医护一体化护理模式对剖宫产后下肢深静脉血栓形成预防效果观察

马凤珠　祝志梅　王晶

[摘要] 目的 探讨医护一体化护理模式对剖宫产后下肢深静脉血栓形成的预防效果。 方法 收集血栓形成高危险的剖宫产孕妇资料，将其随机分为观察组和对照组，分别给予医护一体化护理和常规护理。观察两组患者满意度及深静脉血栓形成率。在整个过程中定期检测血浆DD二聚体（D-dimer， DD）和纤维蛋白原降解产物（fibrinogen degradation product，FDP）及炎症相关指标C反应蛋白（c-reactive protein，CRP）、白介素2（interleukin 2）和白介素6（interleukin 6）的变化。 结果 观察组与对照组相比患者满意度明显升高，观察组深静脉血栓发生率（3.3%）明显低于对照组（12.2%），两者差异具有统计学意义（P<0.05）。DD二聚体和FDP产前两组无明显差异，产后观察组与明显低于对照组；观察组与对照组相比两者IL-2水平的变化无差异，IL-6、CRP相比对照组（96.7±17.6、55.6±11）明显高于观察组（10.6±5、50.3±20.2），差异具有统计学意义（P<0.05）。 结论 医护一体化护理模式能有效降低剖宫产术后DVT形成发生率。

[关键词] 剖宫产；凝血检测；医护一体化护理；深静脉血栓

[中图分类号] R473.6 [文献标识码] B [文章编号] 1673-9701（2017）19-0156-03

[Abstract] Objective To explore the effect of integrated medical and nursing care model on the prevention of deep venous thrombosis of lower extremities after Cesarean section. Methods The data of pregnant women with high risk of thrombosis receiving Cesarean section were collected and randomly divided into the observation group and the control group. They were treated with integrated medical and nursing care and routine nursing care. The satisfaction degree and incidence rate of deep vein thrombosis were observed in both groups. Changes of D-dimer （DD），fibrinogen degradation product （FDP） and inflammation-related index C-reactive protein （CRP）， interleukin-2 （IL-2） and interleukin 6 （IL-6） were detected regularly in the whole course. Results Compared with the control group， the patients' satisfaction in the observation group was significantly increased. The incidence rate of deep venous thrombosis in the observation group （3.3%） was significantly lower than that in the control group （12.2%）， and the difference was statistically significant （P<0.05）. DD dimer and FDP in both groups before delivery were not significantly different， but the observation group after the delivery was significantly lower than the control group； there was no significant difference in the changes of IL-2 levels between the observation group and the control group， and IL-6 and CRP in the control group （96.7±17.6， 55.6 ±11） were significantly higher than those in the observation group （10.6±5， 50.3±20.2）. The differences were statistically significant （P<0.05）. Conclusion The integrated medical and nursing care model can effectively reduce the incidence rate of DVT after Cesarean section.

[Key words] Cesarean section； Blood coagulation test； Integrated medical and nursing care； Deep venous thrombosis

下肢深靜脉血栓（deep vein thrombosis，DVT）是孕妇剖宫产术后常见的并发症之一，下肢深静脉血栓引起严重的后果就是肺栓塞[1]。医护一体化护理模式是在孕产妇早期即有医生进行正常的产前检查又有专门的护理门诊进行护理方面的教育，通过医生护士一体化新的护理模式来提高对孕产妇的护理效果，减少孕产妇的并发症。本文拟探讨医护一体化护理模式对降低下肢深静脉血栓发生率的效果。

1 资料与方法

1.1 一般资料

选取2014年2月～2015年12月期间在具有血栓形成高危因素的剖宫产孕妇180例，平均年龄（32.3±5.6）岁，孕龄27～30周，平均孕周28.5周，随机分为观察组90例，平均年龄（31.2±4.3）岁，对照组90例，平均年龄（332.9±3.8）岁，两组治疗无显著差异，结果具有可比性。围生期下肢DVT形成的高危因素：妊娠期生理性的高凝状态；……