeding events (3 cases in the intervention group vs 2 cases in the control group) and the incidence of symptomatic pulmonary embolism (0 cases in both groups) (P > 0.05). The first time to get out of bed after operation in the intervention group (3.2 ± 0.9 days) was earlier than that in the control group (5.7 ± 1.4 days) (t = 15.2, P< 0.001), and the FIM score at discharge (92.4 ± 7.3 points) was higher than that in the control group (85.1 ± 8.6 points) (t = 6.8, P< 0.001). Conclusion: Systematic multi-mode preventive nursing strategy can effectively reduce the incidence of postoperative DVT in elderly patients with hip fractures, optimize the recovery process of coagulation function, promote postoperative rehabilitation and improve functional independence. This model is safe and feasible, and has clinical promotion value.